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Going against your will

Get treatment for incontinence

Created date

March 22nd, 2011

Urinary incontinence (a loss of bladder control) is, unfortunately, more likely to occur as you age. Symptoms can range from mild leaking to uncontrollable wetting. It s an embarrassing problem that can keep you from enjoying life to the fullest, but take heart: There are more treatments than ever for incontinence. According to the National Institute of Diabetes and Digestive and Kidney Diseases, women experience urinary incontinence twice as often as men. Incontinence in older women can be due to a number of causes, says Lisa Dabney, M.D., a urogynecologist at St. Luke s-Roosevelt Hospital Center in New York, N.Y. Sometimes after menopause, the lack of estrogen can affect the vagina and lead to continence problems. Pregnancy, childbirth, and the structure of the female urinary tract may also be responsible. Prostate problems are often the cause of incontinence in men. Many men tend to experience urinary incontinence as a result of prostate surgery, says Andrew Shapiro, M.D., director of the Center for Continence and Pelvic Floor Dysfunction at Chesapeake Urology Associates in Owings Mills, Md. A recent study, in fact, showed that nearly two-thirds of men who have prostate cancer surgery experience urinary incontinence. Other causes might be nerve damage, infections, or medication. Most bladder control problems happen when muscles associated with urinary control are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh, or lift a heavy object this is called stress incontinence. If bladder muscles become too active, you may feel a strong urge to go when you have little urine in your bladder. Overactive bladder, also called urge incontinence, is prevalent in both men and women, Shapiro says.

Where to get help

Incontinence is not a diagnosis but rather a symptom of an underlying condition, says Janice Gable, M.D. Your primary doctor may be able to determine what s causing it and recommend treatment. If specific testing is needed, such as bladder pressure testing, you may need to see a urologist or gynecologist. Some women may benefit from seeing a urogynecologist. Urogynecology is a relatively new field that combines gynecology with urology, Dabney says. Urinary incontinence and vaginal problems often go together, so our special training helps us treat those problems. As a general rule, the simplest and safest treatments should be tried first. For stress incontinence, certain exercises may help. Kegel exercises [see sidebar] strengthen your pelvic muscles. A physical therapist can teach you how to do these for the most effective results, but one of my patients describes it well to imagine that you re sitting on a marble and have to pick it up, Gable says. Timed voiding is a strategy many people use to control incontinence, Gable explains. First, you watch the clock to figure out how long you can go without leaking. Then, go to the bathroom a little before that time comes. Try measuring your fluid intake. Figure out how much liquid you can drink at one time. Too much can be a problem but so can too little if your urine is concentrated, it can irritate your bladder, Gable explains. An important tip, especially for people with an overactive bladder, is to avoid bladder stimulants like caffeine not only coffee and tea but soda or chocolate, for example. Alcohol is also a bladder stimulant, Shapiro says. If a medication like a diuretic is the problem, you may need to discuss with your doctor how to alter your medication schedule to better control incontinence, Shapiro says.

More treatments

When conservative measures like exercises, physical therapy, or lifestyle changes alone don t work, you have other options. An effective treatment for stress incontinence is sling surgery, Shapiro says. In sling surgery, a piece of your own tissue or a synthetic material is used to support the bladder neck and urethra. This is an outpatient procedure that takes about 30 minutes. Another treatment is injecting bulking agents into the urethra. These injections are done right in the doctor s office, Shapiro adds. Yet another option is the use of electric stimulation devices, in which electrodes are placed temporarily in the rectum, vagina, or behind your ankle to painlessly strengthen the pelvic floor muscles. While it sounds scary, it s really quite a simple procedure, according to Shapiro. Urge incontinence can often be treated with medication, and newer drugs are on the market that have fewer side effects and are much safer than older ones, Shapiro says.

How to do Kegel exercises

Kegel exercises help tighten your pelvic floor muscles. Here are the basics:
  • Lie on your bed with your knees bent.
  • Locate the pelvic muscles by pretending to stop the flow of urine.
  • Squeeze and hold these muscles for 6 8 seconds, then relax them for a count of 3.
  • Aim for three sets of 10 contractions 3 4 times a week.

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