OK, real-talk time: About half of all women will have urinary problems at some point in their life, according to the National Institutes of Health. And these issues tend to crop up more over time. “Lots of factors come into play,” says Benjamin Brucker, MD, assistant professor of urology and obstetrics and gynecology at NYU Langone Medical Center. “Hormones change, pregnancy and delivery have an impact, the bladder ages, and other medical conditions that could make pee problems worse become more common.”
Often, though, the solution isn’t clear. Use this symptom tracker to determine what urinary issues you may be suffering from. Then, find the treatments and strategies that can help end your toilet troubles below.
To beat stress incontinence
Your first move is to do pelvic floor exercises (aka Kegels), which firm up the hammock of muscles supporting your pelvic organs. If you are really wetting yourself, consider a removable device: a vaginal pessary (which physically props up the bladder and urethra), disposable vaginal insert (it’s inserted like a tampon and supports the urethra to reduce leaks), or other inconspicuous options like Depend Fit-Flex Underwear. Surgery is an option, too. Laser and radiotherapy treatments are also being touted as effective for stress incontinence, but the technology is new and needs further study.
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To beat an overactive bladder
Start by cutting back on food and drinks that can irritate the bladder; common culprits include coffee, tea, alcohol, carbonated drinks, artificial sweeteners, citrus, and spicy foods. Mastering Kegels (on your own or with a pelvic floor physical therapist) can also make a difference. “Squeezing and relaxing your pelvic floor muscles can help ease urgency problems in the moment—or just give you more time to get to the bathroom,” says Jeannine Marie Miranne, MD, a urogynecologist at Brigham and Women's Hospital in Boston. Another strategy: emptying your bladder on a schedule, starting with smaller intervals, like on the hour, then working up to every two to three hours. The next step is medication, including anticholinergics, which help prevent bladder spasms, and Myrbetriq, a drug that works by relaxing the bladder muscle. Botulinum toxin (Botox) is a third-line option. It’s injected into the bladder muscle, which may help prevent the muscle from contracting excessively. Another procedure involves stimulating one of the nerves in the leg, which affects the nerves going to the bladder.
To beat interstitial cystitis
Pelvic floor physical therapy helps, as does stress reduction: “IC tends to flare up under stress,” says Dr. Miranne. Low-dose tricyclic antidepressants can help block pain; the Rx medication Elmiron may protect the bladder lining against irritation. Numbing medications delivered to the bladder via a catheter can offer relief as well. Some people find temporary improvement after a procedure called cystoscopy with bladder distention, in which doctors fill the bladder to capacity with water.
To beat a urinary tract infection
One word: antibiotics. Lower your risk of UTIs by avoiding tight undies, drinking plenty of water, not holding in your pee, peeing after sex and using a vaginal estrogen cream after menopause to help keep tissues healthier and less prone to infection.