Incontinence

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is incontinence?

Millions of North Americans have urinary incontinence, but many never tell their doctors, either because they’re too ashamed or they mistakenly think it’s part of getting older. This is too bad, because there’s a lot your doctor can do to control or cure this condition.

There are two common types of incontinence. If you have a little leakage when you laugh, sneeze, or exert yourself (lifting something or running hard, perhaps), that’s stress incontinence. Your urinary sphincter’the muscles that surround the urethra, which carries urine from the bladder’is weak and opens during ‘stress.’ If you have unpredictable, overwhelming urges to urinate and realize you might not make it to the bathroom, you’ve got urge incontinence. This begins as a condition called overactive bladder, an intense and too-frequent need to urinate. With urge incontinence, problems arise when muscles around the bladder abruptly contract, and suddenly you have to go. Your sphincter and pelvic muscles might be able to stop the flow, but your bladder is insisting on relief.

More severe types of incontinence are called overflow incontinence and total incontinence. People with these conditions often need special devices to hold urine overflow.

Who is at risk for incontinence?

Urinary incontinence is more often a problem for women than men: Pelvic floor muscles get strained during pregnancy and childbirth, and hormonal changes during menopause add to urinary urges.

Treatment for incontinence

For stress and urge incontinence, many people have success with lifestyle changes’pelvic floor muscle exercises (Kegels) and bladder training to improve control. Changes in diet and drinking habits may also help. Your doctor can recommend medications for incontinence, and many surgical procedures are available.

Medications for incontinence

If lifestyle changes and exercises don’t banish your incontinence, your doctor may want to treat it with medication. If you have a urinary tract infection, you’ll first be given antibiotics to clear it up.

For both stress and urge incontinence: Your doctor may prescribe a tricyclic antidepressant, such as imipramine (Tofranil) or doxepin (Sinequan). These medications relax the bladder, strengthen the urinary sphincter, and prevent involuntary bladder contractions. They work for both men and women. For postmenopausal women, various topical estrogen products’creams, ointments, rings (Estring), and patches’applied to the vagina are often recommended.

For stress incontinence: Your doctor will likely suggest alpha adrenergic agonists, commonly found in over-the-counter decongestants. These drugs strengthen the muscle that opens and closes the urinary sphincter.

For urge incontinence: You might be given an anticholinergic drug, such as oxybutynin (Ditropan) or tolterodine (Detrol), which inhibits involuntary bladder contractions. Certain antispasmodics, including flavoxate (Urispas) and dicyclomine (Bentyl), may help control urge problems. They help relax the bladder.

Drugs used to treat incontinence all have side effects. Be sure to tell your doctor how your medication affects you, so timing and dosages can be adjusted, if necessary.

Lifestyle changes

The following everyday measures can help you better control incontinence and may even eliminate the problem:

‘ Learn Kegel exercises. Good for stress and urge incontinence, these exercises strengthen the pelvic floor muscles that support the bladder. Begin by periodically contracting your pelvic muscles, as tightly as possible when urinating, to stop the flow. (Women should also contract the vaginal area.) Then, practice tensing these muscles when you’re not urinating. But don’t hold your breath or squeeze your stomach, groin, or thigh muscles, which adds pressure to the bladder. Do the exercises daily, alternating a series of slow contractions (holding for 5 to 10 seconds) with rapid ones (holding for just a few seconds). Work up to sets of 10 to 15 contractions, repeating the exercise three times daily. Do Kegels when you’re driving, standing on line, or sitting at your desk. No one will ever know. For women, your doctor may recommend practicing with graduated vaginal cones to further strengthen your muscles.

‘ Try bladder-training if you have urge incontinence. You begin by voiding at set intervals, such as every hour. Then, gradually increase the intervals until you can manage the normal three or four hours between bathroom visits.

‘ Check for triggers. Many foods can send you to the bathroom more often. These include carbonated drinks, caffeine, alcohol, citrus fruits and juices, tomato products, spicy foods, chocolate, sugar, honey, artificial sweeteners, and milk products. Try eliminating each in turn for 10 days. Note any improvements.

‘ Lose weight. If you’re overweight, extra pounds can exert more pressure on the bladder, making an existing incontinence problem worse.

‘ Stop smoking. Nicotine irritates the bladder, so smokers are much more likely to have incontinence problems.

‘ Limit evening fluids. It’s a good idea to drink normal amounts of fluids during the day (in fact, drinking too little fluid can irritate the lining of the urethra and bladder). Stop drinking two to four hours before you go to bed to prevent nighttime accidents.

‘ Use protective devices if you need them. Some women benefit from foam pads to catch leaks or ‘barrier devices’ such as urethral shields or caps to block the urine. For both sexes, a variety of disposable undergarments and underwear liners are available.

Related procedures for incontinence

For more serious urge incontinence, doctors may recommend women try transvaginal pelvic floor electrical stimulation. This painless office procedure uses gentle electrical stimulation to strengthen muscles around the bladder and urinary sphincter. Another option is sacral nerve stimulation (InterStim). It involves sending electrical pulses from a small device implanted in your abdomen to sacral nerves in your lower back to stimulate nerves and control muscle spasms in the bladder.

There are many possible surgical procedures for structural problems. Bladder neck suspension, in which the bladder neck and urethra are sewn into their proper position, has an excellent success rate. If you have severe stress incontinence, you may be helped with a sling procedure. The surgeon attaches the urethra and bladder neck to the abdominal wall with a synthetic sling or one made from muscle tissue. If your urinary sphincter doesn’t work well or at all, an artificial sphincter can be implanted. In some cases, you can instead get injections of collagen (or other material) to provide bulk around the urethra and help the sphincter close more tightly. Talk with your doctor about what’s best for you.

Questions for your doctor

‘ Could my incontinence be related to another health condition or a medicine I’m taking?
‘ Can I put a complete stop to my problem with exercises or bladder-control training?
‘ Could anything in my diet be contributing to my incontinence?
‘ Will this problem get worse as I get older?
‘ Is incontinence a ‘warning sign’ of a more serious health condition? If so, what other symptoms should I be watching for?

Living with incontinence

If you’re living with Incontinence, here are a few quick tips that will help you take control:

‘ Find a specialist. If you have a serious problem, a urologist or urogynecologist (for women) can often identify the best approaches.

‘ Keep a diary. For three days, write down when you urinate, your feelings of urgency, when you have leaking, what you eat, and what you’re doing when the problem occurs. This will help you uncover what might trigger your incontinence, and help your doctor choose the best treatment for you.

‘ Cross your legs. When you think you’re going to sneeze or cough’causing involuntary leakage’this simple maneuver might stop the flow.

‘ Join a support group. Just talking to others who’ve suffered similar embarrassments can be comforting. It’s also a good forum for exchanging helpful incontinence strategies.