Are you pissed off by incontinence?

In an age when people are talking about sex and Viagra as if they were discussing golf scores, it seems ironic that many of the millions of adults who suffer from urinary incontinence are too embarrassed to broach the subject with their doctor. But if they did, they would learn that there are treatments that can improve or eliminate the problem in nine out of 10 people who experience urine leakage.

Although urinary incontinence affects both women and men, it is more common in women, and it is not, as many people believe, a problem mainly of older people. In fact, many women develop difficulties with urine leakage in their 40s and 50s. The problem is believed to affect 10-20 percent of men and 20-40 percent of women over 60. Out of nearly a thousand Filipinos surveyed in 1998, 12 percent had a history of incontinence or involuntary urine leaks. Incontinence is not considered normal at any age, and it should not be seen as an inevitable part of growing older.

Sometimes, incontinence is minor, and all you need is an occasional absorbent pad to keep enjoying your normal activities. But when you begin organizing your life around easy access to a bathroom or start giving up the activities that are important to you — your daily walk, travel, career or sex — because you can’t control leakage, it may be time to take action.

Besides disrupting daily activities and nighttime sleep, incontinence can also chip away at your health. If you have stopped exercising, for example, you are giving up one of the most effective strategies for maintaining a healthy heart and bones. Getting up several times during the night can lead to sleep deprivation, which makes it difficult to function normally during the day. Nighttime trips to the toilet can also be dangerous for those with mobility impairment. And incontinence that causes withdrawal from social interactions can result in depression.

Untreated incontinence can gradually become a major impediment to maintaining health and independence. For example, older women who frequently must rush to the bathroom are 26 percent more likely to suffer a fall and 34 percent more likely to break a bone.

While it engenders fear and embarrassment, rest assured that incontinence is not a psychological problem, a character flaw or a personal failure. Incontinence is a medical symptom, and it deserves the same attention you would give to any other medical problem.

Micturition 101

Urine is produced in the kidneys and flows through two tubes called the ureters to the bladder, where it is stored until it leaves the body through the urethra, another tube. The process of urination is largely controlled by the detrusor muscle, the smooth muscle in the wall of the bladder, and the sphincter muscles, which are located in the wall of the urethra, at the base of the bladder. (See illustration.)

When the bladder is filling, the detrusor relaxes and the sphincter muscles contract, preventing urine from flowing through the urethra. A sheet of pelvic-floor muscles supports the base of the bladder and closes off the top of the urethra, further blocking the flow of urine. During urination, the detrusor muscle contracts and the sphincter muscles relax, opening the way for the passage of urine.

Types Of Incontinence

Incontinence may be caused by weakened pelvic or sphincter muscles due to childbirth, prostate enlargement or surgery, nerve damage, an overactive bladder or infections. Because, in rare instances, it may signal a spinal tumor, prostate tumor or a slipped disc, it is important to seek medical attention.

Incontinence is divided into three types: Stress, urge and overflow. Stress incontinence occurs when involuntary pressure is put on the bladder by coughing, laughing, sneezing, lifting or straining. It develops most frequently in women in their 40s and 50s.

Urge incontinence, which is generally due to involuntary contractions of the bladder muscle, is most common in people over 60. Those who suffer from it report an urgent need to urinate, accompanied by a sudden loss of urine. Women often experience a combination of stress and urge incontinence. Overflow incontinence, which is much less common, occurs when the bladder is so full that it continuously leaks urine. It is often due to weak bladder muscles, a blocked urethra due to prostate enlargement or nerve damage.

Treatment

Fortunately, incontinence can be treated or even cured in most people by strengthening the pelvic muscles, taking medications or both.

Strengthening the pelvic floor muscles with Kegel exercises has been shown to reduce urine leakage in 50-75 percent of women and cure it in 20 percent of those with stress incontinence. The easiest way to identify these muscles is to start to urinate and then stop the flow mid-stream. Kegel exercises are performed simply by contracting and relaxing these muscles. To reap the greatest benefit, tighten the pelvic floor muscles and hold for a count of 10 seconds, then relax the muscles completely for a count of 10. Do the exercises three to five times a day in sets of five to 15 contractions. It may take four to six weeks for any improvement to become noticeable, and the exercises may have to be continued indefinitely to keep the pelvic muscles strong. Fortunately, they take only a few minutes and, of course, can be performed anywhere.

Timed urination, also called bladder retraining, is used to increase the bladder’s storage capacity in people with urge incontinence. If a person normally has an incontinent episode every three hours, he or she may be asked to urinate every two hours and then focus on suppressing the urgency. Once there is improvement, the person then extends the time between bathroom visits.

Another form of treatment is biofeedback therapy. In this technique, electrodes are placed around the abdomen and in the rectum; in women, they may be inserted into the vagina. The electrodes are hooked to a monitoring device. When the patient is asked to contract certain muscles, the monitor will display a graph showing the contractions, letting him/her know if the exercises are being performed correctly.

Drugs used for urge incontinence include oxybutynin (Driptane) and tolterodine (Detrusitol). Men with overflow incontinence are often helped by a class of drugs called alpha-blockers, which include prazosin (Minipress), tamsulosin (Harnal), doxazosin (Carduran) and terazosin (Hytrin). Most of these are also used to treat hypertension. They work by relaxing the smooth muscles in the capsule that surrounds the prostate. This relieves constriction of the urethra and allows urine to flow more easily.

Another treatment involves inserting a stiff ring known as a pessary, which puts pressure on the urethra and results in less leakage. Some women substitute a tampon for the pessary. People are also sometimes helped by collagen injections near the sphincter. This bulks up tissue and helps strengthen muscles.

Surgery is generally considered a last resort and is mainly used to strengthen pelvic muscles or lift the bladder to alleviate stress incontinence. Fortunately, most cases of incontinence can be cured or improved with less drastic measures. In addition to pelvic exercises and medication, your wetness protection program also includes cutting down on alcohol and caffeine, which can stimulate the bladder and trigger urinary frequency.

Don’t get pissed off by incontinence. No matter how serious or long-standing the problem, there is help available – you may not find a total cure, but you can get help. And even if you have not had success in the past, advances in medical cure provide a good reason to try again.