Some symptoms of incontinence are obvious: Urine leaks out inappropriately, or you simply can't "hold it" long enough to reach a commode. But many adults with incontinence may be oblivious to bladder problems or in denial about how serious the underlying issue may be -- that is, if their behaviors are any indication, says urologist Adam Tierney of Dean Clinic in Madison, Wisconsin.
Here are five lifestyle signs that you should see a doctor. You might be then referred to a urologist (a doctor specializing in the urinary system) or a gynecologist (a doctor specializing in the female reproductive system, who also manages certain urinary problems).
Some women turn to sanitary pads intended for menstruation to absorb the occasional uncontrollable leakage that seeps out when they cough, laugh too hard, lift something, or exercise -- or for leakage that appears seemingly at random.
Why it's unnecessary: "It's very common to leak urine, but that doesn't mean it's normal -- or shameful," says Jill Rabin, coauthor of Mind Over Bladder and chief of ambulatory care and urogynecology at the Albert Einstein College of Medicine in Hyde Park, New York.
If you're postmenopausal and still buying pads, or if you've taken to wearing sanitary pads routinely even after your period to "catch" bursts of wetness, it may be urine and warrants checking out.
What you can do: Stress incontinence (when urine leaks due to a physical stressor, such as laughing or moving a certain way) can be fixed in many ways without surgery. These include physical therapy to strengthen the pelvic muscles, nerve stimulation, and biofeedback.
Losing weight has also been shown to slash stress incontinence symptoms in women who are overweight or obese to begin with. Shedding just 10 or 20 pounds can cut symptom frequency in half.
Preparing for disasters is one thing. But if your disaster-worry centers on the possibility that you might wet your pants or skirt, and it's no random nightmare -- it's actually happened to you before -- you needn't live in fear.
Why it's unnecessary: These random acts of incontinence aren't a normal part of aging. A doctor can help discover the underlying cause. Overflow incontinence, for example, is when something blocks normal urinary flow, making it harder to control output. (It's more common in men.) Urge incontinence is the sudden overwhelming need to empty your bladder. In some cases nothing is produced, or you can make it to a bathroom in time. But sometimes the urge comes too fast or with almost no warning. (Both men and women can experience this.)
What you can do: If a kidney stone or tumor is behind the blockage causing overflow incontinence, it can be removed. Urge incontinence treatments include medications, dietary changes, bladder retraining programs, biofeedback and electrical stimulation, and surgery. While treatments are underway, modern absorbent products also help you avoid costume changes.
"It's very common to have your circle of interactions with others grow smaller and smaller because you're afraid of incontinence episodes," says Rabin. "Plenty of people become a prisoner of their own home." As someone with bladder symptoms grows wary of social outings, he or she starts turning down invitations; this snowballs over time into receiving fewer invites, because the person is perceived as not wanting others' company-- when the real cause for going Greta Garbo is a bad bladder, not a rude personality.
Variation on this theme: Planning your day around bathroom opportunities or feeling unable to relax in a new setting until you've first scoped out the location of the loo.
Why it's unnecessary: Avoiding life to avoid embarrassment is a drastic lifestyle cost, Tierney says. Ultimately, getting your body to a specialist is easier than adapting your lifestyle to your body.
What you can do: A thorough workup can usually pinpoint the cause of your incontinence episodes. Once you understand the cause, it's possible to live normally with a leaky bladder. Management tactics include monitoring fluid intake, avoiding foods that irritate the bladder, avoiding mental triggers for urination, and learning how to strengthen the pelvic floor.
Obviously couples say, "Not tonight, dear" for many reasons, including those that originate in the head and heart, not just the body. But one physical reason that can embarrass both men and women to the point of avoidance is the inopportune appearance of urine.
Why it's unnecessary: The following common sex-stealers aren't normal.
For women, stress incontinence can cause small leakages at any time during sex play, especially during orgasm. Urge incontinence, the need to urinate immediately, can also be triggered by orgasm. Net result: inhibition.
For men, the need to urinate urgently and frequently -- known as overactive bladder -- can hamper what happens postarousal. According to a recent Pfizer study of 12,000 men, reported by the National Association for Continence, only half of men with overactive bladder are sexually active (compared to eight out of ten men with no urinary symptoms) -- and of these, one in four reported that their OAB symptoms were why they stopped having sex.
What you can do: All these forms of incontinence can be lessened with therapy, medication, or other interventions. Behavior modification techniques can help both men and women.
Urinary system troubles aren't always flagged by visible urine. A persistent heaviness or an annoying sensation of pressure near your plumbing -- urethra, vagina, vulva, kidneys -- is always worth having checked out, Rabin says. The discomfort often lifts when you lie down.
Why it's unnecessary: The cause of the discomfort may be prolapse, in which muscle weakness causes one or more organs to slip out of their usual positions. Common after childbirth or menopause, vaginal prolapse can also affect the bladder, urethra, uterus, bowel, and rectum. A heavy sensation may be the clue of a mass in the area that should be evaluated.
What you can do: The first line of defense is to strengthen the pelvic floor muscles through therapies and other measures, including vaginal weights and pessaries (devices worn in the vagina to strengthen musculature). Surgery is sometimes needed to correct prolapse.
If the source of the heaviness is found to be a mass or other blockage, you may need to have it removed surgically or biopsied for further evaluation.