Urinary incontinence is a common and often embarrassing condition that results in the unintentional loss of urine. While women are more likely than men to experience symptoms of urinary incontinence, it can be particularly troublesome for men.

About 3% to 10% of men will experience symptoms in their lifetimes and report a high level of associated stress due to the condition. Some men say they would rather be impotent than incontinent.

Gender differences

Both genders can have urinary incontinence, but their experiences may differ. Often, people have similar symptoms, such as increased frequency and urgency. However, waking up in the night to urinate — called nocturia — is more common in men.

Men are more likely to have urge incontinence than stress incontinence. This occurs when there is a compelling and sudden urge to void that cannot be delayed or postponed and results in urine leakage. About 80% of men with urinary incontinence experience urge incontinence, compared to 31% of women.

Stress incontinence is more common in women, with about 48% of all instances. It accounts for only about 10% of instances in men. It is possible to have urge and stress incontinence simultaneously.

Urge incontinence imposes restrictions on a person's lifestyle, with many people practicing toilet mapping strategies and limiting social gatherings because they are afraid of being embarrassed in public.

Structural changes in the pelvic floor area can cause urinary incontinence. For men, the most common change is an enlarged prostate — called benign prostatic hyperplasia. As the prostate grows, it can cause frequent or urgent need to urinate, nocturia and many other symptoms. Furthermore, surgery on the prostate can lead to damage of the sphincter muscle, which can lead to stress urinary incontinence. In women, pregnancy and vaginal delivery can damage or weaken pelvic floor muscles.

Finally, urinary incontinence symptoms are more likely to be overlooked in men. This could because it's less common because of embarrassment to discuss it or other factors.

Treatment options for men

The good news is that urge and stress urinary incontinence can be treated. A combination of treatments may be needed. Usually, the health care team recommends less-invasive treatments to start with and move on to other options if these techniques fail to help the person.

Treatment options include:

• Behavioral techniques
  Lifestyle changes can improve in urinary incontinence symptoms in some people. This could include bladder training, double voiding and scheduled toilet trips. The health care team may recommend reducing or avoiding alcohol, caffeine or acidic foods that stimulate the bladder.
• Pelvic floor muscle exercises
  These exercises are not just for women. These exercises strengthen the muscles that control urination and support the bladder and penis.
• Medications
  Alpha blocker medications can relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder. Mirabegron is another medication used to relax the bladder muscle and increase the amount of urine the bladder can hold.
• Benign prostatic hyperplasia treatments
  Several effective treatments for prostate gland enlargement are available, including medications, minimally invasive therapies and surgery. The health care team will recommend the best approach based on a person's symptoms, size of the prostate, preferences and other health conditions.
• Slings or artificial urinary sphincter
  Men with stress urinary incontinence may benefit from a surgery to prevent unintentional urinary leakage. Your health care team will determine if you are a good candidate for this type of surgery based on history and physical exam.

Some men feel embarrassed about their bladder control problems. They may try to cope on their own by wearing absorbent pads, carrying extra clothes or not going out. But effective treatments are available for urinary incontinence. It's important to talk with your health care team about treatment to regain an active and confident life.

Adam R. Miller, M.D., is a urologist in Albert Lea and Austin, Minnesota. He also sees patients at Mayo Clinic in Rochester, Minnesota.

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The pelvic floor is a group of muscles that run across the bottom of the pelvis and hold up various organs, including the bladder and bowel. Weakening of the muscles or connective tissues in the pelvic floor can cause issues such as urinary or fecal incontinence or organ prolapse.

One of the biggest misconceptions about pelvic floor disorders is that they only affect women after a pregnancy. "Pregnancy can contribute to pelvic floor disorders, but pelvic floor issues can affect both men and women," says Dr. Olivia Cardenas-Trowers, a Mayo Clinic urogynecologist.

In addition to urinary and fecal incontinence, pelvic floor dysfunction can contribute to overactive bladder issues, such as urinary frequency and urgency, pelvic pressure or heaviness, pelvic pain, and sexual problems.

Approximately 1 in 3 women over age 20 report some form of pelvic floor dysfunction, but Dr. Cardenas-Trowers says the number is likely significantly greater.

"Unfortunately, many people suffer unnecessarily with pelvic floor issues because they are embarrassed to discuss their concerns.  Pelvic floor disorders are not normal, no matter the age or gender of the person," she says.

