My two-year-old son doesn’t pee in his pants or wear diapers. But, ever since he was born, I do.
I’m 35 years old and I buy diapers, for myself.
Some studies report that one out of 10 women my age are peeing themselves. Others say the numbers could be higher. But peeing in your pants is still embarrassing.
“Incontinence is still one of those frontiers that’s not really comfortable for many women to talk about,” said Dr. Amy Rosenman, Health Sciences Clinical Professor at UCLA in the department of OB-GYN, Division of Urogynecology. “So if their doctor doesn’t specifically ask, ‘Do you leak urine?’ most of them won’t even tell.”
I have what’s called stress incontinence. Not from emotional stress, though leaking pee can cause that. It's from the physical stress of coughing. Or jumping. Or wrestling and laughing with a two-year-old.
No, I’m not going to die from this. But it has changed my life. I have all but stopped jogging, the activity that helps me stay calm and clear. For many women it’s a lot worse.
“There’s clearly a level of severity, and women who have mild incontinence aren’t terribly troubled by it,” Rosenman said. “Moderate incontinence is annoying, it requires wearing protection most of the time, but it doesn’t limit activities. Women will still go about their normal activities. Severe incontinence, women stop traveling, they don’t want to be around other people at night, they’re embarrassed about their absorptive products and how they dispose of them, and it’s major life-altering. It makes some individuals have to be in assisted living or a nursing home environment.”
Urinary incontinence is what’s known as a Pelvic Floor Disorder. There are two other major ones — there’s fecal incontinence, which is leaking poop. And organ prolapse — when the uterus or bladder or intestines actually start to sag and fall into the vagina.
About a quarter of American women have at least one pelvic floor disorder — and urinary incontinence is the most common.
“After age 60, greater than 30 percent of all women have some form of incontinence,” said Rosenman. And after age 80, about half of American women leak pee.
The good news is, there’s an entire subspecialty of medicine called urogynecology, that treats pelvic floor disorders.
There is also pelvic floor physical therapy that includes exercises and tech tools to help women regain their muscle strength.
These include the kGoal interactive kegel exerciser that you insert into your vagina. When you tighten your muscles, you can see how well your muscles are performing when the data pop up on your smartphone via Bluetooth.
The kGoal is a play on the word kegel, a well-known exercise in which you tighten then relax the pelvic floor muscle in an effort to reconnect with and strengthen the muscles that control pee and poop.
There are also apps, lots of apps. For tracking your pad usage and leaking. Or reminding you to pee more frequently. Urologists from the University of California San Francisco recently developed the Kegel Nation app, that can help monitor the frequency, progress and quality of a Kegel exercise regimen. The app features a built-in voice coach for the exercises.
In addition to physical therapy and strengthening exercises, you can treat pelvic floor disorders with diet, medication and surgery. Some women get Botox injected into the bladder to stop spasms. Some get bulking agents inserted into the urethra to beef it up. There are bigger surgeries, too, like installing a supportive mesh to hold the pelvic floor in place.
“Our field is changing rapidly and I think that’s what’s fun about it,” said my physical therapist Aimee Diaz. She’s a faculty member at the University of Southern California, Division of Biokinesiology and Physical Therapy. “From a prognosis perspective I think we’re only gonna get better at treating these things, but unfortunately it’s still something that we’re going to have to deal with.”
Take my friend Donna Myrow. She is 70 years old, and has two kinds of incontinence. To treat her stress incontinence, she had surgery to install a big supportive mesh sling under her weakened pelvic floor muscles. That worked.
But, her urge incontinence still plagues her. Urge incontinence, where she suddenly has to go right now, has forced her to make some adjustments. Like memorizing the location of every McDonald's off of LA’s East-West 10 freeway.
“Because they’re designed the same,” she said. “And I know when you going in, you turn right and there’s the bathroom.”
She also had a small device surgically implanted in her back -- it gives a little bzzzz when her bladder is full, so her brain gets the signal and she knows it’s time to find a toilet.
But she still soaks through three or four pads a day. Donna’s urogynecologist says her only option may be more surgery.
She’s not alone.
Some studies suggest that the number of American women with urinary incontinence will increase by 55 percent in the next 35 years. Due to an aging and increasingly overweight population.
So innovators have their work cut out for them.
Thankfully for me, though, there is new product on the market that could help me get back to running.
It looks like a tampon, but it’s made out of silicone. It’s called the Poise Impressa Bladder Support. It’s inserted into the vagina, and holds the urethra in place so it doesn’t leak pee.
“I think it’s really a game changer, because prior to that the only thing we had was surgery unless it was mild,” Rosenman said. “Mild stress incontinence is treatable with pelvic floor exercise and physical therapy and biofeedback. But anything more than very mild isn’t. And then, now we have a non-surgical option.”
This audio piece was part of the STEM Story Project — distributed by PRX and made possible with funds from the Alfred P. Sloan Foundation.