By Heide Brandes
When Alannah, 54, laughed too hard at a friend’s dinner party, she quietly excused herself to the restroom. Again.
For millions of women like her, urinary incontinence isn’t just an inconvenience, it’s a daily reality that affects everything from exercise routines to social lives. However, the “inevitable” leakage that touches up to 45 percent of women over 40 isn’t actually inevitable at all.
“I started limiting things I loved to do because I was always leaking,” Alannah said. “I gave up dancing, started wearing dark pants everywhere, started wearing pads all the time, and kept wipes and clean underwear in my purse. It was ruling my life.”
What Alannah didn’t know, and what many women don’t realize, is that urinary incontinence isn’t a life sentence or simply “part of getting older.” It’s a treatable condition with more solutions than ever before.
The Silent Epidemic
Recent medical data reveal a startling statistic: More than 60 percent of women in the United States experience some form of urinary incontinence. Yet fewer than half ever discuss it with their healthcare providers.
Specialists across the country are trying to change this culture of silence. At City of Hope Orange County, Dr. Seth A. Cohen, a urologic surgeon and urogynecologist, emphasizes that women shouldn’t suffer in isolation.
“There are a number of safe and effective treatment options to help reduce the burden of UI and improve your quality of life,” he says.
Dr. Adam Hare, Assistant Professor of Urogynecology at OU Health University of Oklahoma Medical Center, frequently encounters women who have been told, or have told themselves, that incontinence is inevitable.
“I often hear women who think urinary incontinence is a ‘normal part of aging’ and ‘something I’ve learned to live with,'” he said. “My message is simple. This is a common problem but should never be considered ‘normal’ and is not something that you have to live with.”
This distinction between “common” and “normal” is a crucial one that Dr. Lopa Pandya, Assistant Professor in Obstetrics and Gynecology at the University of Illinois in Chicago, also emphasizes.
“It’s common, not normal,” she said firmly. “The fact that we’ve just told women to normalize this isn’t fair.”
For Christine from Oklahoma City, incontinence meant a dangerous habit of limiting fluids.
“I was 24 when I had my son. It started with little leaks when I would sneeze or stand,” she said. “I stopped going out to events like concerts or anywhere I would have trouble getting to a bathroom. I stopped hydrating the way I should, so I would get dehydrated.”
There’s also a cost associated with managing these symptoms. The adult incontinence product industry has ballooned to over $7 billion annually in the United States alone, with the average woman spending approximately $900 per year on pads and protective garments.
The Types of Incontinence
One reason treatment options remain underdiscussed is confusion about the different types of incontinence. Dr. Hare provides a clear explanation:
“The main types are stress urinary incontinence, which is leakage of urine triggered by sneezing, coughing, exercise, or movement. The other is urgency urinary incontinence, which is urinary accidents when you have a strong urge to rush to the bathroom and cannot make it on time.”
Dr. Pandya uses more relatable language.
“Urgency-related incontinence is that gotta-go-gotta-go, can’t-make-it feeling. Or that ‘I got to my house and hit the garage door button, but still didn’t make it’ feeling.”
Many women experience both types simultaneously, a condition called mixed incontinence, which is the most common presentation. Understanding which symptoms predominate helps determine the best treatment approach.
Lifestyle Modifications
Before exploring medical interventions, doctors recommend several lifestyle modifications that can significantly reduce symptoms.
“We usually discuss monitoring fluid consumption in women with urinary incontinence so they are not consuming too much fluid, usually this is limited to two to three liters of fluid per day,” Dr. Hare said. “Practicing ‘timed voiding’ can also decrease the amount of leakage episodes.”
Dr. Pandya adds that certain dietary choices can make a significant difference; caffeine and carbonation can worsen overactive bladder symptoms. Weight loss can also be effective, though she acknowledges it’s “easy to say, hard to do.”
Non-Surgical Innovations
Specialized Physical Therapy
Pelvic floor physical therapy has evolved significantly in recent years, becoming far more sophisticated than basic Kegel exercises. This specialized therapy strengthens the pelvic floor muscles that support the bladder.
“For women with stress urinary incontinence, restrengthening the pelvic floor muscles can reduce the amount of bothersome leakage,” Dr. Hare said. “We usually have women work with a Pelvic Floor Physical Therapist specializing in this treatment.”
These specialists use biofeedback devices, targeted exercises, and sometimes electrical stimulation.
Pessaries and Insertable Devices
“We offer pessaries (insertable devices) as a non-surgical option,” said Dr. Pandya. “I always say there are surgical options and non-surgical options, and it’s up to the patient to decide which they want.”
Beyond the traditional pessary rings, newer options include tampon-like disposable devices designed specifically for incontinence. The FDA-approved Impressa device, for example, supports the urethra to prevent leakage during activities.
Urethral Bulking Agents
Among the lesser-known but effective options for treating stress incontinence are injectable treatments called urethral bulking agents.
“For stress urinary incontinence, our treatments have evolved and improved over the last 20 years,” Dr. Hare said. “Bulkamid is a procedure that does not involve mesh placement, can be done in clinic, and may work for up to three years before repeating.”
These treatments can provide significant relief, but they aren’t permanent. Industry data suggests effects can last up to seven years for some agents, but eventually the procedure will need to be repeated.
Bladder Botox
“In-office bladder Botox injections are also a great option for women looking to avoid surgery and can be done every six to nine months to control urgency,” Dr. Hare said.
“We can place it through a camera on the bladder, which is called a cystoscopy,” explains Dr. Pandya. “It can be done very quickly, within three to four minutes.”
Many women find this life-changing; success rates are up to 80 percent. The procedure is performed without anesthesia, and patients can go home immediately afterward.
Surgical Solutions When Needed
Surgical procedures can offer more durable solutions.
“Sling surgeries with mesh are much improved and safer compared to older mesh products that are now off the market,” Dr. Hare said. “Slings are very durable and give high rates of improvement. This is one of the most common procedures we do for women.”
For women concerned about synthetic materials, Dr. Hare notes alternatives, such as “fascial slings where tissue is harvested directly from your own body. A non-mesh surgery called a Burch suspension is a robotic minimally invasive surgery with good results.”
Advanced Treatment Options
For urgency incontinence, Dr. Pandya says Sacral Neuromodulation can be an effective minimally invasive procedure. It involves implanting a small stimulator in the back that works for 15 to 20 years to control bladder urgency. The success rates are up to 85 percent for those who experience 50 percent improvement or better.
Other innovative treatments include percutaneous tibial nerve stimulation (PTNS), where an acupuncture-like needle is placed near a nerve in the ankle, though this requires weekly visits followed by monthly maintenance.
Finding the Right Help
For women ready to address their incontinence, all three doctors emphasize the importance of seeking specialized care.
Alannah found relief through a combination of pelvic floor therapy and a pessary device she uses during high-impact activities.
“I’m back to going to the gym and dancing, wearing whatever I want, and laughing without fear,” she said. “It seems so simple now, but for years I just didn’t know these options existed.”
As more women break the silence around incontinence and demand solutions beyond the pad aisle, medical professionals are responding with innovations that help women reclaim activities they love.
“When a patient is experiencing challenges in their day-to-day functions like going to the bathroom, it has a significant impact on quality of life,” Dr. Cohen said. “My message for those patients is to seek out an integrated team of experts. Get back the quality of life that reflects the full, whole person you want to be.”