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Questions that may be too embarrassing to ask…

I’ve been having some bladder leakage when I run or do aerobics. What can I do about it? I hope I won’t need to wear diapers!

The loss of urine with coughing, sneezing, laughing, lifting, exercise or any activity that causes pressure on the bladder is known as stress urinary incontinence. It has nothing to do with psychological stress, but is due to changes in the pelvis as a result of pregnancy, childbirth, or menopause, and leads to a weakening of the sphincter muscle and tissues supporting the urethra. The amount of leakage is usually small (drops), but can be more severe. Fortunately, there are effective treatment options ranging from
pelvic floor muscle exercises, also known as Kegel’s, to surgery. Over the last decade the surgical treatment for stress urinary incontinence has changed dramatically. Procedures performed today are minimally invasive, have very high success rates, and few risks. The most common surgery performed, known as a mid-urethral sling, can be done in less than 30minutes, on an outpatient basis, with success usually noted immediately.

Lately it seems that my need to urinate comes on too fast — so fast, that I don’t always make it to the bathroom. What’s wrong? 

Urge urinary incontinence, also known as overactive bladder, is usually associated with frequency
of urination, a need to urinate repeatedly at night, and an intense urge to urinate with very little warning. This type of leakage is caused by abnormal contractions of the bladder muscle and affects 33 million Americans making it more common than asthma, osteoporosis, or diabetes. Unfortunately, much like
stress incontinence, many do not seek medical care likely due to embarrassment, the feeling
that nothing can be done, or the belief that incontinence is a normal part of aging. Treatment
options for overactive bladder begin with behavioral changes, pelvic floor muscle exercises,
and medications. If unsuccessful, other therapies can be pursued, such as percutaneous tibial nerve stimulation (PTNS) or sacral nerve stimulation (also known as InterStim®), which is similar to a “pacemaker” for the bladder. While not yet FDA approved, another potential treatment is Botox®, which can be injected into the bladder to help calm the bladder muscle.

Dr. Travis Bullock earned his medical degree from Eastern Virginia Medical School. He completed his residency in urologic surgery at Washington University, and a fellowship in female urology, neurourology and pelvic floor reconstruction at the Center for Continence Care and Urology in Minneapolis.

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