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Normalizing the Conversation Around Women's Bladder Health (and Seeking Treatment)

Urinary incontinence and other bladder issues affect women at a higher rate than men. It's time to normalize the conversation.

Bladder conditions can drastically impact quality of life for both men and women, especially as they age. Some common bladder issues that women experience include overactive bladder, urinary incontinence and urinary tract infection. Pelvic organ prolapse is also quite common.

Overactive bladder (OAB) can describe several urinary issues, but the most common symptom is a sudden, uncontrolled need or urge to urinate. According to the Urology Care Foundation, as many as 40 percent of women and 30 percent of men live with overactive bladder symptoms. Most instances of OAB are treatable and a urologist can explain treatment options.

Studies have shown that women are twice as likely as men to develop urinary incontinence, which is any leaking of urine that you cannot control. Reproductive health events unique to women — like pregnancy, childbirth and menopause — can all lead to this condition.

Despite the prevalence of bladder issues, regardless of gender, many people hesitate to seek treatment from a doctor due to embarrassment about their symptoms or because they think it’s a normal part of getting older. Most bladder conditions are not a normal part of aging, but they are still experienced by a lot of older adults. There is no need for stigma or shame.

How serious is an overactive bladder?

It’s very rare for an overactive bladder to be a sign of serious illness, such as bladder cancer or some other life-threatening medical condition that needs immediate treatment.

“Overall, overactive bladder is a benign condition, but it’s one that can significantly impact quality of life,” says Kevin Cwach, MD, a urologist at The Iowa Clinic’s West Des Moines campus. “There are people getting up five or six times at night. I’ve seen patients too scared to travel because of leaks. They may even become homebound and stop exercising. This may lead to weight gain. We can help people get back to normal routines and a better quality of living.”

Dr. Cwach also notes that symptoms of overactive bladder can vary from mild to more severe. For example, he may recommend behavioral interventions for patients with mild symptoms.

“How we progress in medication or procedure is the degree of symptom bother,” says Dr. Cwach. “Some people with urinary incontinence use adult diapers and are not bothered. That’s fine. But if someone is struggling then we can recommend treatment and let them know help is available.”

What treatments are available for overactive bladder?

When it comes to overactive bladder, there are quite a few treatment options available. 

A urologist can work with you to identify your symptoms and the severity of them. Treatments for overactive bladder range from lifestyle or behavioral changes to medication and periodic interventions, like BOTOX®, or even the use of a special device to regulate urinary control.

Lifestyle Changes

For patients experiencing minor symptoms of overactive bladder or urinary incontinence, a medical provider may first recommend specific lifestyle changes after assessing your situation. Your urologist might refer to these types of lifestyle changes as behavioral modifications.

Untreated Bladder Conditions Can Affect Your Quality of Life

Connect with a urologist at The Iowa Clinic to learn more about treatment options. 

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Common lifestyle changes used to ease symptoms of overactive bladder include:

  • Limiting or avoiding certain food and drinks.
  • Stopping smoking, losing weight and/or avoiding caffeine.
  • Emptying your bladder twice in one trip to the bathroom (double voiding).
  • Waiting a certain amount of time before using the bathroom (delayed voiding).

Exercises that strengthen the pelvic floor may also be part of behavioral therapy. Kegel exercises, contracting and relaxing your pelvic floor muscles, are just one example.


When lifestyle changes don’t work to treat your overactive bladder, then your urologist may recommend medication. There are several types of prescription drugs available that aim to relieve symptoms of overactive bladder. Your doctor will review any other medications you’re taking and potential side effects. They will help decide what’s best for your situation.

Periodic Treatment

Sometimes it takes more than medication and lifestyle changes to overcome the symptoms of overactive bladder. BOTOX injections and percutaneous tibial neuromodulation (PTNM) therapy are two proven periodic treatments used at The Iowa Clinic to help patients find relief.

Placing BOTOX directly in your bladder muscle can help block nerve signals that trigger OAB. On average, this treatment will need to happen every six months at your urologist’s office.

PTNM treatment uses a device that delivers electrical pulses through an acupuncture-like needle to stimulate your tibial nerve, which runs down the back of your leg to your foot. PTNM therapy can help you regain control of your bladder. It starts with 30-minute sessions for 12 weeks.

Continuous Treatment

Sacral neuromodulation (SNM) is a form of therapy that relies on a small device placed underneath your skin near the back of your hip. This device sends mild electrical signals to your sacral nerve, which regulates urinary control, to help alleviate overactive bladder symptoms.

The implanted device used in SNM therapy is called a neurostimulator. A neurostimulator can last from around 5 to 10 years, depending on battery life, before replacement is necessary.

Normalizing conversations around bladder health.

While Dr. Cwach does think things have improved, there is still a lot of hesitation built up around talking about bladder issues that impact a large portion of older adults, regardless of gender.

“I think things have gotten better in recent years,” says Dr. Cwach. “But as far as society’s perception of bladder issues are concerned, we still have a way to go. There will be patients who come into the office for a different reason, like a kidney stone, who may say they have no problems urinating. Then you tease it out only to find out they are leaking and going to the bathroom all the time. People need to understand that it doesn't have to be their normal.”

Female Patient Overcomes Urinary Incontinence

Dr. Cwach went on to share the story of a female patient who finally sought treatment.

“There was a female patient that had urinary incontinence,” says Dr. Cwach. “This was stress incontinence. It got to the point she could no longer partake in any sort of physical activity. All it took was a 45-minute procedure and she went from wearing four pads a day to being dry.”

“She has been telling everyone about this seemingly taboo experience,” adds Dr. Cwach. “She said she almost wants to ask everyone if they are experiencing incontinence. That way she can tell them … ‘I have something to help you.’ Normalization around talking about incontinence and knowing there are treatments available for those who are struggling is what’s most important.”

A Urologist Is Your Partner in Bladder Health

Is overactive bladder or urinary incontinence impacting your quality of life? Neither of those conditions are a normal part of aging. That is true of many bladder conditions that occur in our lives. Call now to schedule an appointment with a urologist to learn about potential treatment options.

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