Breaking the Silence: Addressing Incontinence During National Women’s Health Month

By Bela Kudish, MD, MS, ACOG, URPS

National Women’s Health Month presents an ideal opportunity to discuss a condition that affects millions of women but remains shrouded in unnecessary silence: urinary incontinence. While common, affecting approximately 25-45% of adult women, many suffer silently due to embarrassment or misconception that it’s an inevitable part of aging or motherhood.

Understanding Incontinence in Women
Urinary incontinence—the involuntary leakage of urine—exists in several forms. Stress incontinence occurs during physical activities like coughing, sneezing, or exercise. Urge incontinence involves sudden, intense urges to urinate followed by involuntary leakage. Mixed incontinence combines both types.

Women face unique risk factors across different life stages. In younger women (20s-30s), pregnancy and childbirth can weaken pelvic floor muscles. During perimenopause and menopause (40s-60s), hormonal changes affect urethral tissue integrity. In older women (70+), age-related muscle weakening and neurological changes may contribute to symptoms.

Breaking Myths: It’s Not Just Age or Childbirth
While aging and childbirth are significant factors, they’re not the only causes. Other contributors include:
. Chronic constipation creating persistent pressure on the bladder
. High-impact exercises without proper pelvic support
. Untreated urinary tract infections
. Certain medications affecting bladder function
. Neurological conditions impacting nerve signals
. Pelvic surgeries, including hysterectomy

Evidence-Based Management Strategies
The good news? Most cases respond well to conservative interventions:

Pelvic Floor Therapy: Beyond Basic Kegels
Pelvic floor physical therapy has emerged as a frontline treatment. Professional therapists assess muscle function and prescribe personalized exercise regimens. Treatment may include:
. Biofeedback to visualize muscle contractions
. Internal and external manual therapy
. Electrical stimulation to improve muscle recruitment
. Functional retraining for everyday activities

Self-Management Exercises
Between therapy sessions, these exercises build strength and control:

1. Basic Kegels: Identify the correct muscles by stopping urine mid-stream (for identification only, not as regular practice). Contract these muscles for 3-5 seconds, then release. Build to 10-second holds with equal rest periods.

2. Elevator Kegels: Visualize your pelvic floor as an elevator. “Lift” it floor by floor, pausing briefly at each level before descending slowly.

3. Quick Flicks: Perform rapid pelvic floor contractions (1-second contract, 1-second release) to improve reactivity during sudden pressure increases.

4. Bridge Pose: Lie on your back with knees bent. Lift hips while contracting pelvic floor muscles, hold for 5 seconds, then lower.

5. Squat-to-Stand: Perform controlled squats while maintaining pelvic floor engagement throughout the movement.

Lifestyle Modifications
Simple changes can significantly impact symptoms:
. Bladder training: Gradually increasing time between bathroom visits
. Fluid management: Maintaining hydration without excessive intake
. Dietary adjustments: Reducing bladder irritants like caffeine, alcohol, and artificial sweeteners
. Weight management: Even modest weight loss can reduce pressure on the pelvic floor
. Smoking cessation: Chronic coughing strains pelvic floor muscles

When to Seek Professional Help
While self-management helps many women, certain situations warrant medical attention:
. Incontinence interfering with daily activities or sleep
. Symptoms developing suddenly
. Pharmacotherapy for overactive bladder symptoms
. Pain accompanying leakage
. Blood in urine
. Recurrent UTIs
. Failed response to conservative measures

Healthcare providers might recommend additional treatments like pessaries (supportive devices), medication, or minimally invasive surgical procedures for appropriate candidates.

Empowerment Through Education
National Women’s Health Month reminds us that health literacy empowers self-advocacy. Incontinence, though common, is never normal. With proper assessment and targeted interventions, most women can experience significant improvement or complete resolution of symptoms.

By bringing these conversations into the open, we normalize seeking help and ensure women of all ages understand that effective solutions exist for this treatable condition.

About Bela Kudish, MD, MS, FACOG, URPS
Urogynecology and Reconstructive Pelvic Surgeon

Bela Kudish, MD, MS, ACOG, URPS, is a double board-certified urogynecologist specializing in the diagnosis and treatment of complex pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. With more than 20 years of experience and a compassionate approach, Dr. Kudish is committed to enhancing her patients quality of life through the latest medical advancements and evidence-based practices. She values the importance of building trusting relationships with her patients and is dedicated to empowering them with knowledge and ensuring they are actively involved in their care decisions.

UF Health Medical Group Urology

352.323.5665
UFHealth.org/locations/uf-health-medical-group-urogynecology