The good news is that quality of life can be restored once patients receive a diagnosis.

"There are various medications, physical therapy, devices, and even minimally invasive surgical procedures available today that can help a patient overcome pelvic floor issues, but it's important to speak with a health specialist about your specific situation since some individuals may have several issues," Dr. Cardenas-Trowers adds.

She recommends men speak to a urologist and women seek out a urogynecologist, which is a physician who is not only a gynecologist, but is also specially trained in and focused on female pelvic floor disorders, incontinence and prolapse.

Dr. Cardenas-Trowers also suggests adding pelvic floor strengthening exercises to any workout routine. "As with other parts of our body, our muscles and tissues lose strength and elasticity as we age. We know exercise is good for our heart, and brain, and can help improve our overall health. Our pelvic floor is no exception. There are certain exercises that can help to optimize pelvic health," she says.

Watch: Dr. Cardenas-Trowers demonstrate easy pelvic floor strengthening exercises.

Learn more:

Women’s Wellness: Lifestyle strategies ease some bladder control problems

Women’s Wellness: Sexual health after cancer treatment

Women’s Wellness: Chronic pelvic pain can have multiple causes

Consumer Health: Gentlemen, are you doing your Kegels?

The post Pelvic floor disorder awareness appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I am in my mid-30s and a mom of twins, and it seems that I recently developed what must be an overactive bladder. It hinders my daily activities and makes me feel embarrassed, as I often must excuse myself abruptly. I wake up multiple times at night, too. Sometimes I also seem to leak urine. Are these conditions common for women my age, and what can I do to make them more manageable?

ANSWER: An overactive bladder causes a sudden urge to urinate. The condition is common, affecting over 33 million Americans. It affects both men and women, although women are more susceptible because of pregnancy, childbirth and menopause.

With a healthy bladder, the brain signals that the bladder is getting full. When you get to a bathroom, your bladder muscles contract and force urine out of the bladder. Overactive bladder can result from the nerve signals between the bladder and the brain not functioning properly. People with overactive bladders frequently feel a sudden urge to urinate.

In general, the risk for overactive bladder increases with age. Several conditions can contribute to signs and symptoms of overactive bladder, including:

• Neurological disorders, such as stroke and multiple sclerosis.
• Diabetes.
• Urinary tract infections that can cause symptoms similar to those of an overactive bladder.
• Hormonal changes during menopause in women.
• Abnormalities in the bladder, such as tumors or bladder stones.
• Factors that obstruct bladder outflow, such as enlarged prostate, constipation or previous operations to treat other forms of incontinence.

Sometimes medications, excess caffeine and incomplete bladder emptying can contribute to overactive bladder issues.

A bladder function test may be necessary to assess how your bladder is working and rule out any other issues. This test typically measures how much urine is left in your bladder after you urinate and your urine flow rate, and tests the pressure in your bladder.

The good news is that there are a variety of treatments for managing overactive bladder. A combination of treatment strategies may be the best approach to relieve overactive bladder symptoms. Depending on your situation, options can include simple behavioral modifications, physical therapy, oral medications or outpatient procedures. It is important to discuss your situation with your gynecologist or other health care provider who can refer you to a specialist to learn more about treatment options.

The urgency associated with an overactive bladder can be difficult to stop and can lead to episodes of involuntary loss of urine. This is known as urge incontinence, which may be the leaking you are experiencing. Urge incontinence is the most prominent form of incontinence among women in the U.S. Approximately 1 in 4 women over 18 report experiencing episodes of leaking urine involuntary.

Overactive bladder can cause urgency, even when the bladder is not full. The muscles of the bladder start to contract involuntarily, even when the volume of urine in your bladder is low. This creates the urgent sensation to void your bladder. Sometimes the muscle contractions occur too quickly and can cause you to pass urine, causing leakage.

It is important to note that women who have an overactive bladder also may have a disorder called mixed incontinence, when both urgency and stress incontinence occur. Stress incontinence is the unintentional loss of urine prompted by physical movement or activity that puts pressure on your bladder, such as coughing, sneezing, laughing or exercising. Depending on when you experience urine leaks, this may be the cause.

Talking with your gynecologist or health care provider about the details can help determine if your leaking is related to overactive bladder urgency or stress incontinence.

