Dear Dr. Roach: I can’t recall you ever addressing urinary incontinence in women. As it’s a subject that’s not normally addressed socially, I wonder if you can tell us what can be done about it.


Dear O.P.: Urinary incontinence is a big and important topic. Twenty-five to 60 percent of all women (and 11 to 34 percent of older men) seek care for urinary incontinence, and many more do not report it due to embarrassment or worry about treatment. This can lead to social isolation, poor quality of life, sexual problems, infection and increased burden on caregivers.

The two major types of incontinence in women are stress incontinence (for example, losing urine with a cough or a sneeze) and urge incontinence (the sensation of needing to go to the bathroom RIGHT AWAY for fear of an accident, or associated with accidental loss of urine). Other types include overflow (continuous dribbling from the bladder, associated with a weak stream). It’s possible to have a mixture of several types.

Treatment depends on the type of incontinence, but most women benefit from pelvic floor exercises and bladder training. My experience has been that many providers, especially male ones, don’t know how to recommend these properly, and a referral to a pelvic-floor physical therapist can be helpful, as can biofeedback (which is covered by Medicare in the United States in women who don’t have good results after a four-week trial without it). Since excess weight is a major risk factor for incontinence, weight loss can be helpful in many women.

The other condition I see frequently overlooked is vaginal atrophy. Many older women have thinning of the lining of the vagina and urethra, which can predispose a person to stress and urge incontinence. Estrogen cream can improve incontinence, though it may take several months.

If none of these is effective, medication can be used.

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