Difficult Conversation Starters: Talking to Your Doctor About Urinary Incontinence

April 29, 2024

doctor and patient

It’s easy to tell your doctor when you have a cough or ear pain. But when your issue is bladder control and you leak drops of urine at inopportune times, you may not know where to begin.

Alexandria Geist, DO
Alexandria Geist, DO

Urinary incontinence is a loss of bladder control, and it’s not unusual, says MU Health Care family medicine doctor Alexandria Geist, DO. Leaking urine can happen with age, after childbirth or as a side effect of surgery. But the fact that it’s common doesn’t make it any easier to talk about.

“It plagues 50% of women between 25 and 50,” Dr. Geist adds. “And fewer than half of those women seek treatment.” The good news is that there is treatment available for urinary incontinence — you just need to be willing to talk about it.

For the second installment in our series on how to have difficult conversations with your doctor, we asked Dr. Geist for tips about discussing urinary incontinence.

Why Is Urinary Incontinence Important to Discuss?

Leaking urine when you cough or not quite making it to the bathroom in time doesn’t harm you physically. But it can interfere with your daily life.

“Incontinence can be life-changing,” Dr. Geist says. “Having to constantly worry about where the bathroom is or carry an extra set of pants can severely diminish your quality of life. It’s important to address the issue.”

Incontinence can also be a sign of an underlying health issue, such as:

  • Blocked urinary tract
  • Constipation
  • Diabetes
  • Nerve damage or a neurodegenerative condition
  • Obesity
  • Pelvic floor dysfunction (women)
  • Prostate issue (men)

Putting the conversation off might mean delaying treatment for that underlying cause.

When to Talk to Your Doctor About Bladder Leakage

If your incontinence only happens infrequently or doesn’t bother you, the conversation can wait until your next well check. But if it bothers you even a little, Dr. Geist says not to wait.

“No amount of incontinence is normal,” she says. “The sooner you address it, the better — especially if it’s affecting your quality of life.”

There are some instances where urinary incontinence can be an emergency. Make an appointment to see your doctor right away if you:

  • Can’t hold your urine at all
  • Feel pain or stinging when urinating
  • Have difficulty urinating or emptying your bladder
  • Notice blood in your urine (hematuria)
  • Pee more than eight times a day
  • Urinate without realizing it

How to Talk to Your Doctor About Bladder Incontinence

Most doctors will ask about your bathroom habits during a well visit. But don’t hesitate to bring it up if your doctor doesn’t.

“Simply say, ‘Hey doc, I’ve been having issues going to the bathroom lately,’” Dr. Geist says. “That will prompt your doctor to ask about your bathroom habits.”

If you know you’ll be discussing your bladder issues with your doctor, Dr. Geist recommends that you:

1. Learn About Incontinence

Understanding a little about urinary incontinence can help the conversation go smoothly and make you more confident broaching the topic. There are several types of urinary incontinence, including:

  • Stress incontinence: This is the most common type in women. The telltale sign is your bladder leaking urine when stressed by a cough, sneeze, laughter or exercise.
  • Urge incontinence: Also known as overactive bladder, this type is characterized by a strong, sudden need to urinate and difficulty making it to a bathroom on time.
  • Overflow incontinence: If your bladder cannot empty itself completely, the remaining urine may leak out.

“You can also have more than one type of incontinence,” Dr. Geist says. “Just be open with your doctor about what you’re experiencing.”

2. Bring Detailed Information About Your Symptoms

The more you can tell your doctor about your bladder issues, the easier it will be for them to diagnose your problem and provide treatment options that work. While you don’t have to keep a log, it can be helpful, Dr. Geist says. At a minimum, you should be able to provide a generalized idea of when it happens and how often.

If you want to keep a log, the National Association for Continence recommends doing it for two days and recording:

  • Any urinary accidents and the circumstances surrounding them
  • Nighttime bathroom use
  • Notes about the strength of your urine flow
  • Toilet habits, including bowel movements
  • What you drink and eat

3. Be Prepared to Talk About Bowel Movements

Urinary incontinence and constipation often go hand in hand. Constipation can cause a blockage that presses on the bladder. Over time, it can lead to nerve damage that makes it hard to know when you need to urinate.

To figure out whether constipation is playing a role in your bladder incontinence or urgency, your doctor may ask about your bowel movements, specifically:

  • How often they happen
  • If they are difficult

“If you only have a bowel movement once a week, that is worth mentioning,” Dr. Geist says. “You won’t be able to address the incontinence without addressing the constipation.”

4. Prepare Some Questions

When you’re nervous talking about a delicate matter, it’s easy to get flustered and draw a blank. Jotting down some questions ahead of time will ensure you stay on track and get the information you need.

Good questions to ask include:

  • How can I find out what’s causing the incontinence?
  • Are there any dietary or lifestyle changes I can make to improve my situation?
  • Can I train my bladder to reduce symptoms?
  • Until the incontinence is treated, what over-the-counter products do you recommend?

What Can Be Done for Incontinence?

Your doctor will spend some time learning about your symptoms. They may take a urine sample to rule out infection and perform an abdominal exam. The more they know about your condition, the better they can personalize treatment.

“There are a lot of different options,” Dr. Geist says. “Your treatment may depend on whether you leak when coughing or sneezing and whether the incontinence involves urgency. But there are options for every lifestyle and type of patient.”

Treatment for urinary incontinence can include:

  • Lifestyle changes, such as maintaining a healthy weight and limiting alcohol and caffeine
  • Pelvic floor physical therapy
  • Topical estrogen (usually a cream you apply to your body)
  • Oral medication
  • Catheter (for overflow incontinence)
  • Surgeries and procedures

“Don’t hesitate to voice your opinion on what you want moving forward,” Dr. Geist says. “There’s no right or wrong solution. What may work for one may not work for another. What’s important to know is that there are easy things you can do on your own or with the help of a physical therapist to minimize your symptoms and regain control of your bladder and your life.”

Next Steps and Useful Resources



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