Although overactive bladder and urinary leaking can be disruptive, maintaining a healthy lifestyle, including regular physical activity and exercise with core strengthening, is important. Also, although it may seem counterintuitive, drinking plenty of water is important, so that your body and muscles function regularly. You also can ease overactive bladder symptoms by limiting consumption of caffeine and alcohol, and quitting smoking. ― Compiled by Mayo Clinic staff

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Related Articles 

• Mayo Clinic Q and A: Effective treatment available for stress incontinence published 2/28/20
• Women’s Wellness: Stress urinary incontinence surgery published 9/26/19
• Study shows advantages for stress urinary incontinence surgery published 7/15/19
• Mayo Clinic Minute: Treatment options for stress urinary incontinence published 6/7/19

The post Mayo Clinic Q and A: Dealing with an overactive bladder appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I am 56 and have noticed a few things are changing as I get older. I know as I age there will be more changes in my body and mind, but can you provide insights on what are some common things that I can expect?

ANSWER: Throughout life, your body is constantly changing, and there are some surprising changes that can occur within your body and mind. As you age, some of those changes become more obvious, like wrinkles or forgetfulness. Learning what to expect as you get older can help alleviate some anxiety with aging.

Below are some common questions from patients about aging:

I used to be 6 feet tall. Now I am 5 feet, 11 inches tall. Why am I shrinking?

When looking at height loss, some changes are normal, and some are not. You have 24 bones, or vertebrae, in your spine with discs in between each vertebra. These discs begin to lose strength and thin as you age. This thinning process causes you to start to shrink.

The bone remodeling process becomes more disordered after age 25. This causes you to break down your bones faster than you rebuild them.

You can help prevent bone breakdown to a substantial degree through weight-bearing exercise, such as walking, jogging, aerobics or resistance training, and through a healthy diet rich in calcium and vitamins. Also, speak to your primary health care provider about appropriate screening for your risk of osteoporosis. Though screening recommendations differ, most organizations suggest screening universally at 65 for women and 75 for men. However, other risk factors, such as premature menopause, fractures and hormone deficiency, can warrant earlier testing.

I leak urine when I laugh. What can I do?

Urinary incontinence, or urinary leakage, is a common problem, especially for older women. This issue can result from many causes, including pregnancy, childbirth, menopause, overactive bladder muscles, weakened pelvic muscles and nerve damage. The right treatment will require a proper diagnosis. Making the right diagnosis will include a full history of symptoms; a physical exam; urine testing; and possibly more advanced studies, such as urodynamic testing, or ultrasound and X-ray imaging.

Treatments are helpful, and they include behavioral modifications, dietary changes, pelvic muscle strengthening, medications and surgery. Incontinence or voiding difficulties in men can be a sign of an enlarged prostate or prostate cancer. Generally, I would recommend talking with your health care provider about these symptoms.

Why am I in the bathroom again?

Nocturia, or getting up in the middle of the night to go to the bathroom, is a common problem for many people. About one-third of men over 30 make at least two trips to the bathroom after they've gone to bed. This is usually caused by benign prostatic hyperplasia, or BPH, which is an enlarged prostate. However, there are other causes, including medications; alcohol; caffeine; nighttime drinking and dietary habits; diabetes; heart conditions; and sleep disorders, such as sleep apnea.

Treatment for nocturia requires a proper diagnosis by your health care provider. This visit will involve a history, an exam and simple laboratory testing to start. Treatments include behavioral modifications, dietary changes, medications or surgical intervention.

Why do I have so many wrinkles?

Wrinkles are a natural part of aging that can be caused by several factors. Some common factors can include stress and sun exposure — both of which break down the elastin fibers and collagen in skin. Exposure to air pollutants and tobacco smoke also can play a significant role.

As you age, skin becomes less elastic, and the natural oil production in skin decreases, causing it to dry out. You start to lose the fat in the deeper layers of your skin, and the crevices and lines become more prominent. Wrinkles are also genetic.

You can slow the effects on the skin by using sunscreen; wearing protective clothing, including hats; using moisturizers; eliminating smoking; and eating a diet full of natural antioxidants found in fruits and vegetables.

If you are interested in treatment beyond these tips, talk to your health care provider or a dermatologist who can suggest more specific cosmetic options.

Every day I seem to lose my reading glasses. Why can't I remember the simplest things anymore?

