Chester C. Wilmot, MD, a urologist with Florida Urological Institute in St. Petersburg, Florida, is fellowship-trained in Female Urology and Pelvic Floor Reconstructive Surgery. He talks about the different triggers that can cause women to leak urine and how they can overcome these triggers.
Q: What are the different types of triggers that can cause a woman to leak urine?
A: The triggers for stress incontinence include stressful maneuvers like coughing, sneezing, laughing, or vigorous activity. Triggers for urge incontinence typically include a sensation of urgency that comes on very quickly, and the triggers for that can vary. For example, if a woman hears rushing water or if she feels water on her hands, it can trigger the desire to urinate—and that can lead to some urinary leakage.
Q: Are there ever any psychological triggers?
A: Absolutely. Stress can exacerbate urinary symptoms, so an individual who has no urinary leakage may experience urinary frequency with a stressful job or social stressors. For someone who has urge incontinence, stress can make the condition worse.
Q: Do triggers differ from one woman to another?
A: Yes. The common ones that women talk about for stress incontinence are some kind of activity or exercise, or it may just involve walking vigorously. For most people, it's something a little bit more than that, like laughing, coughing, sneezing, or picking up something heavy, like a small child. The risk factors for that type of bladder leakage include one's age, having had children before, being postmenopausal, and having had any kind of pelvic floor surgery or possibly radiation therapy.
Q: When a woman comes to you with bladder leakage issues, how do you go about identifying her particular triggers and then finding ways for her to avoid them?
A: The most important thing is to first get an accurate history and then identify what's happening. When is the leakage occurring? Does she wear a protective pad? Does she ever leak so much that she has to change her clothes or bedding?
Then it's important to get an accurate social history. How much does she drink a day? Does she drink coffee, tea, or soda? Does she smoke? All of these things are triggers for worsening urinary symptoms.
Other questions to ask are: Does she have other medical conditions that can affect bladder control such as a thyroid disorder? Does she have a neurological disorder such as Parkinson's Disease? Those are all important factors that must be identified.
It's also important to do a physical exam, which includes a focused urological exam of the patient's pelvic area to determine that everything is in its correct location.
Q: If you found that a woman's bladder leakage was related to an unusually large fluid intake, could simply cutting back on fluids possibly lessen or eliminate her problem?
A: Absolutely. It's not uncommon for me to discover that a patient of mine is drinking 180 fluid ounces of liquid a day or more. Or if a woman has diabetes, she may feel very thirsty and end up drinking liquids excessively. Once you identify the reason for bladder leakage, you can then work to correct it. For someone with diabetes, it may just involve tightened control of blood sugar levels so the patient won't feel so thirsty.
Q: Have you found that your patients sometimes attempt to treat their bladder leakage at home?
A: Yes. Virtually everyone who experiences any bladder leakage will begin to restrict their fluid intake. They may learn that drinking more than two cups of coffee a day makes their urinary symptoms worse. Or they may find that when they stop smoking, their bladder weakness improves. Whether they're aware of it or not, they'll begin to make lifestyle changes at home that have a positive impact on their bladder health.
For more information about urinary incontinence, its symptoms, consult your doctor or health care provider.