Ashlee Williams, MD (Host): Many people think urinary incontinence is just something that comes with age or something that women have to live with after childbirth, but that's simply not true. Incontinence is incredibly common. It affects millions of women of all ages, and it's highly treatable. Welcome to The Healthier You Podcast.

I'm Dr. Ashlee Williams, and today I'm joined by Dr. Nwamaka Fadahunsi, a Board Certified Urologist here at Kaiser Permanente to talk about what causes urinary incontinence, why it happens, and the wide range of treatments available that can help people regain bladder control. Dr. Fadahunsi, thank you so much for joining us today.

Nwamaka Fadahunsi, MD: Thank you for having me.

Host: What is urinary incontinence and how common is it?

Nwamaka Fadahunsi, MD: Urinary incontinence is the unintentional loss of urine due to bladder control. It can manifest in different ways. One such case being a strong sudden urge to urinate that you can't control. It's much more common than people think. Millions of women experience it, especially during or after pregnancy, as they age, or during high impact activities like exercise.

There are different types of incontinence, and the two most common types are stress urinary incontinence and urge urinary incontinence.

Host: I see it frequently in my clinics. I think it's something that's common that people don't talk about enough. Can you talk about what causes urinary incontinence in women?

Nwamaka Fadahunsi, MD: Yes, it is very, very common and there are a variety of reasons that incontinence can occur. Pregnancy and childbirth can stretch and weaken the pelvic floor muscles, making it harder to control the bladder. As women age, the hormonal changes that happen during menopause can also affect bladder control.

There are many medications such as diuretics or blood pressure medications that can lead to increased urinary urination and, that increased urination can also lead to leakage of urine, due to other problems that patients may have that are outside of their control. In addition, there are dietary factors such as caffeine and alcohol and artificial sweeteners that can irritate the bladder, giving you the sense of urge. And finally, there are other medical conditions such as diabetes, obesity and other neurological disorders that can cause urinary incontinence in women.

Host: What are some early signs that incontinence should be taken seriously?

Nwamaka Fadahunsi, MD: If you find yourself leaking urine during normal activities such as laughing, coughing, exercise and jumping, or you're waking up frequently at night to urinate; these are signs that it's probably time for you to talk to your doctor. Unfortunately, many women wait for months or even years to bring it up because they feel embarrassed.

But it's important to know that incontinence is a medical condition that can be treated, and it's not just a normal part of the aging process.

Host: And there's different types of incontinence, right? There's urge incontinence and stress incontinence. Can you talk a little bit about the difference between the two?

Nwamaka Fadahunsi, MD: Stress urinary incontinence is the leakage of urine that happens when one applies physical pressure to the abdomen. The pressure causes the involuntary loss of urine through the urethra and some of the common activities that can cause this is laughing, sneezing, coughing, jumping.

All of those types of activities can lead to stress incontinence because of the pressure that is applied to the abdomen and this often happens because the pelvic floor muscles that hold up the bladder and the urethra are weak. And that can happen from childbirth or with aging. The other type of incontinence is urge urinary incontinence. A type of leakage that happens when someone gets the sudden urge to urinate and they cannot hold it, they cannot hold that urge. They cannot stop themselves and they lose urine because the urge is so great. People often feel that they can't get to the bathroom fast enough.

And the other term that is often used for urge incontinence is an overactive bladder. Some women can experience stress incontinence. They can experience urge incontinence or they can experience both. And when that happens, we call it mixed urinary incontinence.

Host: What can people do at home for treatment of incontinence?

Nwamaka Fadahunsi, MD: Yes, there are some very bladder friendly habits that you can do. One of the few things that can be done easily by most everyone is to really cut down or eliminate their intake of caffeine, carbonated drinks and alcohol. These are all things that can irritate the bladder and cause you to have that sense of urge.

Can also practice pelvic floor exercises daily. These are typically called Kegel exercises, and these exercises help to strengthen the bladder, the pelvic floor muscles, which help to strengthen the bladder and the urethra. The other thing that can be done at home is to not delay going to the bathroom for too long when you get the urge to urinate. It's very, very good to stick to your natural schedule to avoid confusing the bladder. So when you get the urge to go, if you can, please go. And lastly, what you can do is keep what we call a bladder diary. And this will help track how often you are going to the bathroom, what you are drinking, the type of fluids you're ingesting, and when exactly leakage happens.

We can identify what you're doing that causes you to leak and this can help identify patterns and help us tailor your treatment that way.

Host: So you've made the dietary changes, you're doing all the Kegel exercises, and you're still having issues, so you decide to go to the doctor. What treatment options are available from a medical professional?

Nwamaka Fadahunsi, MD: So the very first things that we like to do, is to have you see a pelvic floor physical therapist, as the first line of treatment. And again, these are Kegel exercises that help to strengthen the muscles of the pelvic floor and they help to support the bladder and the urethra. There are other treatment options that are available depending on the type of incontinence you have and the severity of the incontinence.

And there are a variety of treatment options outside of surgery that are available to individuals that suffer from this condition.

Host: Is there a cure for incontinence or is it something that you just have to manage?

Nwamaka Fadahunsi, MD: In many cases, incontinence can be improved significantly or even resolved. Stress incontinence often responds very well to pelvic floor therapy and minor lifestyle changes. Urge incontinence may take longer to manage, but they can also be greatly improved with consistent treatment and support. The key is really identifying the cause and choosing a plan for that patient.

Most patients don't necessarily need surgery. There are many conservative treatment options that are highly effective, especially when these symptoms are addressed early.

Host: Thank you Dr. Fadahunsi for helping us to better understand urinary incontinence and how to manage it. Here are a few key takeaways. One: Urinary incontinence is common and affects women of all ages. It's also highly treatable. Two: Stress incontinence involves physical pressure being placed on the bladder, like when you cough or sneeze while urge incontinence is tied to a sudden need to go. Three: Causes can stem from weakened pelvic floor muscles, hormonal shifts, caffeine, medications, and certain health conditions. Four: Most cases can be managed with pelvic floor therapy, bladder training, and lifestyle changes without surgery. And five: if you're experiencing symptoms, talk to your doctor early.

The sooner you do, the better your chances are for improvement. For more information from our experts, visit kp.org/doctor and be sure to check out more episodes of Healthier You wherever you get your podcast. If you found this episode helpful, be sure to share it with others and subscribe. Thank you and from all of us at Kaiser Permanente, be well.