Why can’t I control my bladder?

Leakage of urine is one of the most frustrating problems that women deal with. It can be an extremely embarrassing problem, and often forces women to avoid doing types of exercise they enjoy, or going places where they don’t know whether there will be easy access to a bathroom.

The type of leakage that happens with coughing, laughing, and exercise is called, “stress urinary incontinence.” This occurs when the muscles around the urethra and the sphincter become weak, which can happen with childbirth or menopause. It also happens in female athletes. Many women describe stress incontinence when they go to their favorite exercise class or go jogging, when they are running to catch the train, laughing very hard with their friends, or when they have been coughing from a respiratory illness.

The other type of bladder leakage is called, “urge incontinence.” This happens when the bladder tries to urinate before you are actually sitting on the toilet. The classic example is when you get home and know you need to use the bathroom as soon as you walk in, but urine starts to leak out when you are putting the key in the door.

I’ve done pelvic floor exercises and I’m still peeing on myself. What else can I do?

Many women start with pelvic floor physical therapy to help strengthen the muscles and this is a very important first step. However, when this is not effective, there are excellent non-surgical and surgical options that can lead to significant improvement in urinary leakage.

One of the popular treatments we offer for stress incontinence is a filler injection called “bulkamid.” It is a hydrogel we use to plump the urethral tissue so it forms a tighter seal. This is a popular option because it is safe and effective, can be done in the office, is non-surgical, and has no downtime. We typically recommend 2 injections 8-12 weeks apart to achieve the best results.

Please see the stress incontinence page for other options including pessaries and sling surgery.

For urge incontinence, pelvic floor physical therapy and certain types of behavioral modification are typically done as first line therapy. But when these are not effective, other great options include medication, bladder botox or nerve stimulation procedures for this problem.

Many women also suffer from both stress and urge incontinence. We call this “mixed incontinence.” Dr. Kumar may recommend urodynamics to get a better sense of your bladder issues, so she can recommend the best treatment plan. In some women, the bladder muscle is overactive, whereas in others the sensory bladder nerves are sending inappropriate signals of needing to urinate too frequently. Based on your symptoms or urodynamics testing, Dr. Kumar may also recommend a bladder nerve test.