Just like your joints, muscles and skin, your brain ages, too. While it may seem like your glasses are misplacing themselves, your brain is simply having a harder time with recall. You may notice that you forget names or can't remember a loved one's birthday. You also may find it takes longer to learn new things. All of these are usually signs of normal aging.

Just as staying physically fit is important as you age, so, too, is keeping your mind active. You're encouraged to keep active physically, mentally and socially to the best of your ability.

Certainly, there are other causes of memory loss, including medication interactions; vitamin deficiencies; metabolic conditions, such as a thyroid disorder; depression; anxiety; or ongoing infections. If you or your loved ones have noticed that memory is a problem for you, you're encouraged to talk with your health care provider to determine if it is normal aging or something more significant.

Aging can be challenging, so continue to maintain regular touch points with your health care provider so you can address any concerns in a timely fashion. Being prepared for the future will make it easier for you to enjoy your upcoming birthdays. — Dr. Steven Perkins, Family Medicine, Mayo Clinic Health System, La Crosse, Wisconsin

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Related Articles 

• Consumer Health: Nutrition challenges for seniors published 3/26/21
• Consumer Health: Aging and sexual health published 2/12/21
• Consumer Health: Treating osteoporosis with bisphosphonates published 10/20/20
• Mayo Clinic Q and A: Effective treatment available for stress incontinence published 2/28/20

The post Mayo Clinic Q and A: Aging and changing appeared first on Mayo Clinic News Network.

Research is advancing a regenerative solution for a quality of life-limiting complication of mesh-based surgical repairs for stress urinary incontinence and pelvic organ prolapse in women. While mesh-based surgical treatments are durable and provide symptom relief for a great number of patients, there is a risk of mesh complications following surgery, such as mesh exposure. In this situation, many patients require an additional surgery to revise their implant. Mayo Clinic research, supported by the Center for Regenerative Medicine, is testing a regenerative approach to restoring form and function without additional corrective surgery in the setting of vaginal mesh exposure.

Vaginal prolapse is a medical term for a condition that leads to bulging of the pelvic organs, such as the bladder, uterus or rectum. It happens when ligaments and muscles on the pelvic floor stretch and weaken, no longer providing adequate support. Those internal organs slip down, bulging through the vagina wall, causing prolapse. Alternatively, women can also experience accidental leakage of urine with activity or cough, laugh and sneeze. This is termed stress urinary incontinence. Often linked to child birth, obesity or aging, incontinence and prolapse affect many women.  

Women with vaginal prolapse or urinary incontinence may choose to undergo placement of mesh if they have failed conservative therapies. Mesh is used in gynecology surgery to lift and support the pelvic organs, typically the bladder or uterus, relieving the pressure that caused the pelvic floor defect. However, like all surgery, there are potential risks. The mesh sometimes wears through the vaginal walls, causing vaginal discharge and possibly discomfort for women and their partners. Therein lies the dilemma: should there be another surgery to remove the mesh or would the patient prefer to live with the symptoms?

Mayo Clinic researchers are studying a new regenerative option, called purified exosome product (PEP) to treat a complication of the use of mesh in gynecologic surgery. Research, currently in animal models, is looking at whether PEP could promote regeneration of tissue that would grow over the mesh and restore the vaginal wall.

“While gynecological mesh is a viable option for many women, we wanted to create a non-surgical reparative option for our patients,” says John Occhino, M.D., clinician-scientist in gynecologic surgery with specialty training in urogynecology and pelvic reconstructive surgery. “We are studying the use of PEP to correct one of the most common side effects of mesh placement, the exposure of mesh through the vaginal wall after surgery.”

Exosomes are small membrane-bound vesicles secreted into the body’s cellular environment. Imagine bubbles carrying a signal that tell the body to regenerate and renew. For example, when the skin is scratched, exosomes are sent to repair the skin. By delivering a high dose of purified exomes, researchers can recruit numerous cells and pathways to help heal the tissue back to its original state.

“Our research injects an exosome gel into the vaginal tissues of a preclinical model of mesh exposure,” says Cassandra Kisby, M.D., female pelvic medicine and reconstructive surgery fellow. “Four weeks after treatment we saw the vaginal tissues had repaired and covered the prior mesh exposure.”

