FAMILY MATTERS: Incontinence not just about aging

Urinary incontinence, or the involuntary leakage of urine, isn’t something most women want to talk about. For the millions of United States women who have UI, the problem can range from mildly annoying to seriously interfering with daily life. Many cope in silence, mistakenly thinking UI is a normal part of aging. But UI is a medical condition and it can often be successfully treated.

In the U.S., approximately 20 million adult women and 6 million adult men experience or have experienced urinary incontinence, according to recent reports by the National Institutes of Health.

There are several types of UI; the two most common are stress incontinence and urge incontinence.

Stress urinary incontinence is seen predominantly in women. The pelvic muscle is the key muscle in the pelvis that controls urine loss during increases of intra-abdominal pressure. Stress incontinence occurs when you sneeze, cough, laugh, jog or do other things that put pressure on your bladder.

Stress incontinence can be caused by childbirth, weight gain or other conditions that stretch the pelvic floor muscles. The muscles and nerves that help hold and release urine can be damaged by childbirth, stroke or other problems.

Urge incontinence happens when you have a strong need to urinate but can’t reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine.

Mixed incontinence is a combination of different types of bladder control problems, usually stress and urge incontinence. These problems often occur together in older women.

Once you realize you have a problem, you should seek medical help. Some preparation will help with your diagnosis. Keep a voiding diary. This can help you keep track of how often and how much you urinate or leak urine. Your doctor will diagnose your problem based on the patterns found in the voiding diary, a physical exam and medical tests.

Urodynamic tests are measurements taken to evaluate your bladder’s function and efficiency. Some urodynamic tests are relatively simple and can be done in a doctor’s office; other tests require expensive and sophisticated instruments to measure the amount of pressure experienced by the bladder and urethra, the tube that carries urine from the bladder.

There are many treatments for UI: which one is right for you depends on what kind of UI you have. Often a combination of treatments is used.

Treatment options for urinary incontinence range from more conservative approaches, including behavioral techniques and physical therapy, to surgery. Stress incontinence is usually treated with one of several surgical procedures. Urge incontinence is typically treated with medications.

Some things you can try

• Scheduled toilet trips. Going to the bathroom at a specific time instead of when you feel the need to go, usually every two to four hours.

• Fluid and diet management. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity are other lifestyle changes that can help the problem.

• Physical therapists who specialize in pelvic floor problems also use education, biofeedback and exercises to treat incontinence. For instance, Kegel exercises strengthen the pelvic floor muscles and help prevent urine leakage.

To do Kegels, pretend to stop the flow of urine by squeezing those muscles and pulling up and in. The number of times you should repeat this exercise depends on your specific case.

Surgical options

• A sling procedure. This is the most common surgery to treat stress incontinence. It uses tissue, synthetic material or mesh to create a pelvic sling or hammock around your bladder neck (thickened muscle where the bladder connects to the urethra and the urethra. The sling provides support to keep the urethra closed, especially when you cough or sneeze. Slings typically have high rates of effectiveness and low risks of complications.

• Bladder neck suspension procedure. This procedure is designed to provide support to your urethra and bladder.

While there are many treatments for incontinence, it usually takes a combination of therapies to completely resolve the problem.

Dr. John Lenihan is a gynecologist and the medical director of Robotics and Minimally Invasive Surgery at MultiCare Health System.

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