incontinence
Incontinence
Are you reluctant to talk to your doctor about your bladder control
problem? Don’t be. There is help.
Loss of bladder
control is called urinary incontinence. It can happen to anyone, but
is very common in older people. At least 1 in 10 people age 65 or
older has this problem. Symptoms can range from mild leaking to uncontrollable
wetting. Women are more likely than men to have incontinence.
Aging does not
cause incontinence. It can occur for many reasons. For example, urinary
tract infections, vaginal infection or irritation, constipation, and
certain medicines can cause bladder control problems that last a short
time. Sometimes incontinence lasts longer. This might be due to problems
such as:
weak bladder muscles,
overactive bladder muscles,
blockage from an enlarged prostate,
damage to nerves that control the bladder from diseases such as multiple
sclerosis or Parkinson’s disease, or
diseases such as arthritis that can make walking painful and slow.
Many people with bladder control problems hide the problem from everyone,
even from their doctor. There is no need to do that. In most cases
urinary incontinence can be treated and controlled, if not cured.
If you are having bladder control problems, don’t suffer in silence.
Talk to your doctor.
Bladder Control
The body stores urine in the bladder. During urination, muscles in
the bladder contract or tighten. This forces urine out of the bladder
and into a tube called the urethra that carries urine out of the body.
At the same time, muscles surrounding the urethra relax and let the
urine pass through. Spinal nerves control how these muscles move.
Incontinence occurs if the bladder muscles contract or the muscles
surrounding the urethra relax without warning.
Diagnosis
The first step in treating a bladder control problem is to see a doctor.
He or she will give you a physical exam and take your medical history.
The doctor will ask about your symptoms and the medicines you use.
He or she will want to know if you have been sick recently or had
surgery. Your doctor also may do a number of tests. These might include:
urine and blood
tests and
tests that measure how well you empty your bladder.
In addition, your doctor may ask you to keep a daily diary of when
you urinate and when you leak urine. Your pattern of urinating and
urine leakage may suggest which type of incontinence you have.
Types of Incontinence
There are several different types of urinary incontinence:
Stress incontinence
happens when urine leaks during exercise, coughing, sneezing, laughing,
lifting heavy objects, or other body movements that put pressure on
the bladder. It is the most common type of bladder control problem
in younger and middle-age women. In some cases it is related to childbirth.
It may also begin around the time of menopause.
Urge incontinence happens when people can’t hold their urine
long enough to get to the toilet in time. Healthy people can have
urge incontinence, but it is often found in people who have diabetes,
stroke, Alzheimer’s disease, Parkinson’s disease, or multiple
sclerosis. It is also sometimes an early sign of bladder cancer.
Overflow incontinence happens when small amounts of urine leak from
a bladder that is always full. A man can have trouble emptying his
bladder if an enlarged prostate is blocking the urethra. Diabetes
and spinal cord injury can also cause this type of incontinence.
Functional incontinence happens in many older people who have normal
bladder control. They just have a hard time getting to the toilet
in time because of arthritis or other disorders that make moving quickly
difficult.
Treatment
Today there are more treatments for urinary incontinence than ever
before. The choice of treatment depends on the type of bladder control
problem you have, how serious it is, and what best fits your lifestyle.
As a general rule, the simplest and safest treatments should be tried
first.
Bladder Control
Training
Your doctor may suggest you try to get back control of your bladder
through training. With bladder training you can change how your bladder
stores and empties urine. There are several ways to do this:
Pelvic muscle
exercises (also known as Kegel exercises) work the muscles that you
use to stop urinating. Making these muscles stronger helps you hold
urine in your bladder longer. These exercises are easy to do. They
can lessen or get rid of stress and urge incontinence.
Kegel Exercises
The muscles you
want to exercise are your pelvic floor muscles. These are the ones
you use to stop the flow of urine or to keep from passing gas. Often
doctors suggest that you squeeze and hold these muscles for a certain
count, and then relax them. Then you repeat this a number of times.
You will probably do this several times a day. Your doctor will give
you exact directions.
Biofeedback helps
you become more aware of signals from your body. This may help you
regain control over the muscles in your bladder and urethra. Biofeedback
can be used to help teach pelvic muscle exercises.
Timed voiding and bladder training also can help you control your
bladder. In timed voiding, you keep a chart of urination and leaking
to determine the pattern. Once you learn that, you can plan to empty
your bladder before you might leak. When combined with biofeedback
and pelvic muscle exercises, these methods may help you control urge
and overflow incontinence.
Management
Besides bladder control training, there are several other ways to
help manage incontinence:
Sometimes doctors
suggest a small, throwaway patch; a small, tampon-like urethral plug;
or a vaginal insert called a pessary for women with stress incontinence.
A doctor can prescribe medicines to treat incontinence. Some drugs
prevent unwanted bladder contractions. Some relax muscles, helping
the bladder to empty more fully during urination. Others tighten muscles
in the bladder and urethra to cut down leakage. These drugs can sometimes
cause side effects such as dry mouth, eye problems, or urine buildup.
Vaginal estrogen may be helpful in women after menopause. Talk with
your doctor about the benefits and side effects of using any of these
medicines for a long time.
A doctor can inject an implant into the area around the urethra. The
implant adds bulk. This helps close the urethra to reduce stress incontinence.
Injections may have to be repeated after a time because your body
slowly gets rid of these substances.
Sometimes surgery can improve or cure incontinence if it is caused
by a problem such as a change in the position of the bladder or blockage
due to an enlarged prostate. Common surgery for stress incontinence
involves pulling the bladder up and securing it. When stress incontinence
is serious, the surgeon may use a wide sling. This holds up the bladder
and narrows the urethra to prevent leakage.
You can now buy special absorbent underclothing. It is not bulky and
can be worn easily under everyday clothing.
If you suffer from urinary incontinence, tell your doctor. Remember,
under a doctor’s care, incontinence can be treated and often
cured. Even if treatment is not fully successful, careful managing
can help you feel more relaxed and comfortable.
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