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April 2, 2001
Don't Settle for Wet
Incontinence can be alleviated, prevented, and cured
By Meredith Phillips

Illustration: Incontinence

Incontinence can be embarrassing -- no ifs, ands, or buts about it. But because of the stigma, people who lose urine involuntarily sometimes resign themselves to using an absorbent product instead of searching out the cause of the problem. Even though urinary incontinence (UI) affects 13 million Americans -- 85 percent of them female -- the fact remains that it should not be considered a normal part of life at any age. And while certain conditions tend to provoke it, there may be things that can help -- like exercise, medications, and, in more extreme cases, surgery. In 90 percent of incontinence cases, treatments can improve or even cure the problem.

One of the major mechanisms of "continence" is the resistance (pressure) in the urethra that counteracts the pressure in the bladder. This "urethral pressure" is a combination of several forces:

  • The external sphincter muscle, which squeezes on the urethra like your hand would on the neck of a balloon
  • The muscle in the wall of the urethra
  • The cohesiveness, or stickiness, of the lining of the urethra

Damage or subtle changes to any of these forces can cause problems. What many people don't realize is that there are at least five different types of urinary incontinence, with a host of different causes.

Stress incontinence is the most common form of incontinence. It often occurs when the bladder muscles are weakened or when the urethra has been pushed out of place (for women, after childbirth; for men, after prostate surgery; and for the elderly, due to muscle atrophy). In these instances, dribbling can occur whenever pressure is put on the bladder during a physical exertion. Unfortunately, exertion can be something as simple as coughing, sneezing, lifting something heavy, or even laughing. Sometimes, transient UI develops in women after menopause. The tissues in the urethra and in the bladder neck, as well as the tissues in the vagina, are responsive to estrogen. When the amount of estrogen produced begins to decline, the atrophy that might occur to these tissues exacerbates the weakening of the muscles of the pelvic floor.

Since stress incontinence is caused by a weakening of the pelvic muscle, it can often be alleviated or prevented altogether by simple strengthening exercises called Kegel exercises , weight loss, or surgery if the symptoms are severe. When UI is associated with menopause, Kegel exercises can help strengthen the muscles of the pelvic floor and estrogen replacement therapy may reverse the tissue degeneration and prevent or decrease episodes of leakage.

Urge incontinence , also called "irritable bladder," affects many people over the age of 60. It can be caused by obstructions in the bladder, such as tumors or stones, or by bladder infection. Most of the time, people with urge incontinence feel the need to urinate urgently just before they lose control of their bladder. Medications , biofeedback relaxation, muscle control techniques, and exercises are often used to treat urge incontinence.

Overflow incontinence , a less common type of incontinence, occurs when the bladder is full enough to continually leak urine. The bladder is full because the person is not able to void all of the urine when going to the bathroom. This can happen to men with a urinary tract obstruction, and though it is rare, to women following a hysterectomy, due to the formation of scar tissue between the bladder and the vagina. Bladder problems can be exacerbated by heart and blood pressure medication, narcotics, and antidepressants.

Functional incontinence , which often affects the elderly, might be the trickiest instance of incontinence. In these cases, the leakage has less to do with a person's bladder and more to do with the inability to get to the toilet. This could stem from a physical problem -- like arthritis or Parkinson's disease -- or a condition involving limited speech or sight, or decreased mental function. Incontinence becomes the secondary result of these primary problems. Sometimes, merely having a more accessible toilet can be the key to solving functional incontinence.

Mixed incontinence. Unfortunately, many people suffer from more than one type of incontinence and commonly exhibit symptoms of three major types at once. It is important for a doctor to determine which types of UI a patient has, and then decide on the best solution through careful evaluation and testing.

If the cause of incontinence isn't known, it can't be treated, and this often leads to a vicious cycle of isolation and depression. But in some cases, relieving incontinence can be as simple as cutting out caffeine, taking an antibiotic, or practicing some easy exercises. Effective drug therapy may also be available. Of course, incontinence can sometimes indicate a more serious problem, so it is important to tell your physician if you are experiencing any of these symptoms. A physical exam is probably the best way to determine what can be done about this condition. After all, a higher quality of life is well worth an uncomfortable moment in front of your doctor.

Kegel Exercises (Pelvic Floor Exercises)

Pregnancy, childbirth, and weight gain can weaken pelvic muscles. But just as a regimen of biceps curls at the gym will eventually increase upper arm strength, pelvic muscles can also be built up through isolation exercises. If practiced regularly and early, these exercises can prevent the onset of bladder control problems altogether. If you're already experiencing a level of stress incontinence , they can help you regain control again. Before you perform this or any other type of exercise, check with your doctor. Before proceeding in exercises for bladder control, you should be sure that your incontinence is not a symptom of a serious medical condition.

Find the right muscles. At the bottom of the pelvis, between the hip bones, several layers of muscles stretch between the legs. Two pelvic muscles do the most work, one shaped like a hammock, the other, a triangle. These muscles prevent the leakage of urine and stool. To do Kegel exercises properly, you must find the right muscles -- a doctor, nurse, or physical therapist can help you.

  • Try to stop the flow of urine while sitting on the toilet. If you can, you've located the muscles.
  • When you feel the urge to pass gas, try to stop it by squeezing your muscles. If you feel a pulling sensation, you are on the right track.
  • Women can lie down and place their finger inside their vagina. Squeeze as if you were trying to stop the flow of urine. If you feel tightness on your finger, you're squeezing the pelvic muscles successfully.

Five minutes, three times a day. You might want to try these at first in a private place, like a bedroom or bathroom, but they can also be done (as long as you are able to concentrate) at the office or even in line at the grocery store. What's more, you can prevent damage to your muscles by squeezing them tightly before and holding on while sneezing, lifting an object, or jumping. When performing these exercises, try to isolate your pelvic muscles and keep your stomach and legs relaxed. Make sure to breathe, so that your muscles get the oxygen they need to grow stronger. Most of all be patient. Bladder control may not visibly improve for 3-6 weeks, but some people will get results sooner.

  • Pull in the pelvic muscles and hold for a count of three.
  • Work up to 10-15 repetitions each session.
  • Repeat pelvic floor exercises three times a day for best results.
  • Use three positions: sitting, standing, and lying down, for pelvic cross-training.
  • Start slowly; don't overdo it.

Medications associated with the treatment of UI:

  • Ditropan (oxybutynin Cl; available in generic): This commonly prescribed medication exerts a direct antispasmodic effect on smooth muscles, diminishing the frequency of urination and the initial desire to void.
  • Detrol (tolterodine tartrate; not available in generic): Blocks receptors in the smooth muscles of the bladder to decrease spasms.
  • Urispas (flavoxate HCl; available in generic): Most commonly used with an antibiotic to treat UI associated with infection such as cystitis, prostatitis, and urethritis. Urispas counteracts smooth muscle spasms of the urinary tract and also exerts anesthetic and analgesic effects.

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