Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I am only 55 but I feel like one of those very old women in television ads: I developed urgency and frequency to urinate in the last two years that is making my life miserable. Not only do I have an intense urge to urinate but if I don’t get to the bathroom quickly, then I begin to lose urine! I now wear pads just in case and I don’t drink before going to the gym, getting into a car for a drive longer than 45 minutes or going out anywhere unless I know where the bathrooms are. These symptoms seem to be getting worse and I think about how to avoid losing urine all the time.

My two children weighed less than seven pounds at birth and I had easy vaginal deliveries. My last period was three years ago. I am divorced and have not had a sexual relationship for three years. I smoked a little in college but gave it up at 25. I don’t have any other bad habits. My GP tested me for diabetes and bladder infections several times and I never had those. I don’t have blood in my urine on the office urine test. The GP sent me to a urologist who told me that I needed a painful procedure to look into my bladder to make sure that I didn’t have bladder cancer but I couldn’t tolerate the procedure. He was unwilling to treat me unless I had this procedure.

Is it really necessary to make sure that I don’t have bladder cancer before prescribing some medication to help with these symptoms? What do these drugs that I hear about on television actually do to prevent the urgency and frequency and loss of urine?

I have been too embarrassed to discuss this with my friends but wonder how common is this in someone my age?

JoAnn

Dr. Pat Responds

Dear JoAnn,

The symptoms that you describe do trouble many women and I can understand your reluctance to discuss this issue with friends since wearing pads to prevent loss of urine is something that we often think is found primarily in women in nursing homes who wear Depends and other incontinence underwear. This condition may get in the way of social activities, careers, and relationships. It can also make you feel bad about yourself.

Urinary urge incontinence often affects interest in sexual activity since there may be concern that incontinence might occur during sex. Wearing pads can cause irritation to the genital tissue from chafing, as well

Loss of urine is generally one of two types: stress or urge incontinence. You indicate that your symptoms occur with a sudden urge to empty your bladder often not allowing you to reach the bathroom in time. With urge incontinence, the bladder contracts when it should not, causing some urine to leak through the sphincter muscles. This condition is also known as overactive bladder, bladder spasms or irritable bladder. As you described your reaction to these symptoms, the condition often gets worse when a woman with urge incontinence becomes hypervigilant about any possibility that she might lose urine and begins to plan her life around avoiding drinking, avoiding social activities, avoiding intimacy and avoiding travel.

I always ask patients to keep a voiding diary as part of the evaluation for urge incontinence or overactive bladder syndrome. A voiding diary is a daily record of the your fluid intake and urinary output. The diary serves as a pretreatment baseline and may identify issues with urinary frequency, urgency and incontinence episodes that may be contributing to these symptoms. This information provides details about bladder function that may direct diagnostic testing. As a primary care physician, I do order urine cytology, which is a screening test for bladder cancer. The truth is that women who smoke do have more bladder cancer so smoking cessation is an important part of preventive care for bladder cancer. So glad that you stopped smoking, JoAnn.

If the urinalysis, urine culture for infections and urine cytology are normal, I recommend bladder retraining as the next step. This involves gradually increasing the time between the trips to the bathroom, working up to longer and longer intervals between bathroom stops. It attempts to increase how long you can wait before having to urinate. Ideally, a schedule for urinating is established and you are trained to resist the first urge to urinate and to refrain from urinating until the scheduled time. The interval between scheduled bathroom visits is increased until you can refrain from urinating for several hours. If this method fails to help a patient achieve improvement in voiding frequency, urgency and incontinence, I refer patients to a urologist who has a special interest in uro-gynecology and is trained to do more extensive evaluation and offer drug treatment that may be more effective.

We welcome a new member of the Women’s Voices for Change Medical Advisory Board today, Dr. Richard Lee, who will discuss your concerns further.

Dr. Pat