Simple solutions for incontinence
Kristene E. Whitmore
More than 13 million Americans have trouble controlling their bladders. Urinary incontinence is not a disease. Its a symptom of an underlying problem diabetes, stroke, multiple sclerosis (MS), Parkinsons disease or even chronic bladder infection.
Obese people face heightened risk for incontinence. So do smokers and women especially those who have recently had a baby. Passage of the baby through the birth canal often damages the abdominal muscles responsible for holding and releasing urine. In men, incontinence is usually a result of nerve damage caused by surgery to treat prostate enlargement or cancer.
Good news: Incontinence can often be preventedor controlled. If youre incontinent or worried that you might become incontinent avoid caffeine, alcohol, spicy foods, chocolate, artificial sweeteners and other bladder irritants...urinate before and after intercourse to expel infection-causing bacteria.. .and drink lots of water.
Do not drink large quantities of water at one time, however. Doing so causes the bladder to fill too rapidly. Have one sip every five to 10 minutes throughout the day.
Women: To keep pelvic floor muscles strong, do Kegel exercises.
Women with recurrent bladder infections should take a cranberry pill with each meal. The pills contain compounds that keep infection- causing bacteria from sticking to bladder walls.
Cranberries and cranberry juice also contain these compoundsbut at lower levels.
Men: Ask your doctor about taking a zinc supplement and saw palmetto extract. Both have been shown to prevent or relieve prostate enlargement.
Types of incontinence
Four out of five cases of incontinence can now either be cured or made better. The first step is to identify which of the four types is involved...
Stress incontinence is associated with a weakness of the urinary sphincter, the circular valve-like muscle around the bladder neck and urethra that controls the flow of urine.
Coughing, laughing, etc., exert more pressure on the bladder than the sphincter can contain, and urine spills out.
Usual causes: Abdominal or pelvic surgery, childbirth, estrogen deficiency. Certain drugs, including alpha blockers and diuretics, make matters worse.
Urge incontinence occurs when overexcited nerves cause involuntary contraction of bladder muscles. You have a sudden urge to urinatebut cant reach a toilet in time.
Usual causes: Parkinsons disease, multiple sclerosis, bladder infection, the bladder disorder interstitial cystitis, spinal cord problems, chemotherapy.
Overflow incontinence occurs when weak bladder muscles or a urinary obstruction makes it hard to empty the bladder. Urine eventually overflows, like water over a dam.
Usual causes: Diabetes, enlarged prostate in men, prolapsed (dropped) bladder or uterus in women. The problem can also be caused by over-the-counter cold and allergy medications... or by the decongestant pseudoephedrine.
Functional incontinence is a transient problem associated with stool impaction, restricted mobility, vaginal irritation and other conditions.
Bladder training
The aim of bladder training is to empty the bladder on scheduleso that urine wont build up to the point where an accident occurs.
At first, urinate every 90 minutes. Gradually lengthen the interval between trips to the bathroomup to three hoursuntil you find a schedule thats safe and convenient.
Helpful: A voiding diary. For two to three days in a row, record how often you urinate and when leakage occurs. Review the diary with your doctor.
Kegel exercises
Most people with stress or urge incontinence get partial relief if they strengthen the urinary sphincter. To do Kegel exercises...
Identify the muscle you want to train. Its the same muscle used to control a bowel movement. If you have trouble identifying it, place a finger in your vagina (if youre a woman) or anus (if youre a man). Practice squeezing only the muscle around your finger.
For the first three to six days, squeeze the muscle for three seconds at a time. Over the next few weeks, gradually build up till you can tighten the sphincter for 10 seconds at a time. Relax the muscle for 10 seconds after each contraction. Do 50 every day.
Biofeedback and weights
Biofeedback uses a special tampon, inserted in the vagina or rectum, to help you identify the muscles that need to be strengthened. The tampons are available by prescription.
Women whose incontinence is caused by weak abdominal muscles often benefit from vaginal weight training. Cone-shaped weights are held in the vagina for 15 minutes, twice a day, as you go about your daily activities.
Helpful medications
Drug therapy brings faster relief than do the nondrug approaches outlined abovebut it often causes side effects.
Best approach: Start taking the medication when you begin bladder training, diet and Kegel exercises. Gradually wean yourself off the drugs as the non-drug methods start to work.
Oxybutiniti (Ditropan), propantheline (Norpanth), tricyclic antidepressants like imi- pramine (Tofranil) are good for stress and urge incontinence. Side effects include dry mouth, constipation and dry skin.
Diet pills containing pseudoephedrine are good for stress incontinence. Side effects include anxiety, insomnia, sweating. Do not use if you have high blood pressure.
Estrogen is useful for women who develop mixed incontinence after menopause. However, since it can promote breast and uterine cancer, it should be taken only after a thorough discussion of these risks with a doctor.
The surgical option
When other treatments fail to provide relief from incontinence, surgery may be the answer.
Several different forms of surgery are available, depending upon the exact nature of the problem and its severity.
Hemorrhoid self-defense
Eat high-fiber foodsfresh fruits, vegetables and whole grains...drink plenty of waterat least six cups a day... stay active, which reduces pressure in anal and rectal veins that results from being in one position too long. Regular also helps prevent constipation.
The author is a clinical associate
professor of urology at the University of Pennsylvania in Philadelphia. She is coauthor of Overcoming Bladder Disorders