The regenerated tissues were physiologic, adds Dr. Kisby, meaning there were new blood vessels, the tissues had normal amounts of collagen, and there was minimal scaring.

While this research is currently only being done in animal models, Drs. Occhino, Kisby and team are working to develop a phase 1 clinical trial to test the safety of PEP in humans within the next year.

“This technology opens the door for numerous applications in gynecology, including birth injury and repair, urinary incontinence, and fistulas.” says Dr. Kisby. “Our goal is to create a women’s health regenerative medicine program to help expedite the research and translation of this technology into clinical  practice.”

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The Center for Regenerative Medicine recognizes Michael S. and Mary Sue Shannon for their generosity and support in advancing regenerative women’s health research.

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For years, Roxann Neumann, kept spare clothes in her car and desk for the days when incontinence got the best of her. But after an innovative surgery that resets the nerve signals between the brain, bladder and bowel, Roxann's incontinence has improved immensely, and the extra clothing is back in her closet.

Roxann Neumann loves nothing more than holding and snuggling her eight little grandchildren. Until recently, however, Roxann was affected by urinary incontinence, and lifting the children triggered an extremely uncomfortable experience.

"Picking up my 3-year-old granddaughter, I could completely soak a super absorbent pad and go through to my underwear," Roxann says.

Not only did Roxann have overactive bladder that caused her to routinely leak urine, she also struggled with irritable bowel syndrome and experienced bowel incontinence. Roxann combated the exasperating condition for years using traditional approaches. But lifestyle modification, medication and pelvic floor strengthening exercises did not stop her symptoms. "I was pretty much told this is the way it is," Roxann says.

In summer 2019, however, Roxann saw a new primary care provider who offered a different perspective. A visit with Marvin Vaughan, M.D., at Mayo Family Clinic Northeast, opened a door that led Roxann in a new direction toward a permanent remedy for the incessant leaking. "(Dr. Vaughan) listened to my issues and asked me, 'Has anyone sent you to urogynecology?'" Roxann says. "I said no, and he said, 'Well, let's do that,' and that's how I met Dr. Linder."

Under the care of Brian Linder, M.D., a Mayo Clinic urologist and urogynecologic surgeon, Roxann learned about an innovative therapy for urine and bowel incontinence called sacral nerve stimulation. Sacral nerve stimulation, sometimes called sacral neuromodulation, targets the nerves that signal the brain that it's time to release the bladder or bowel. The treatment can greatly diminish symptoms related to urgency leaking.

In September 2019, Dr. Linder implanted a sacral neuromodulation device into Roxann's lower back during an outpatient procedure. Since then, Roxann's life has undergone a profound change.

"I never dreamt it could be this way again. I was hoping for help with one or the other (the bladder or the bowel issue). I didn't imagine I would have both," Roxann says. "When the grandkids come over, they love for grandma to pick them up and cuddle. I can do that now and not worry. And that's such a comfort."

Escalating symptoms

Roxann's symptoms of urinary incontinence started mildly years ago. Decades of horseback riding and the delivery of six babies affected her pelvic floor muscles and her ability to control elimination. "The last three years were the worst, but I've been having issues for probably the last seven years," she says. "When we'd go out anywhere, my husband would always scope out to see where the ladies' room was, so I could make a fast trip if I needed to."

Eventually, the leaking got so bad that Roxann began keeping spare clothes in her desk at work and in her car. "I can't tell you how many pairs of clothing I've had to toss over the last several years," she says.

Worse than the inconvenience her condition presented during waking hours was the implications that the frequent and urgent need to urinate had on her sleep. "I was getting up every half hour to go to the bathroom, so I wasn't getting any rest," Roxann says.

"Treatment with sacral neuromodulation is FDA-approved for both overactive bladder, as well as accidental bowel leakage. The idea is that it's normalizing the control of bladder reflexes."

Brian Linder, M.D.

Roxann took prescription medications designed to decrease the frequency of urination. They were helpful, but she still was using the bathroom every hour or so. Years of practicing pelvic floor exercises, called Kegel exercises, did not decrease her symptoms. At Dr. Linder's recommendation, Roxann also tried a therapy that supplied external electrical stimulation to the pelvic floor, but that didn't stop the leaks either.

