Incontinence, or the unintentional leakage of urine, affects roughly 13 million people in the United States each year [1]. Women can develop incontinence at any age, but it is more common in women over 50.

There are four major types of incontinence, namely:

1. Stress incontinence (SUI): Loss of urine that occurs with any activity that increases the pressure on your bladder. This includes coughing, sneezing, laughing, jogging, lifting heavy objects, or doing anything else that exerts strain on the bladder.

2. Urgency or Urge Incontinence: Urgency incontinence is defined as leakage of urine that occurs in the presence of a strong sudden desire to urinate that is difficult to delay.  

3. Overflow Incontinence: The leakage of urine that happens when your bladder can’t hold anymore urine and it leaks out. 

4. Functional incontinence is urine leakage that occurs as a result of an inability to access a restroom in a timely manner due to a mobility impairment. An injury, arthritis, or any other ailment that restricts movement might induce this form of incontinence.

5. Worsening or new incontinence may indicate the presence of a different disease or condition. Urinary Tract Infections (UTIs) are a leading symptom of frequent urination that can be treated quickly. If you have new sudden symptoms please see your primary care doctor to get evaluated for a possible UTI.

Key SUI stats:

ICYMI, urinary incontinence affects up to 30 percent of the population [2], and while it is more common in women than men experience it as well. One in four women suffers from some bladder leakage in their lifetime and up to 75% of women suffer from incontinence after the age of 75.

Urinary incontinence occurs less frequently in men. Overactive bladder (OAB) is more common in men with urinary leakage than SUI. Prostate cancer surgery, pelvic nerve injury, or damage are the most common causes of SUI in males.

What is the Treatment for Incontinence?

Only after consulting with your urologist should you decide on a treatment strategy. They will evaluate your age, health, and clinical [medical] history when discussing treatment options, as well as your tolerance for different types of the numerous therapies and medications available.

Dietary adjustments, behavioral therapy, medications, pelvic floor physical therapy, in-office procedures, and surgery are all options for treating incontinence. 

1. Pelvic Floor Muscle Exercises or Kegel Exercises

Your urologist may advise that you perform these exercises on a regular basis for muscle strengthening to aid in urine control. These techniques, often known as Kegel exercises, are particularly useful for stress incontinence but may also help with urge incontinence.

Imagine you’re trying to stop your urine from flowing while doing pelvic floor muscle exercises. Then:

• Start by contracting) or tightening your muscles like you’re stopping your urine from flowing, (some describe this as the feeling like you are holding in a fart or trying to lift your penis up) for 5 seconds, then release the muscles and relax for 5 seconds. (If that’s too challenging, start with two seconds of holding and three seconds of relaxing.)
• Start by doing this lying down, once you get stronger you’ll be able to do these sitting or even standing

• Work your way up to 10 seconds of contractions at a time.

• Every day, try to complete at least three sets of ten repetitions.

Your urologist may recommend working with a pelvic floor physical therapist or using biofeedback techniques to help you locate and contract the proper muscles.

2. Behavioral strategies

Your urologist may advise you or introduce to:

• Bladder training is a technique for delaying urinating when you feel the urge to go. Once you feel the urge you distract yourself and then do quick kegels until the urge passes. After it does you can walk calmly to the bathroom. Using this strategy you can slowly go longer between toilet sessions until you’re only urinating every 2.5 to 3.5 hours.

• Double voiding can help you learn to completely empty your bladder. Double voiding is when you urinate, wait a few minutes, and then try again.

• Timed voiding: Instead of waiting until you need to go, schedule restroom trips every two to four hours.

• To regain bladder control, you must monitor your fluid and dietary intake. Alcohol, caffeine, and acidic meals may need to be limited or avoided. Reduced beverage consumption, weight loss, and quitting smoking can all help reduce urinary leakage.

3. Medical Regiments

Anticholinergic drugs may be prescribed by your physician. These work by inhibiting the function of the neurotransmitter acetylcholine preventing bladder contractions. Beta-3 agonists work by relaxing the bladder muscle. Both of these medications reduce urgency, urgency urinary incontinence, urinary frequency (going to the bathroom more than 8 times a day), and nocturia (urinating more than once at night). Make sure to talk about the potential adverse effects with your doctor. 

Absorbent Products are often used to help manage urinary incontinence. Did you know?

• These products end up in our landfills and take hundreds of years to decompose. In fact seven percent of our landfills are made up of adult diapers. That’s three times more than a child’s diaper!

• Cost of incontinence pads – In a 2004 study, researchers calculated the monthly  expenses of the absorbent pads and laundry and estimated that these were approximately $968.10 for women for community dwellers and $378.40 for men [2].

• The cost of UI routine care at the nursing home resident level has been reported to range from $9 to $17 per day, depending on the severity of the UI. The daily cost of normal care is estimated to be around $15 per UI resident [3]. 

How severe is your leakage?

