Help for Urinary Incontinence
A patient recently shared with me that she rarely sees her sister anymore. They live two hours away by car, but neither the distance nor the price of gas keeps her from visiting. Rather, it's the fact that she cannot last the trip without the urgent need to urinate.
Urinary incontinence is a big problem for many. Imagine walking into a restaurant and worrying about the location of the restroom before even considering the menu. Imagine needing to know the restroom situation for any public location for that matter. Imagine worrying every time you coughed or sneezed there would be an embarrassing leak urine.
Luckily, if you are one of these people or if you know one of these people, there is help.
Urinary Incontinence Demographics
Incontinence is more common in women, affecting between 11% and 17% of the female population. In women, the incidence increases dramatically after menopause and also with increased numbers of children born naturally. In other words, pushing a baby out the birth canal can take its toll, even years later. Of the affected women surveyed, most report significant lifestyle imposition due to the problem.
Urge vs. Stress Incontinence
Basically, there are two types of incontinence - urge and stress.
- Urge incontinence exists with a sudden, unheralded need to urinate.
- Stress incontinence is the leakage of urine with coughing, sneezing, laughing, jumping, etc.
While urge incontinence is considered a functional problem, stress incontinence is a mechanical problem. Our bladder is basically a bag of muscle used to store urine. Within this muscle are nerves that measure stretch. Typically, these nerves warn us three times with increasing urgency. We get the, “You should put visiting the bathroom on your schedule over the next several minutes,” to “HEY, start looking for a bathroom,” to “If you don’t find a bathroom immediately we are going to have problems!!” Urge incontinence causes a bypass, jumping to the third stage with the initial signal.
With stress incontinence, tissues in the area of the urethra relax and cause problematic dynamics of urine flow. Muscles weaken that give us the ability to hold urine in. Thus, urine flows with greater ease when it's undesired.
Incontinence can also be classified as a “mixed” urge and stress varieties.
Treatment Options for Urinary Incontinence
Evidence supports the use of Kegel exercises for first-line treatment for all types of incontinence in men and women. These exercise aim to strengthen the muscles of the pelvic floor, namely a muscle called the pubococcygeus. A repetition consists of one tightening everything from the genitals to the anus and holding for a number of seconds before releasing. This is done repeatedly in order to strengthen the muscle.
BONUS! Beyond improved continence, the Kegel exercises are hailed to enhance orgasm and male erections in addition to assisting with premature ejaculation.
A number of medications are FDA approved for incontinence. The grouping of these medications is called the anticholinergic class. In general, the medications tone down the bladder’s nerve communication with the brain. Really, these medications work best for urge incontinence. While the newer medications are tolerated quite well, problems can arise with constipation and dry mouth. Less commonly, but especially in the elderly, the medications can alter mental functioning.
Over recent years, significant advancements have emerged to treat the problem of incontinence in a less invasive manner. This is the mainstay for structural problems causing stress or mixed incontinence that are refractory to conservative treatment. Procedures utilizing Teflon (that’s right - the same stuff you cook your eggs on) to tack up a woman’s anatomy to where it was before childbirth and menopause.
For more significant structural problems, more invasive procedures are available which may also require hysterectomy (removing the uterus). Such problems would include a prolapsed (falling or relaxing) uterus, cystocele (bulging of the bladder out of the vagina), or rectocele (bulging of the rectum out of the vagina).
Incontinence is common, especially in women. It is categorized as urge, stress and mixed incontinence. Incontinence can pose a huge inconvenience on a person, but help is out there.
An array of therapies exist including the Kegel exercises, medication and surgery.
If you're dealing with incontinence, consider a trial of the Kegel exercises and/or discuss the issue with your doctor.