Think about the last time you visited the doctor. What were the most common health issues you discussed? Weight? Blood pressure? Taking your prescriptions? What about urinary incontinence - do you have problems with bladder control?

If you just cringed at that last one, you’re not alone.

One of the most common issues we hear from Blue Cross & Blue Shield of Rhode Island’s senior members is that they need help better addressing issues with urinary incontinence, or the inability to control urination. It’s not a sexy topic, and involves social stigma, embarrassment, increased risk of falling and can lead to isolation and loneliness – issues that already pose a larger risk for the senior population.

Bladder control can be a complicated issue to address. Common causes can include: infection or constipation (which may be easily treatable); changes with aging; hysterectomy or menopause; enlarged prostate; obstruction or neurological issues.

There are several different types of urinary incontinence:

• Stress Incontinence
  Leakage of urine when doing things such as coughing, sneezing, laughing, lifting or jogging.
• Urge Incontinence
  Caused by sudden involuntary contraction of the bladder muscle and is associated with a strong desire to urinate and the inability to delay.
• Overflow Incontinence
  Frequent or constant leakage of urine due to a bladder that doesn’t empty completely.
• Functional
  A physical or mental impairment that keeps you from making it to the toilet in time.
• Mixed
  You experience more than one type of urinary incontinence, common in older women.

If bladder control issues are frequent or are affecting your quality of life, it's important to speak with your primary care provider (PCP). . They will help identify and address the underlying causes.

Your PCP may also provide tips for reducing bladder leakage, such as:

• Avoiding fluids that irritate the bladder, such as caffeine and alcohol. For some people, avoiding citrus juices or fruits and tomato products may also be helpful.
• Losing weight, exercising regularly (low impact) and quitting smoking.
• Kegels and pelvic floor exercises.
• Timed voiding and keeping your bowels regular.
• Emptying your bladder before going to sleep. Have nothing to drink for the two or three hours before going to bed.
• Always emptying your bladder completely. At the end of voiding, wait and give an extra push to be sure that all the urine is out.
• Drinking "bladder-friendly" fluids such as water, apple juice or grape juice.
• Don’t smoke, or seek help to quit smoking

The most important thing to know about urinary incontinence is that it’s ok to talk to your doctor.
Solutions to urinary incontinence can be complex and time-consuming, but the risk is in NOT talking about it with your PCP. That goes for any and all sensitive health topics. Silently suffering with an issue like urinary incontinence due to embarrassment can lead to loneliness, social isolation and even depression. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop bladder control issues.

If you’d like help in taking the first step toward addressing a complex or difficult medical topic, Blue Cross & Blue Shield of Rhode Island is here to help. Our Care Coordination team has nurses who work hand-in-hand with members to connect them with the care they need. Call 1-844-563-0892 (TTY/TTD: 711), email care@bcbsri.org or visit www.bcbsri.com/medicare/member/conditions.

Charlotte Crist, RN, is the managing director of clinical programs at Blue Cross & Blue Shield of Rhode Island.