• If you have somewhere between 1 to 20 milliliters or less than an ounce of urine loss over 24 hours you have mild incontinence, 

• If it is somewhere between 20 ml  to 74 ml which is somewhere between a little less than an ounce to a little more than two ounces you have moderate incontinence, and; 

• If you have more than that 75 ml or almost three ounces or more you have severe incontinence 

In other words,

1. If you only have a few drops every time you have incontinence, it’s generally mild incontinence; 

2. If you have a flood or lose your full bladder volume because you don’t get to the restroom in time, it’s more severe incontinence, and;

3. If you’re somewhere in the middle, you’ll probably have moderate incontinence.

What Are the Options for Managing Incontinence?

Depending on their age, level of need, and mobility, many women wear protective pads, absorbent underwear, fitted briefs, or diapers to help manage incontinence on a daily basis.

In this section, we’ll focus on washable and reusable absorbent underwear. 

Products	Features	Specifications	Costs to Cost or Pricing	Discounts/Promo Codes	Giving Back
Ondrwear	Even without the practical component, ONDRwear is trendy and appealing underwear that is highly absorbent and leak-proof.  They are available in: Thong High-waisted brief Boy short Bikini If you don’t absolutely love the pair that you got or the sizing you can reach out to them within 30 days and they’ll send you another pair.	They are biodegradable and machine washable. 29-44 mL XS-2XL Central to Forward – Forward to Catch Liner Placement Available in black color Liner Material is Cotton, Beechwood, and Algae	$26 – $32 depending on the type of underwear you buy.	You can also use coupon code RENA15 for 15% off! Here’s the link for more.
Bambodi	The front-to-back leak-proof layer sits between the outside ‘shell’ of the underwear and an inside bamboo fabric lining of the leak-proof hipster. The leak-proof layer of the absorbent hipster is combined with an additional absorbent layer that rests directly beneath the crotch.	These are also machine washable.  Available in assorted colors bamboo is the primary material.	$14.99 with free shipping.		Buy a pair, they donate  a pair to the Maasai Water Project
Modibodi	These underwear come in a variety of different absorbency levels. Their website offers a quiz to help you determine the best underwear option for you.  Just in case you choose wrong they do have a 60-day risk-free guarantee. They are available in Underpants (including shapewear), Active wearSwimMaternity	They are machine washable.  2XS to 6XL10 to 20mLAvailable in assorted colors.Bamboo Viscose, organic cotton, and merino wool. They have a vegan collection too. They have male incontinence products.	$22 and up	Modibodi Women’s Period-Leak Proof Hiwaist-Light Modibodi Sensual Hi-Waist Bikini Heavy-Overnight Modibodi Men’s Brief Moderate-Heavy	For every pair you buy they donate two pairs of underwear to women in shelters in Australia.  In 2021 they donated over a 100,000 pairs of underwear.
Knix	Knix’s features a more extensive assortment that includes sports bras, personal items, and swimwear in addition to absorbent undies.  Knix says that their leak-proof line can carry many teaspoons of liquid and can be used for periods and sweating.	These are machine washable.  14 mL S-3XLAssorted ColorsCottonSpandexCarbon Liner MaterialCentral Liner Placement	Their starting cost is nearly $23 and up, free shipping over $74.		They have a positive returns program for their bras where they give those returns to women in need and shelters. In light of this initiative they’ve distributed 35,000 bras to shelters in North America in 2020.
Thinx	Thinx is constructed of permeable cotton that has been coated with an antimicrobial coating.  It is meant to absorb and dry rapidly, allowing you to enhance comfort while also neutralizing odor. They also have a sister company called speax. Speax holds up to 40 ml of fluid and is designed for urinary incontinence.	These are machine washable. 18-36 mLXXS-3XLAvailable in assorted colorsCottonElastaneLiner MaterialCentral Liner Placement	$24 and up	Look out for regular sales on their website. Hiphugger Menstrual Underwear  Speax by Thinx Hiphugger Underwear for Bladder Leak Protection
Proof	Proof undies look and feel just like normal undies but have built-in, leak-proof technology. Flexible Savings Account (FSA) and Health Savings Account (HSA) can be used for Proof period underwear!	These are machine washable. hold up to 5 regular tampons or 10 tsp of liquid with front-to-back leakproof protection available in assorted colors and comes with a 60 days guarantee. Proof undies combine patented technology with soft, smooth fabric and thoughtfully designed details.	$25 and up	You can also use MALIKMD10 as a coupon code. FYI, free shipping over $50	They have paired with some great organizations including black women for wellness in LA and the period menstrual movement as well.

Take Home Message

There are a number of great options available on the market if you have mild to moderate incontinence. If you have severe incontinence you may want to try some of the really super absorbency options there are always good return policies. At times, you may want to do a combination, where you can use underwear as a backup and use a pad rather than having to use a full diaper. 

References:

[1] Facts about INCONTINENCE. Available at: http://www.idph.state.il.us/about/womenshealth/factsheets/inc.htm

[2] Nitti, V.W., 2001. The prevalence of urinary incontinence. Reviews in urology. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/ 

[3] Saxer, S. (2008). Urinary Incontinence in Nursing Home Care. Maastricht University. Available at: https://cris.maastrichtuniversity.nl/ws/portalfiles/portal/1426967/guid-63a6bcad-661e-41a3-a03f-d50dba6358b1-ASSET1.0.pdf