The Medical Minute: Leaky bladder? Why it happens (and what you can do about it)

HERSHEY, Pa. — As she neared her 70s, her fourth decade as a dog trainer, Polly Hornberger of Birdsboro, Berks County, faced a new challenge when preparing for dog shows. 

"I was doing agility with one of my Windsprites [a dog breed], and when I had to run with her, I had leakage," Hornberger said. "I always had to wear a panty liner."

It's a common problem. Urinary incontinence affects as many as 62% of adult women in the United States, according to research in the journal Urogynecology. 

Many women assume a leaky bladder is just a fact of life with aging and that they will always have to wear pads or avoid activities like exercise or travel, said Jaime Long, female pelvic medicine and reconstructive surgeon at Penn State Health St. Joseph Medical Center. These misconceptions can leave some women struggling for years before they seek help.

"Many effective treatments are available to restore quality of life when leaking urine is an issue," Long said. "They're often very minimally invasive, very safe and easy to get started once you contact a health care provider who can direct you."

Here's what to know about a leaky bladder:

Common types of leaky bladder

Urge incontinence. This is when you feel a sudden, intense need to go with little warning and sometimes don’t make it to the toilet in time. Often, the cause is a neuromuscular problem in the bladder muscle and pelvic floor muscles, a bowl-shaped group of muscles and connective tissue that holds up your bladder and other pelvic organs. 

"The muscles and nerves of the bladder and pelvic floor allow us to control urine, feel when it’s full and make plans to use the bathroom," Long said. If the muscles and nerves aren't communicating well, your bladder can spasm and release urine involuntarily. 

Common signs and symptoms:

• Frequent trips to the bathroom
• Intense, sudden feelings that you need to go
• Waking up multiple times at night to urinate
• Family members noticing frequent bathroom visits
• Sexual dysfunction
• Leaking urine on the way to the bathroom

Stress incontinence. This happens when activities like exercising, coughing or sneezing puts pressure on your bladder and urethra, the tube that lets urine flow out of your bladder.

"An intra-abdominal force pushes down at the base of the pelvis, and this causes leakage because of a weakness at the urethra," Long said. "The urethra is like the doorway of the system, and if that doorway is weak and there's pressure against it, it pops open, and a little bit of urine escapes." 

Common signs and symptoms:

• Leaking during coughing, sneezing, laughing or exercise
• Leaking with bending, lifting or standing up
• Sexual dysfunction

Mixed incontinence. Some people have both stress and urgency incontinence. 

Treatment for urinary incontinence

A physician can assess incontinence by discussing your symptoms, performing a physical exam and using simple tests, such as an ultrasound, to check your bladder. They can then recommend treatments that help reduce the impact of urinary incontinence on your home and work life, relationships, sleep and mental health.

• Identifying and modifying triggers. For some people, lifestyle changes — like drinking less coffee, soda or tea — can help. 
• Physical therapy. Targeted exercises, like Kegel exercises, can retrain your pelvic floor muscles and boost bladder control. During a Kegel, you squeeze the muscles of your pelvic floor. If Kegels aren't helping, ask your health care provider to check you're using the right muscles, or ask for a referral to a pelvic floor physical therapy expert for help. 
• Medications. Prescription drugs like anticholinergics and beta-3 adrenergic agonists can reduce bladder muscle spasms in urge incontinence.
• Bladder Botox. Botulinum toxin injections, known for relaxing facial muscles to reduce wrinkles, can do the same for overactive bladder muscles in urge incontinence. The treatment lasts about nine months.
• Nerve stimulation. Electrical signals are used to improve the neuromuscular connection problems in urge incontinence.
• Vaginal inserts. These devices, often made of silicone, hold support underneath the urethra to help reduce stress incontinence. 
• Urethral bulking. A doctor injects the urethra with a tissue filler so urine can't escape as easily. 
• Bladder or urethral sling. A surgical procedure where a thin band of material is placed under the urethra to add support and prevent stress incontinence. 

Hornberger sought help from Long and underwent sling surgery at St. Joseph Medical Center to resolve her incontinence. Today, she runs alongside her dogs without worry and stays busy teaching piano lessons and creating art.

"Women should not prolong getting something done," Hornberger said.

While less common, urinary incontinence can also affect men, Long said. Anyone with urinary symptoms should get checked out — for women, by a urogynecologist, and for men, by a urologist. 

Related content:

• Pelvic floor physical therapy offers relief for silent problem
• Ask Us Anything About… Incontinence

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.