New guidelines recommend Kegels, other lifestyle treatments for urinary incontinence in women

New guidelines on urinary incontinence encourage doctors to recommend pill-free treatments first like Kegel exercises, bladder training, weight loss and exercise.

The expression “I laughed so hard I wet my pants” is used in a lighthearted way. But there’s nothing funny about it for the millions of women who leak urine when they laugh, cough, or sneeze. “Women are embarrassed by the condition. And some women live with it because they believe there’s nothing they can do about it,” says Dr. May Wakamatsu, Director of Female Pelvic Medicine and Reconstructive Surgery at Massachusetts General Hospital and co-editor of the Harvard special report Better Bladder and Bowel Control.

Fortunately, there’s plenty a woman can do to rein in urinary incontinence, and most solutions don’t require medication. In fact, new guidelines on urinary incontinence from the American College of Physicians urge doctors to recommend pill-free treatments first. These include Kegel exercises, bladder training, and weight loss and exercise.

Types of urinary incontinence

Problems with bladder control fall into two main categories. Leakage with laughing and other things that put pressure on the bladder is known as stress incontinence. It’s often caused by childbirth, which can stretch or damage the pelvic floor muscles and nerves.

The other common type is known as urge incontinence, or overactive bladder. It’s caused by unpredictable contractions of muscles in the bladder wall. Overactive bladder usually stems from a temporary condition such as a bladder infection, or from a chronic condition such as multiple sclerosis, Parkinson’s disease, stroke, or diabetes. Symptoms of an overactive bladder include needing to urinate often (eight or more times during the day and several times at night); needing to urinate urgently; leaking urine; and waking from sleep to urinate. Postmenopausal women tend to develop overactive bladder, possibly because of age-related changes in the bladder lining and muscle.

There are other types of urinary incontinence. Symptoms of both stress incontinence and overactive bladder are known as mixed incontinence. Overflow incontinence occurs if something blocks urine from flowing normally out of an overfull bladder. This is more common in men, but does affect women. Some medications can cause overflow incontinence.

Drying up urinary incontinence

Here are several of the pill-free methods for fighting urinary incontinence recommended by the American College of Physicians and how they help:

Kegel exercises work for all kinds of urinary incontinence. They strengthen the pelvic floor muscles, which are used to hold in urine. Kegels are done by repeatedly squeezing and relaxing the pelvic floor muscles. Step-by-step instructions for doing Kegels are available from the Harvard Women’s Health Watch. If you have trouble doing Kegels, or they don’t seem to be working, a physical therapist can use techniques like biofeedback to help you find the right muscles to squeeze. Pelvic floor physical therapy can also improve posture, which helps keep pelvic floor muscles functioning properly.

Bladder training (urinating on a schedule) helps you learn to gradually increase the amount of urine you can comfortably hold. It’s most often recommended for women with an overactive bladder. “Many women do not know that they should be able to wait three to six hours between urinating. Bladder training retrains the way the brain and bladder interact to give the woman more bladder control,” says Dr. Wakamatsu.

Weight loss and exercise can help women who are overweight or obese. Extra weight puts extra pressure on the bladder and pelvic muscles. Losing weight through a healthy diet and exercise helps relieve urinary incontinence. Studies have also shown that middle-aged women who are most physically active are least likely to develop incontinence.

“These first line interventions can be very effective for many women. Approximately 70% of women will improve enough so they are satisfied with their bladder control. This does not mean that the women have perfect bladder control, but they can exercise and carry out daily activities without bothersome urinary incontinence,” says Dr. Wakamatsu.

These lifestyle changes may also help:

Watch your fluid intake. Drink only when you feel thirsty, and don’t exceed six to eight 8-ounce cups of fluid per day from all sources, including soup.

If you smoke, stop. Quitting reduces coughing, which puts pressure on the bladder.

Minimize bladder irritants like caffeine, alcohol, carbonated drinks, spicy foods, and citrus fruits and flavorings.

If these approaches aren’t effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin (Botox) to relax overactive bladder muscles.

Most important, seek your doctor’s help if you have any issues with urinary incontinence. You don’t have to live with the condition, and you most likely can fix the problem.