If you’ve ever had a sudden urge or leakage of urine, you’re not alone. Lisa Dabney, MD, a specialist in urogynecology for the Mount Sinai Health System, notes that 30 percent of women aged 60 years and older will experience episodes of incontinence that interfere with their quality of life. In this Q&A, she explains some treatment options and lifestyle changes that could help.

What causes female urinary incontinence?

Female urinary incontinence has two main causes. One is called stress incontinence. This does not mean emotional stress, but rather stress on the bladder in the form of increased pressure from running, jumping, laughing, coughing, or sneezing that causes a loss of bladder control. The other is called urge incontinence.  This occurs when you have a strong desire to void and the urge is so sudden you may not have time to get to the bathroom. The condition called overactive bladder encompasses urge incontinence, but can also include simple urinary frequency and urgency without incontinence.

What are the symptoms?

The symptoms are generally leakage of urine or involuntary passage of urine when you’re not sitting on the toilet. Obviously, it can be a very embarrassing situation. These symptoms increase as women get older.

What causes stress incontinence?

Stress incontinence usually starts to appear in younger women after they give birth. During delivery the passage of the fetal head through the vagina can weaken the delicate supports of the urethra, and that’s when women start to develop stress incontinence. When women are young—in their 30s and 40s—they may not experience symptoms of stress incontinence because their musculature will still be quite strong. Strong pelvic floor muscles can compensate for the weakened support of the urethra.

What causes urge incontinence?

As women get older, urge incontinence becomes more and more common. In 80 year olds, approximately 50 percent of women have some degree of urge incontinence. In this case, the muscle that surrounds the bladder, called the detrusor muscle, contracts when we sit on the toilet.  There’s a lot of complicated communication that goes on between our brains and our bladder. When we are toilet-trained, our brains maintain control over the detrusor muscle. It tells the muscle not to empty until one is sitting on the toilet.  As we get older, some of those connections are lost and the detrusor muscle may start to contract when randomly. It’s not under as firm control from the brain anymore and so patients start to leak urine when they’re not on the toilet. So as you get older, you can’t hold your bladder as long, and that leads to urge incontinence.

How can women manage urinary incontinence and improve their quality of life?

There are a variety of ways to manage incontinence, from lifestyle changes to surgery. Many of these solutions work for both stress incontinence and urge incontinence. In fact, many women have a mixture of both types. Doing Kegel exercises and pelvic floor exercises are the first-line treatment for either type. They also help prevent the condition and prevent it from getting worse. These exercises strengthen the pelvic floor and help compensate for the weakened support of the urethra that causes stress incontinence.

What changes in lifestyle may help?

Dietary changes can help quite a bit with urge incontinence.  For example, one lifestyle change is to limit the consumption of coffee, alcohol, and citrus drinks. These types of drinks are very irritating to the bladder, so patients who have urge incontinence should try to cut back on these types of liquids. It’s also important to understanding that as you get older you can’t hold your bladder for as long, and you simply have to go to the bathroom a little more frequently.

What are some treatment options?

There are a variety of treatments depending on the severity of the symptoms and what’s been tried before.

For stress incontinence, there are small devices called pessaries which can be placed in the vagina. They look like a little ring with a knob on it. When they are placed in the vagina the little knob will sit under the urethra and support it. When a woman coughs or sneezes, the urethra pushes against the knob and this helps with stress incontinence. There are also surgical options such as placing a sling underneath the urethra which replaces the urethral support which has been lost. This is a minimally invasive option that’s 90 percent effective for stress incontinence.   Patients are in and out of the hospital the same day.

What about treatment options for urge incontinence?

For women who have gone through menopause, the tissues in the bladder and vagina get irritable, and that can make urge incontinence worse. Vaginal estrogen treatments can help as they reverse the effects of menopause on the bladder. There are also medications that relax the bladder. There is an acupuncture procedure called posterior tibial nerve stimulation. The nerve near the ankle is very similar to the nerve roots that enervate the bladder. Stimulating these nerves in the ankle has been shown to help with urinary frequency and urgency, and it’s very safe and effective.

Finally, there are Botox injections into the bladder wall. Botox is a substance that paralyzes muscles. The injection is given after giving some anesthetic to the bladder to decrease discomfort.

What is your overall approach to treating this condition?

As a practitioner, I spend a lot of time discussing the patient’s lifestyle with them and figuring out how incontinence is impacting their life. That way, we can come up with options that work for them. Treating incontinence is all about improving quality of life. As a doctor and clinician, I always work the patient to outline her objectives—and that means that there is a lot of flexibility and choices for each patient’s treatment.