Bladder control problems in women: Seek treatment

Talking about bladder control problems is difficult. So hard, in fact, that many women live with bladder control problems for years before finally seeking treatment. You may be too shy or too ashamed to talk about your problems with anyone — even your doctor. After all, it's a highly personal matter.

But if you're one of the many women who experience bladder control problems, don't let embarrassment keep you from getting the help you need. Leaking urine, having to urinate frequently and experiencing other symptoms of urinary incontinence aren't trivial consequences of childbirth or a natural part of aging.

Not all doctors routinely ask about urinary function during an exam. It's up to you to take the first step. If you have bladder control problems, tell your doctor about them and ask for help.

Why to seek help

Bladder control problems require medical attention for several reasons. Reduced bladder control may, for instance:

• Indicate a serious underlying medical condition, such as diabetes or multiple sclerosis
• Cause you to restrict your physical activities
• Lead you to withdraw from social interactions
• Increase your risk of falling if you have balance problems and you often rush to the bathroom to avoid leaking urine

When to seek help

A few isolated incidents of urinary incontinence don't necessarily require medical attention. But if the problem is frequent or affects your quality of life, you should consider treatment.

A visit with your primary care provider is definitely advisable if:

• You're embarrassed by urine leakage, and you avoid certain activities because of it.
• You often feel urgency to urinate and rush to a bathroom but sometimes don't make it in time.
• You have frequent bladder infections.
• You urinate much more frequently than you used to, even when you don't have a bladder infection.
• You experience pain that's unrelated to a bladder infection when your bladder fills and when you urinate.
• You often feel the need to urinate, but you're unable to pass urine.
• You notice that your urine stream is getting progressively weaker, and you feel as if you can't empty your bladder completely.

In most circumstances, effective treatment is available.

When to seek a specialist

Many health care providers can treat bladder control problems without referring you to a specialist. But not all primary care providers have the necessary training or experience. In spite of the current improved understanding and treatment of urinary incontinence, some doctors consider it an inevitable consequence of childbearing, menopause or normal aging — a belief that makes them unlikely to consider treatment.

But indifference doesn't have to be the outcome. If your doctor dismisses your symptoms or seems uninformed about possible treatments, ask for referral to a specialist.

Doctors who specialize in urinary disorders include:

• Urogynecologist. This is an obstetrician-gynecologist with additional training in problems that affect a woman's pelvic floor — the network of muscles, ligaments, connective tissue and nerves that helps support and control the bladder and other pelvic organs.
• Urologist. A urologist specializes in male and female urinary disorders as well as the male reproductive system.
• Geriatrician. This medical doctor specializes in the care of older adults, often with special emphasis on problems related to medications and quality-of-life issues, such as incontinence.

The bladder diary: A detailed symptom record

Whether you see a primary care provider or a specialist, keep a bladder diary for several consecutive days before your visit. This diary is a detailed, day-to-day record of your symptoms and other information related to your urinary habits. It can help you and your doctor determine the causes of bladder control problems.

Record what, what time and how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate, and the number of times you leaked urine. If you leak urine, note the approximate amount and what you were doing when it happened. Don't worry about getting exact measurements of urine output. Just describe the quantity in general terms, such as small, medium or large. If a more precise measurement is needed, your doctor may give you a pan that fits over your toilet rim. The pan has markings like a measuring cup.

The diary should cover a period in which you stick to your normal routine — not a vacation. If you're premenopausal, don't start the diary during your menstrual period. Increased trips to the bathroom to change your sanitary protection during this time may distort the findings.

Sample Bladder Diary (PDF file requiring Adobe Reader )

Medical history review

Your visit will be more productive if you can provide a detailed medical history. If necessary, make a list of:

• Surgeries, births, illnesses, injuries and medical procedures, along with approximate dates
• Current health problems — such as diabetes or arthritis — for which you're seeing a doctor or taking medication
• The approximate date or your age when you stopped having menstrual periods, if you've been through menopause
• Past and current problems with your urinary system
• Medications you're taking, including each drug's brand and generic name, dosage, when you take it, and what you take it for

Medications are among the most common causes of bladder control problems, so list everything — prescriptions, over-the-counter drugs, vitamins, minerals and other supplements. If you're not sure whether something counts as a medication, put it on the list anyway.

Finally, if you want a report of your consultation with your new doctor sent to other health care providers, be sure to take their names and office phone numbers to your appointment.

What to expect from treatment

Treatments for bladder control problems vary from learning special exercises to taking medications to having surgery. What's best for you depends on the type of bladder control problem you have. Nearly all women with bladder control problems can be helped through some form of treatment.

Your bladder function could be greatly improved after treatment. Any improvement, however, counts as a success, as long as it frees you to do what you like and enhances your quality of life.

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