When you've 'gotta go' too often, or you just can't hold it in, inconvenience (and embarrassment) often follow. Take heart: there are numerous solutions--from exercises to medications-for the all-too-common curse of incontinence.
More than 1 million Australians and New Zealanders have urinary incontinence, but many never tell their doctors, either because they're embarrassed or they mistakenly think it's just part of getting older. This is too bad, because there's a lot your doctor can do to help you control or cure this condition. 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. In men, incontinence may be due to prostate problems or surgery (see Prostate enlargement). Other general causes include diabetes, medications, urinary tract infections and structural problems.
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 realise that you might not make it to the bathroom, you've got urge incontinence, 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 your 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 the urine overflow.
LIKELY FIRST STEPS
For stress and urge incontinence, many people have success with lifestyle changes--pelvic floor muscle exercises and bladder training to improve control. Changes in diet and drinking habits may also help. In addition, your doctor can recommend medications, and many surgical procedures are available.
Lifestyle changes
The following everyday measures can help you better control this condition, and may even eliminate the problem:
Treatment Options
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Pelvic floor exercises Strengthen pelvic floor muscles.
----------------------------------------------------------------------------------------------------------------------------------------------
Bladder training Increases intervals between bathroom visits.
----------------------------------------------------------------------------------------------------------------------------------------------
Diet Avoid food triggers; limit fluids at night.
-----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss Relieves pressure on bladder.
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Antibiotics Clear up urinary tract infections.
------------------------------------------------------------------------------------------------------------------------------------------ Drugs for stress form Help keep urinary sphincter closed.
-------------------------------------------------------------------------------------------------------------------------------------------
Drugs for urge form Treat involutionary bladder contractions.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery Often for bladder neck or urinary sphincter.
as possible when urinating to stop the flow. (Women should also contract the vaginal area.) Then practise 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 pelvic floor exercises, when you're driving, standing in a queue or sitting at your desk, and no-one will ever know. For women, your doctor may recommend practising with graduated vaginal cones to further strengthen your muscles.
The same drug that erases wrinkles may also help treat urge incontinence. In one trial, a safe concentration of botullinum toxin (Botox) was injected into the bladder to paralyse and relax sphincter muscles. Among patients with persistent incontinence problems, about two-thirds experienced significant improvement after undergoing this treatment.
Medications
If lifestyle changes and exercises alone don't banish your problem, your doctor may want to also treat it with medication. Of course, if you have a urinary tract infection (see on shortly), 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 strengthen the urinary sphincter, relax the bladder and prevent involuntary bladder contractions. And they work for both men and women. For postmenopasual women, various topical oestrogen products, such as creams, ointments and pessaries, that are applied to the vagina are often recommended.
For stress incontinence: your doctor is likely to suggest alpha adrenergic agonists, such as ephedrine and psuedoephedrine (commonly found in nonprescription 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), which inhibits involuntary bladder contractions. Certain antispasmodics, such as Merbentyl, may also help control urge problems; they help relax the bladder.
Drugs used to treat incontinence all have side effects, so be sure to tell your doctor how your medication affects you so that timing and dosages can be adjusted, if necessary.
Can biofeedback help?
In a study of women who used electronic biofeedback equipment, 79% were able to control incontinence completely or showed a marked improvement. To relay electronic signals to a biofeedback monitor, a small 'probe' is inserted in the vagina or rectum. When doing pelvic floor exercises correctly, the monitor rewards good performance with a beep or a flash of light. The study showed that biofeedback equipment helps to improve control techniques.
Which drugs can cause incontinence?
Among the most problematic medicines are diuretics prescribed for high blood pressure, certain antidepressants, antihistamines, calcium channel blockers for heart disease and sedatives for insomnia. If you're taking any of these prescription drugs, talk to your doctor. Perhaps another medication can be prescribed instead.
Procedures
For more serious urge incontinence, doctors may recommend women try transvaginal pelvic floor electrical stimulation, a painless procedure that uses gentle electrical stimulation to strengthen muscles around the bladder and urinary sphincter. Another option is sacral nerve stimulation. This involves sending electrical pulses from a small device implanted in your abdomen to sacral nerves in your lower back, in order to stimulate the 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. Here 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 to your doctor about what's best for you.
What is happening
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 realise that you might not make it to the bathroom, you've got urge incontinence, 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 your 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 the urine overflow.
LIKELY FIRST STEPS
- Get treated for any contributing condition such as a urinary tract infection.
- Practise pelvic floor exercises or bladder training.
- Watch what and when you eat and drink.
- Medications to improve control.
- Surgery if other treatments don't help.
QUESTIONS TO ASK
- Could my incontinence be related to another health condition or a medicine that I'm taking?
- Can I put a complete stop to my problem with exercises or bladder-control training?
- Is there anything in my diet that could be contributing to my incontinence?
- Will this problem get worse as I get older?