When the electric stimulation failed, Dr. Linder talked to Roxann about sacral nerve stimulation. "Treatment with sacral neuromodulation is FDA-approved for both overactive bladder, as well as accidental bowel leakage," says Dr. Linder, who has implanted approximately 25 such devices in patients at Mayo Clinic in the past year. "The idea is that it's normalizing the control of bladder reflexes."

In people who have incontinence, there is a breakdown in the communication between the brain and the sacral nerves. "The signals aren't lining up how they're supposed to. Instead of the brain being able to say now is not the time to void, the reflex that makes the bladder respond and then squeeze to empty fires on its own," Dr. Linder explains. "So sending a signal with sacral nerve stimulation modulates how the body responds. It's kind of like rebooting the software."

When Dr. Linder told Roxann how sacral nerve stimulation works, and that it can effectively treat bowel and bladder incontinence, Roxann says her ears perked up, and she asked for more information. That evening, Roxann and her husband reviewed the literature on sacral neuromodulation at home. "He looked at it, and I looked at it, and we looked at each other and said, 'This could be the answer,'" Roxann recalls.

Long-term results

More and more, sacral neuromodulation is becoming the answer for many women, and some men, with bladder and bowel incontinence, Dr. Linder says, adding that, until recently, it wasn't widely offered at Mayo Clinic. The treatment is not designed to treat stress incontinence, which is leaking associated with coughing or sneezing.

"To have overactive bladder is very common. Many people start treatment with an oral medicine, but they may not know there are treatments beyond oral medication if they're not having adequate symptom control," Dr. Linder says. "The overall proportion of women who go on to a therapy like this is relatively small. But it's important to know that this option and others are out there for symptoms that cannot be otherwise controlled."

From Roxann's perspective, having access to a physician who worked with her to find an effective treatment made all the difference. "Dr. Linder really went the extra mile in trying to find something that was going to work," she says. "He told me I could do all the electrical stimulation and all of the Kegels I wanted, but it was never going to take care of the issues I had. It was like: 'Yes. Finally somebody finally understands.'"

"People have got to know there is help out there if you do have this problem. Dr. Linder made such a difference in my life, and I'm willing to let people know."

Roxann Neumann

A few weeks after learning about the treatment, Roxann underwent the first phase of a two-part operation to implant the neurostimulator. During the first step, Dr. Linder placed a wire with four electrical leads into Roxann's lower back, near the nerves that control the bladder and rectum. The wire exited her body and attached to an external battery taped to her back.

Roxann wore the external battery for about two weeks as a trial to test the effectiveness of the device, which has seven program settings. "There are four electrodes on the wire itself, so you can change the settings between which of these four electrodes are getting stimulation," Dr. Linder says.

When Roxann woke up from the procedure, she was confident things would be different. "Right from the start, I knew it was going to work," she says. "When I got off the cart coming from the procedure, I was able to walk to the bathroom, and I didn't leave a trail."

Two weeks after the first surgery, Dr. Linder performed the second part of the operation and implanted a small battery into a pocket that he created under Roxann's skin in her lower back. Since undergoing the treatment, Roxann has a renewed vigor for life and readily tells people about her remarkable transformation thanks to the sacral nerve stimulation.

"Not many people are willing to talk about it," she says. "Who wants people to know that they were incontinent of the bowel and bladder? But people have got to know there is help out there if you do have this problem. Dr. Linder made such a difference in my life, and I'm willing to let people know."

HELPFUL LINKS

• Learn more about overactive bladder.
• Check out surgical treatments for urinary incontinence.
• Learn more about urogynecology at Mayo Clinic.
• Explore Mayo Clinic.
• Request an appointment.

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Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.

Though it occurs more often as people get older, urinary incontinence isn't an inevitable consequence of aging. If urinary incontinence affects your daily activities, don't hesitate to see your health care provider. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence.

Symptoms

Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.

Types of urinary incontinence include:

• Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
• Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
• Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
• Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
• Mixed incontinence. You experience more than one type of urinary incontinence.

Lifestyle and home remedies

Bladder training
This involves learning to delay urination every time you get the urge to go. You may start by trying to hold off for 10 minutes. The goal is to lengthen the time between toilet trips until you're urinating every two to four hours. Bladder training may also involve double voiding – urinating, then waiting a few minutes and trying again to empty your bladder more completely.

Schedule toilet trips
The idea here is timed urination – going to the toilet according to the clock rather then waiting for the need to go. Try to go every two to four hours.

