First, Know Your Type
The two most common types of leaky bladder in women are stress incontinence and urge incontinence. Treatments can vary depending on which type you're dealing with.

Stress – Do you pee a little bit when you exercise, laugh, cough, sneeze, etc.? That's stress incontinence, and that kind of leakage is caused by weak pelvic floor and urethra muscles, explains Leslee Subak, MD, a professor of obstetrics and gynecology and urology at the University of California San Francisco. Anything that puts pressure on your abdominal or pelvic muscles (like physical activity or sneezing) also creates force on your bladder. Normally, your pelvic floor and urethra muscles will contract to put the kibosh on leaks, but if they're weak (often because of childbirth), accidents happen. Premenopausal women with incontinence usually have the stress type.

Urge – If your typical situation is suddenly needing to go to the bathroom badly, and you don't always make it there in time, you're dealing with urge incontinence. Other signs: Going to the bathroom eight or more times during the day or needing to get up to pee two or more times per night. Urge incontinence is more common in older, postmenopausal women, says Lisa Dabney, MD, urogynecologist at Mount Sinai Medical Center in New York, and it happens when your bladder muscle starts squeezing without getting the "okay to go" signal from your brain first.

The Solutions (in order from least to most invasive)

The Fix - Weight Loss
Works for – Stress incontinence
How it works – Shedding extra pounds takes pressure off your bladder, says Dabney, so there's less force acting on it during activities that normally lead to leaks. Moderately obese women who lost 5 percent or more of their body weight had a 50 percent reduction in leak frequency, found one small study, and Subak has seen good results in patients who've lost just 3 percent of their total weight.
Try it if – Your doctor thinks your weight might be a contributing factor. Regardless of what the scale says, if you're embarrassed about bringing up incontinence, remember that you're far from the first patient to have this issue. Forty-five percent of women between the ages of 45 and 55 experience a leak at least a few times a month, while 15 percent deal with it on a daily basis, according to one study in The American Journal of Epidemiology.

The Fix - Eliminating Food and Drink Triggers
Works for – Stress and urge incontinence
How it works – For some women, certain drinks and even foods make leaks more likely. Common culprits: alcohol, caffeine, carbonated beverages and acidic and spicy eats. Experts don't know exactly why they give you a gotta-go feeling, but it may have to do with the way they interact with the lining of the bladder, says Subak.
Try it if – You've been keeping a log of your leaks (as something experts recommend doing) and you've homed in on your potential triggers. It's most effective when it's done at the same time as the next two fixes.

The Fix – Kegels (they're good for more than your sex life!)
Works for – Stress and urge incontinence, and it's usually combined with trigger elimination and bladder training, which we'll get to next.
How it works – Kegels strengthen your pelvic-floor muscles to help close off the urethra and prevent leaks. They can be difficult to do without guidance because the muscles you're trying to squeeze are very specific (a common mistake: squeezing your abs or glutes—you want to work only your pelvic-floor muscles). Your doc will likely refer you to a physical therapist with expertise on the topic.
Try it if – You're up for putting in the work down there. If you know you won't be diligent about doing the exercises, there are more options for you farther down on this list.

The Fix – Bladder Training
Works for – Stress and urge incontinence
How it works – By scheduling bathroom visits and gradually increasing the time between them, you get your bladder used to feeling fuller and put your brain back in control of its contractions, says Subak. The goal is to be able to go 3 to 4 hours between bathroom trips. Start by thinking about how often you go during a normal day, and add 15 minutes to your standard in-between time (if you go every hour, start going every hour and 15 minutes). Even if you don't need to pee, head to the bathroom when it's time and empty whatever you've got. Keep adding 15 minutes each week until you reach the 3- to 4-hour mark.
Try it if – You're also working on a Kegel regimen and you've eliminated your triggers. The three methods work best when done together, says Dabney.

The Fix - Pessaries or Impressa
Works for – Stress incontinence
How it works – These devices help support the urethra to prevent leaks. Both are inserted into the vagina. A pessary looks a bit like a diaphragm, is custom fitted for you, and can be used over and over (after washing); Impressa looks like a star-shaped tampon when it's out of the applicator and is for one-time-use only. And, yes, you can still use the bathroom when you have them in.
Try it if – Kegels, trigger elimination and bladder training didn't solve your problem. These are also a good option if you have stress incontinence just during exercise, because it's easy to use them only when you need them. (If those leaks are very minimal, you can even use a regular tampon instead, says Dabney.) You could also use a pad like Poise, if you prefer.

The Fix - Medication
Works for – Urge incontinence
How it works – Meds relax the bladder muscle so it can hold more liquid without sending out the "I need a bathroom now" signal and stop squeezing when it's not supposed to. The most commonly prescribed ones are called anticholinergics, and the most likely side effects are dry mouth and dry eyes, says Subak.
Try it if – Weight loss or the behavioral change trifecta didn't work for you.

The Fix - Nerve simulation or Botox
Works for – Urge incontinence
How it works – Both methods relax the bladder, providing the same end result as medication. They're not onetime fixes, though: Botox needs to be re-injected roughly every 6 months, says Dabney, and, depending on the type of nerve stimulation your doctor recommends (there are two main kinds to chose between), you may need to have it done every month or so.
Try it if – You don't want to take medication, or you tried it and it didn't work.

The Fix – Vaginal Sling Surgery
Works for – Stress incontinence
How it works – A surgeon inserts a piece of mesh (don't worry—it's not the iffy kind you've heard about in prolapse surgeries gone wrong) beneath the urethra. Normal scarring takes place and gives you the support you were lacking before. You could be out of the hospital the same day, says Subak, but you'll need to limit physical activity for a few weeks to several months afterward to make sure the scarring process happens correctly, and because the procedure usually involves an incision in the vagina, intercourse is off the table for 1 to 3 months.
Try it if – You've already tried the other fixes for stress incontinence and haven't gotten the results you want. Subak admits it's not uncommon for patients to want to skip straight to surgery, but in most cases, your doctor will recommend starting with the less invasive options first.


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