What is urinary incontinence and how do I cope with it? A Penn doctor offers advice and how new research may help.

Uduak Andy is from a family of five girls.

“A lot of women in my life,” she says.

From an early age, she knew she wanted to be a physician. As she started to think about what kind of physician, she knew she wanted to improve the quality of women’s lives.

She became a urogynecologist, a subspecialty of urology and gynecology, to help women address a medical issue that is often overlooked as simply a part of aging or postpartum life.

“Taking care of women is what I was born to do,” said Andy, an assistant professor of obstetrics and gynecology and chief of gynecology at Penn-Presbyterian Medical Center.

One of her specialties is female urinary incontinence, and her latest research involves exploring whether addressing incontinence in older women will help reduce their risk of falls.

Basically, it is when a person leaks urine by accident. We all get up and go pee when we feel the urge to. Incontinence is when the process doesn’t happen the way it should. The person doesn’t make it to the bathroom in time. The amount of urine a woman leaks can vary. It can be very embarrassing.

Clinically, there are two main kinds of urinary incontinence. One is what we call stress incontinence — every time you cough, or sneeze or exercise, you leak a little urine because it puts pressure on the bladder.

The second is called urge incontinence, or overactive bladder. This is a strong, sudden urge to pee. It comes on right away. You start leaking before you can make it to the bathroom.

It can happen at any age, but it is more common as we get older. A lot of it has to do with what causes it. It can happen because of injuries a woman suffers during childbirth. Or it can be due to aging-related effects on the muscles.

My research is specifically in older women. In the U.S., 40% of women over the age 70 suffer some form of urinary incontinence. That’s about 10 million women. We expect that number will increase as more women live longer.

The pelvic floor is a group of muscles that help support a woman’s pelvic organs — the bladder, bowel, uterus, and vagina. These muscles are really important in relation to incontinence. If the muscles are weak because of age or injury you are not able to contract them strongly enough to prevent urinary leakage.

Important data show that women with incontinence, particularly urge incontinence, are at a greater risk of falling. It’s roughly double the risk of falling. It’s important because falling among older people can lead to bad outcomes: injuries, functional limitation, hospitalization, and, ultimately, mortality.

There are many reasons for this increased falling risk. A common clinical scenario is that an older woman tells me she wakes up with a sudden need to pee. She jumps out of bed and rushes to the bathroom. But maybe there’s a dimly lit hall. Or maybe there’s a carpet that has become bunched up. So she trips and falls.

Maybe, as an older woman, she also has a general weakness, so getting to the bathroom takes a little longer and she rushes a little more. All these things can increase her risk of falling.

So, to deal with it, you have to deal with the bladder issue, the physical strengthening issue of her pelvic floor, and the environmental issue of the dimly lit hallway.

We’re testing to see if we can address those components and make a difference. If we can improve your bladder health, if we can improve your strength, if we can remove environmental hazards in the home, are we able to reduce the risk of falling as well as the incontinence?

Right now, we’re doing a randomized control trial to find out. It’s called the Move on Up Trial, for mobility and voiding exercises in older women with urinary incontinence. We recruit women who are age 70 and older who have urinary incontinence. Half get multi-component intervention. The others get education materials.

One thing I counsel my patients about is that if you feel a strong urge to pee — even during the day — don’t rush to the bathroom. You probably won’t make it, and the sudden movement might even make the leakage worse. Instead, pause for a moment, take a deep breath, contract your pelvic muscles as hard as you can, and then walk to the bathroom.

Exercise can help strengthen muscles in general, and pelvic muscles in particular. As we get older, even if someone is not incontinent, doing strength training and balance exercises can prevent falls. We recommend getting out and walking, doing some strength training, all the usual things to keep you active and fit.

Then we recommend simple pelvic exercises — Kegel exercises — which is basically contracting and relaxing your pelvic floor muscles. There are different ways to do it, and a simple Google search will produce a lot of information. But, basically, the way I describe it is when you are sitting on the toilet and peeing, and when you contract your muscles to stop the flow, that’s what it is like.

Naturally, you would do the actual exercises when you are not peeing. That just shows you what you are supposed to do. We tell women to do the exercises three times a day, 10 contractions and relaxations each time.

Keeping those muscles strong really helps with incontinence. It’s not 100%. There are certainly women who are beyond that point. But in that case, there are other things to do, including medications and surgical options.

For bladder health, think about the things you are drinking. Caffeine and artificial sugars are what we call bladder irritants. We tell women to pee when you need to. Don’t get into the habit of holding your bladder too long.

But really, keeping yourself healthy, keeping a healthy weight, not smoking — the things that are good for health in general are also good for bladder health.

That, and the Kegel exercises. Young women should be doing these exercises, too. I tell postpartum women, that’s when you should start doing the Kegel exercises. A lot of this is preventative, too. Don’t wait until you’re older and have already lost some muscle strength. It’s easier to maintain it than to try to regain it.

Even if you do have incontinence, there is so much we can do about it. If there’s a takeaway, it’s that you should not accept incontinence as a part of your life. If you have incontinence and it’s bothersome to you, please talk to your physician about seeing a urogynecologist.

There is help. There are lots of things we can do. There are lots of options.