Fluid and diet management
You may be able to simply modify your daily dietary habits to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods.

Pelvic floor muscle exercises
These exercises, called Kegels, strengthen the abdominal muscles that help control urination. Image that you're trying to stop the flow or urine. If you're using the right muscles you'll feel a pulling sensation. Pull in your pelvic muscles and hold for a count of three. Relax for a count of three. Work up to 10 to 15 repetitions each time your exercise. Do Kegel exercises at least three times a day. It may take up to 12 weeks before you notice an improvement in bladder control.

Problems with urine leakage may require you to take extra care to prevent skin irritation:

• Use a washcloth to clean yourself
• Allow your skin to air-dry
• Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections
• Consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine
• Ask your health care provider about special cleansers made to remove urine that may be less drying than other products.

If you have urge incontinence or nighttime incontinence, make the toilet more convenient:

• Move any rugs or furniture you might trip over or collide with on the way to the toilet
• Use a night light to illuminate your path and reduce your risk of falling

If you have functional incontinence, you might:

• Keep a bedside commode in your bedroom
• Install an elevated toilet seat
• Widen an existing bathroom doorway

When to see a health care provider

You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, it's important to seek medical advice because urinary incontinence may:

• Indicate a more-serious underlying condition
• Cause you to restrict your activities and limit your social interactions
• Increase the risk of falls in older adults as they rush to the toilet

This article is written by Mayo Clinic Staff. Find more health and medical information on mayoclinic.org.

The post How can I ease discomfort or stop urinary incontinence? appeared first on Mayo Clinic News Network.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads at the end of the post. Please "Courtesy: Mayo Clinic News Network." Read the script.

For some women, a laugh among friends or a round of golf can lead to an unpleasant moment. Dr. Trabuco says it's called stress urinary incontinence — loss of urine with physical activities such as coughing, laughing, sneezing and exercise. 

"Having prior deliveries, particularly vaginal deliveries, puts women at higher risk.”

Middle-aged women, those who smoke and are overweight are also at risk. Fortunately, treatment works.

"Working with the physical therapist is greatly beneficial if they have weak pelvic floor," says Dr. Trabuco.

When therapy or over-the-counter options don't help, surgery may be an answer.  

"There are both mesh-containing surgeries and non-mesh-containing surgeries," says Dr. Trabuco.

Another less invasive option is the midurethral sling.

"80% to 85% of the women are either significantly dry or completely dry," says Dr. Trabuco.

Most important, he says, is talking with your health care provider. 

"There are surgical and nonsurgical options that we can do to treat a condition that's greatly bothersome and impacts quality of life."

The post Mayo Clinic Minute: Treatment options for stress urinary incontinence appeared first on Mayo Clinic News Network.

Urinary incontinence
The loss of bladder control is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time. Learn more about the causes and risk factors for urinary incontinence.

EXPERT ANSWERS
Does caffeine make depression worse?
There's no clear link between caffeine intake and depression. However, caffeine intake and depression may be linked indirectly for people who are particularly sensitive to the effects of caffeine or who have too much caffeine. Learn more from Dr. Daniel Hall-Flavin, a Mayo Clinic psychiatrist.

Is Vicks VapoRub an effective nasal decongestant?
Vicks VapoRub doesn't relieve nasal congestion, but it seems like it does. Why? Learn more from Dr. Jay Hoecker, an emeritus Mayo Clinic pediatrician.

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HEALTH TIP OF THE WEEK
Know when to move your winter workout indoors
Wind chill extremes can make exercising outdoors unsafe even if you dress warmly. The wind can penetrate your clothes and remove the insulating layer of warm air that surrounds your body. If the air temperature dips well below 0 degrees F (minus 18 C), choose an indoor activity instead.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org.

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On the next Mayo Clinic Radio program, Dr. Deborah Lightner, a Mayo Clinic urologist, will discuss options for preventing and treating urinary incontinence. Also on the program, Dr. James Naessens, a researcher at the Kern Center for the Science of Health Care Delivery, will share findings on the importance of getting a second opinion. And Dr. Juan Brito Campana, a Mayo Clinic endocrinologist, will explain why thyroid medications may be overprescribed in older adults.

Here's the Mayo Clinic Radio podcast.

The post Female urinary incontinence: Mayo Clinic Radio appeared first on Mayo Clinic News Network.