Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Urinary incontinence means you have trouble controlling your bladder and accidentally leak urine. Many women feel embarrassed to talk with us about incontinence, but there's no reason to feel uncomfortable or ashamed. Many women have this condition at some time in life, and it can be caused by a variety of normal life events.
It is common to experience incontinence during or after pregnancy, or with aging or weight gain. Incontinence can be related to weakening muscles or ligaments in the pelvic area, or the use of certain medications. There is also an apparent relationship between incontinence and genetics, so if you have incontinence, you are likely to find that your mother or sisters do, too. Infections in the bladder can also cause incontinence even without other symptoms.
The good news is that there are many treatments that can control or even cure urinary incontinence. It may be reassuring to know that many of these are small, effective changes you can make at home, and that this kind of home treatment has successfully cured incontinence for many women. We strongly encourage you to try these recommended home treatments. If, however, these aren't fully effective, we can work together to adjust your existing medications, add a new medication, or discuss other treatment options.
There are 2 main types of incontinence that typically affect women. The type of incontinence you have will determine the pattern of symptoms you experience. Based on your symptoms, you can determine if you have 1 or both types of incontinence. The 2 types and their symptoms are:
There are other types of urinary incontinence that both women and men may experience. Some of these types may happen because of short-term conditions like a urinary tract infection or constipation. When we treat the underlying condition, the urinary incontinence goes away. Other types of urinary incontinence can result from neurological conditions such as stroke, multiple sclerosis, Parkinson's disease, nerve damage, or dementia. Surgery, trauma, or radiation treatment to the pelvic area may also cause urinary incontinence.
If you find yourself leaking urine, you can begin home treatment immediately to try to control or eliminate your symptoms. Bladder training (establishing routines to prevent incontinence), pelvic muscle control exercises (Kegel exercises), changes in the types of fluids you drink, and other modifications work for many women.
If we discuss incontinence during an office visit, we will review your symptoms and the conditions that cause you to leak urine. It's helpful if you keep a record of your symptoms in a urinary diary. We can use this to talk about the cause of your symptoms and choose between your treatment options. We will discuss the situations that may improve or worsen your symptoms. We will usually do a physical examination and urinalysis. These tests look for urinary tract infections, which commonly cause urinary incontinence.
Risk factors that increase your chance of developing female urinary incontinence include:
Aging. As women age, lower estrogen levels cause changes in the lining of the bladder and urethra. This can decrease the ability of the urethra to tightly seal, resulting in leaking urine. Bladder muscles may weaken or become hyperactive, and tissues supporting the urethra also weaken.
During Pregnancy. When you are pregnant, the developing baby pushes on your bladder, increasing the chance of urinary incontinence. This condition usually returns to normal after pregnancy. If you give birth several times, the structures that support your pelvic organs may permanently weaken and increase your chance of developing urinary incontinence.
Post Pregnancy. Pregnancy and childbirth can cause changes in the body's support structure for the bladder and urethra. Weak muscles and ligaments in the pelvis may lead to urinary incontinence.
Obesity. Extra weight creates more pressure on the bladder and the support structures of the pelvis. This increases your risk of having both stress and urge incontinence. The good news is that losing weight can significantly improve both types of incontinence.
Smoking. Smoking can lead to coughing, which then puts more pressure on your bladder, increasing your risk of stress incontinence. Smoking also irritates the bladder and may lead to urge incontinence.
A bladder infection. New leaking or loss of control of your urination may be caused by a bacterial infection in your bladder. If this is the case, we can easily treat the infection with antibiotics.
If you have symptoms of urinary incontinence, we want to help you find the best treatment. Urinary incontinence can affect the quality of your life and lead to other health problems. Feeling embarrassed by urinary incontinence causes some women to avoid social activities or sex. Some women experience loss of confidence or depression as a result of incontinence. Leaked urine may also cause skin irritation and infections. Some women have difficulty sleeping because of the frequent urge to urinate, which sometimes leads to bedwetting. Slipping and falling on leaked urine when rushing to the bathroom can result in injury.
Our first treatment recommendation will be to experiment with treatment strategies you can try at home that have helped many women relieve incontinence. If these don't help, we can discuss medications, pessaries (devices that help support the urethra), or surgical options.
We recommend small, effective changes to your lifestyle or behavior as the first treatment for urinary incontinence. For many women, these treatments effectively control or cure the incontinence completely.
Kegel exercises strengthen your pelvic floor muscles. This allows better control of your urine flow and prevents leaking. Stronger pelvic muscles can also improve your sexual function. We recommend all women do Kegels as one of the best ways to prevent urinary incontinence. Learning to properly do Kegels takes a bit of practice and patience. It may take a few weeks to feel an improvement in your symptoms.