- Is this a 'warning sign' of a more serious health condition--and, if so, what other symptoms should I be watching for?
Treatments
For stress and urge incontinence, many people have success with lifestyle changes--pelvic floor muscle exercises and bladder training to improve control. Changes in diet and drinking habits may also help. In addition, your doctor can recommend medications, and many surgical procedures are available.
Lifestyle changes
The following everyday measures can help you better control this condition, and may even eliminate the problem:
- Learn pelvic floor exercises. Good for stress and urge incontinence, these exercises strengthen the pelvic floor muscles that support the bladder. To begin, periodically contract your pelvic muscles as tightly
Treatment Options
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Pelvic floor exercises Strengthen pelvic floor muscles.
----------------------------------------------------------------------------------------------------------------------------------------------
Bladder training Increases intervals between bathroom visits.
----------------------------------------------------------------------------------------------------------------------------------------------
Diet Avoid food triggers; limit fluids at night.
-----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss Relieves pressure on bladder.
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Antibiotics Clear up urinary tract infections.
------------------------------------------------------------------------------------------------------------------------------------------ Drugs for stress form Help keep urinary sphincter closed.
-------------------------------------------------------------------------------------------------------------------------------------------
Drugs for urge form Treat involutionary bladder contractions.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Surgery Often for bladder neck or urinary sphincter.
as possible when urinating to stop the flow. (Women should also contract the vaginal area.) Then practise 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 pelvic floor exercises, when you're driving, standing in a queue or sitting at your desk, and no-one will ever know. For women, your doctor may recommend practising 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 you 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 and note any improvements.
- Lose weight. If you're overweight, extra kilos can exert more pressure on the bladder, making an existing problems worse.
- Stop smoking. Nicotine irritates the bladder, so smokers are much more likely to have incontinence problems.
- 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 men there are specially designed condoms and drip collectors. For both sexes a variety of disposable undergarments and underwear liners are available.
- 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). But stop drinking two to four hours before you go to bed to prevent nighttime accidents.
TAKING CONTROL
PROMISING DEVELOPMENTS- Find a specialist. If you have a serious problem, a urologist or urogynaecologist (for women) can often identify the best approaches.
- keep a diary. For three days, write down when you urinate, your feeling of urgency, when you have leaking, what you eat and what you're doing at the time the problems occurs. This will help you uncover what might trigger your incontinence, and will help your doctor choose the best treatment for you.
- Cross your legs. If you think you're going to sneeze or cough and cause involuntary leakage, this simple manoeuvre might stop the flow.
- Join a support group. Just talking to others who've suffered similar embrassments can be very comforting. It's also good forum for exchanging helpful strategies.
The same drug that erases wrinkles may also help treat urge incontinence. In one trial, a safe concentration of botullinum toxin (Botox) was injected into the bladder to paralyse and relax sphincter muscles. Among patients with persistent incontinence problems, about two-thirds experienced significant improvement after undergoing this treatment.
Medications
If lifestyle changes and exercises alone don't banish your problem, your doctor may want to also treat it with medication. Of course, if you have a urinary tract infection (see on shortly), 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 strengthen the urinary sphincter, relax the bladder and prevent involuntary bladder contractions. And they work for both men and women. For postmenopasual women, various topical oestrogen products, such as creams, ointments and pessaries, that are applied to the vagina are often recommended.
For stress incontinence: your doctor is likely to suggest alpha adrenergic agonists, such as ephedrine and psuedoephedrine (commonly found in nonprescription 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), which inhibits involuntary bladder contractions. Certain antispasmodics, such as Merbentyl, may also help control urge problems; they help relax the bladder.
Drugs used to treat incontinence all have side effects, so be sure to tell your doctor how your medication affects you so that timing and dosages can be adjusted, if necessary.
Can biofeedback help?
In a study of women who used electronic biofeedback equipment, 79% were able to control incontinence completely or showed a marked improvement. To relay electronic signals to a biofeedback monitor, a small 'probe' is inserted in the vagina or rectum. When doing pelvic floor exercises correctly, the monitor rewards good performance with a beep or a flash of light. The study showed that biofeedback equipment helps to improve control techniques.
Which drugs can cause incontinence?
Among the most problematic medicines are diuretics prescribed for high blood pressure, certain antidepressants, antihistamines, calcium channel blockers for heart disease and sedatives for insomnia. If you're taking any of these prescription drugs, talk to your doctor. Perhaps another medication can be prescribed instead.
Procedures
For more serious urge incontinence, doctors may recommend women try transvaginal pelvic floor electrical stimulation, a painless procedure that uses gentle electrical stimulation to strengthen muscles around the bladder and urinary sphincter. Another option is sacral nerve stimulation. This involves sending electrical pulses from a small device implanted in your abdomen to sacral nerves in your lower back, in order to stimulate the 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. Here 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 to your doctor about what's best for you.
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