When should I see a doctor for urinary incontinence?
If bladder leakage bothers you, see a specialist. No amount of leaking is too small to count. If it affects your daily life, your confidence, or what you choose to do, you deserve help.
Signs it’s time to seek help
- You’re wearing pads or liners as a precaution
- You’ve stopped doing things you enjoy, like exercise, travel, or social outings
- You plan your day around bathrooms
- Leaking is getting worse or happening more often
- You wake up more than once a night to urinate
- You get sudden, strong urges that are hard to control
- You keep getting urinary tract infections
- Leaking is affecting your relationships or self-confidence
Symptoms that need a prompt visit
Some symptoms point to a problem beyond ordinary leaking. Make an appointment soon if you have bladder symptoms along with any of these:
- Blood in your urine
- Pelvic or bladder pain that’s your main symptom
- Trouble emptying your bladder, or a feeling that you never empty all the way
- A bulge or heavy feeling in the vagina
- New numbness, weakness, or other nerve symptoms
- Leaking you’ve had your whole life
- Leaking that hasn’t improved with treatment you’ve already tried
Why sooner is better than later
Only about 1 in 4 women with incontinence ever gets care for it. That leaves a lot of women living with something treatable. Leaking often gets worse when nobody treats it, and a problem that might respond to pelvic floor physical therapy today could need more involved treatment later.
I’ve had patients tell me they wish they’d come in years earlier. Many of them didn’t need surgery. A few sessions of physical therapy changed their daily life.
What kind of doctor should you see?
Your primary care doctor or OB/GYN can talk with you about incontinence. A urogynecologist has the most focused training. We complete a 3-year fellowship after OB/GYN residency, or a 2-year fellowship after urology residency, focused on pelvic floor problems, including all types of incontinence.
In one study of women having surgery for stress leaking, board-certified urogynecologists were more likely to offer nonsurgical options first. They were also more likely to do the full set of standard checks: a complete prolapse exam, a cough test, a check of how well the bladder empties, and a look inside the bladder during surgery.
The right treatment depends on the type of leaking. For stress leaking, the kind that happens when you cough, sneeze, or exercise, options include pelvic floor physical therapy, a pessary, urethral bulking, and a sling. For urge leaking, options include lifestyle changes, medication, Botox, sacral neuromodulation, and the Altaviva tibial implant. If you have both types, I usually start with whichever one bothers you more.
You don’t have to try these in a set order. We pick together based on your symptoms, your goals, and how much treatment you want.
What happens at your first visit
It’s normal to feel nervous, and we go at your pace. A typical first appointment includes:
- A conversation about your symptoms, health history, and goals
- A pelvic exam, including a check for prolapse and of how your pelvic floor muscles work
- A urine test to look for infection or blood
- Sometimes a cough test or a quick bladder scan to see how well you empty
- A talk about what’s going on and what your options are
I may ask you to keep a bladder diary for 1 to 3 days before your visit. It’s a simple log of what you drink, when you go to the bathroom, and when you leak. It shows me your pattern.
Many insurance plans let you schedule with a urogynecologist without a referral. Some require one from your primary care doctor, so check with your plan before you call.
References
- Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary Incontinence in Women: A Review. JAMA. 2017. doi:10.1001/jama.2017.12137
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Kenton KS, et al. Urinary Incontinence in Women (ACOG Practice Bulletin No. 155). Obstetrics & Gynecology. 2015. doi:10.1097/AOG.0000000000001148
- Sanses TVD, Zillioux J, High RA, et al. Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment. Urogynecology. 2023. doi:10.1097/SPV.0000000000001274
- Erekson E, Whitcomb EL, Kamdar N, et al. Performance of Perioperative Tasks for Women Undergoing Anti-incontinence Surgery. Urogynecology. 2023. doi:10.1097/SPV.0000000000001392
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