Here is how to do Kegel exercises correctly:
Urinary incontinence is sometimes caused by contractions (sudden squeezing) of the bladder. Bladder training is a technique to teach the bladder to stay relaxed when you want it to.
Double voiding. Relax and empty your bladder sitting on the toilet, then stand and count to 10, and finally sit and relax again. This helps completely empty your bladder. Double voiding is helpful for people who find that they have a small amount of urine leakage after they get up from the toilet, or “postvoid dribbling.”
Watch for foods or drinks that irritate or stimulate the bladder. Everything that you eat or drink can be broken down during your body’s digestion and eventually end up in your bladder as liquid waste. If these foods or drinks irritate your bladder, this can feel like an urge to go to the bathroom, even if your bladder isn’t full. Sometimes if the bladder is very irritated, it will spontaneously squeeze, resulting in urine leakage or urinary incontinence.
To prevent this kind of irritation, it can be useful to identify any foods and drinks that bother you and avoid them. People are sensitive to different foods, so you’ll likely need to experiment to see which ones cause irritation, make you to go to the bathroom frequently, or cause you to leak urine.
Lose weight. If you carry extra weight, losing weight can reduce the pressure on your bladder. Studies show that a loss of less than 10 percent of total body weight improves incontinence problems for many women.
Quit smoking. If you smoke, consider quitting. This can decrease coughing, which may in turn decrease incontinence.
Wear absorbent pads or briefs. Some women choose to wear absorbent pads or briefs for certain activities that tend to cause urinary incontinence. While this does not cure the incontinence, it is a way to manage the condition while trying other treatments.
Don’t force fluids. Drink if you are thirsty but remember that most of the fluid that you need comes from the food that you eat. You need about 2 to 3 glasses of fluid each day in addition to regular meals.
If changes in your lifestyle or behavior do not relieve your urinary incontinence, we will discuss other interventions, like the use of medication or a pessary. It’s important to remember that stress urinary incontinence and overactive bladder are different problems (although they both lead to urine incontinence) and therefore have different treatments.
Medications will not help with stress incontinence, but they can be effective for an overactive bladder. Medications include:
Talk with us about medications that you take on a routine basis. Some prescription and over-the-counter drugs may affect urination. We may decide to make some adjustments.
An incontinence ring, or pessary, is a thin, flexible ring or disk that you wear inside your vagina to support the pelvic area. It is fitted by a specialist. An incontinence ring reduces incontinence by improving the sealing of the urethra so you do not leak urine. It is often most effective when used together with lifestyle changes. Most women cannot feel a pessary when it is in place. We can teach you how to take it out and put it in so you can wear it only when you want to wear it.
For urge incontinence that is not responding to home treatments or medication, stimulation of bladder nerves or injections of Botox into the bladder muscles can help some patients. Although these treatments can be effective, they are not for everyone. The treatments may involve frequent visits to your doctor’s office.
Biofeedback is a treatment technique that measures and tracks your bladder function. Tracking when your bladder and urethral muscles contract, for example, can help you gain control over these muscles. Biofeedback is often used in addition to pelvic muscle exercises and neuromodulation to help treat incontinence.
A variety of bulking agents, such as collagen, can be injected near the urinary sphincter to help treat urinary incontinence. This helps make the tissues around the urethra and the narrow part of the bladder thicker, which can reduce stress incontinence. This procedure is done under local anesthesia or sedation. Repeat injections are necessary, because your body slowly eliminates the bulking agent over time. We can discuss which type of bulking agent might work best for you.
If you have overflow incontinence or weak muscles due to past surgery or injury, you might use a catheter to empty your bladder. A catheter is a tube inserted through the urethra into the bladder to drain urine. It’s possible to learn to insert this tube yourself, so you may either use a catheter once in a while or on a constant basis. If you use a catheter all the time, the tube connects to a bag that you can attach to your leg.
If other treatments do not reduce your symptoms of stress incontinence, there are surgical procedures that may help.
One type of procedure that we offer on an outpatient basis involves supporting the urethra with a device known as a midurethral sling. There are several types of midurethral slings, but both use synthetic mesh materials that a surgeon places midway along the urethra. To perform the surgery, a surgeon makes small incisions behind the pubic bone and inside the vagina, and places a synthetic tape under the urethra. The ends of the tape are pulled through the incisions and adjusted to provide the right amount of support to the urethra.
We can discuss whether surgical treatment is a good option for you.
Urinary incontinence can usually be treated with self-care at home. If your symptoms concern you or are not improving with home treatment, please contact me.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you and I will send the prescription electronically in advance of your arrival at the pharmacy.
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
My goal is to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:
I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.