Gotta Go. Fast…

Nearly half of middle-aged women are affected by urinary incontinence. See what local experts say about the problem

By Deborah Jeanne Sergeant

Loycano
Loycano

If you’re a woman experiencing urinary incontinence, you’re like many other American women. The National Institutes of Health estimates that about 20 to 30 percent of young adult women experience urinary incontinence; that rises to 30 to 40 percent of middle-aged women and then to 30 to 50 percent of elderly women.

Urinary incontinence involves urge incontinence — the feeling of needing to urinate — and stress incontinence, which occurs when the patient sneezes, coughs, laughs or otherwise moves in a way that causes urine leaks. The leaks are significant enough to cause health or social problems.

Several factors relate to why women experience urinary incontinence, including childbirth. During pregnancy, the body decreases support in the pelvic floor and produces hormones that relax the connective tissues to make birthing easier.

The growing baby places pressure on the bladder and can stretch tissues as well.

Preventing urinary incontinence during and after pregnancy depends mostly upon maternal weight, according to Paula Doyle, OB-GYN with University or Rochester Medical Center.

“Have a body-mass below 25 before becoming pregnant,” Doyle said. “If a woman’s BMI is 30 or higher before pregnancy, for every BMI point above 30, the risk is 3 percent higher during and after pregnancy. They’ll probably have incontinence if their BMI is 35 or 40.”

Advanced maternal age also increases the risk, as women in their mid-30s have experienced more wear and tear on their pelvic floor. That’s also the age at which people begin losing muscle tissue.

“They’re also more likely to be overweight and diabetic and, if they’ve been smoking, they’ve been smoking longer than younger women,” Doyle said.

Genetics also play a role.

The more children a woman bears, the greater risk she has of urinary incontinence, but the risk doesn’t increase much more after the third or fourth pregnancy.

“The pelvic floor muscles play a vital role in both types of incontinence,” said Elizabeth Loycano, who earned a doctorate in physical therapy, and practices at Finger Lakes Health. “The stress of delivering a baby directly affects these muscles.”

Loycano earned additional certification related to women’s pelvic health.

She helps women learn movements that strengthen the core muscles, including the pelvic core.

“Good body mechanics, such as when lifting the baby or car seat and remembering to keep a flat back and engage abdominal muscles, can help,” Loycano said.

This advice applies for both vaginal and C-section births, once cleared for exercise. Despite the difference in delivery method, both experience the months of hormonal changes that result in lax connective tissues and the pressure of carrying a baby.

Loycano also recommends Kegel exercises. To find the right muscles, try to stop a flow of urine while on the toilet and then engage those muscles elsewhere throughout the day, increasing the time holding the muscles for each repetition.

Most women recover from childbirth-related urinary incontinence within three months of delivery. Especially for those who don’t, “a physical therapist can tailor a program if you have urge or stress or both to figure out the kind of contraction you need and the kind of exercises do to,” Loycano said.

Physician Leila Kirdani is  board-certified in both metabolic medicine and family practice. She operates Quality of Life Medicine in Rochester. She also recommends Kegels.

“Do them throughout the day until you work up 50 or 100 a day,” Kirdani said.

Of course, women need to wait until they’re cleared for exercise and have healed from delivery.

Older women may benefit from balancing their hormones. Kirdani said that low estriol can affect urinary control but topical, over-the-counter estriol cream can help.

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