Autumn 2002
Incontinence—You Can Do Something About It!

Women Walking Her Dog It's uncomfortable, it's embarrassing—and it's much more common than you think. About 13,000,000 American adults have urinary incontinence at some point in their lives, and six out of seven of them are women—of all ages. (Why so many women? The stress of childbirth and the shorter length of a woman's urethra—the tube that carries urine out of the body—increase women's chances for incontinence.)

Types of Incontinence
There are several types of incontinence, with different symptoms.

  • Do you leak urine when you cough, laugh, sneeze, exercise? That's stress incontinence.
  • Do you sometimes have the urge to void that is so strong you can't reach the bathroom in time? That's urge incontinence.
  • Do you have both stress and urge incontinence? That's mixed incontinence.
  • Do you leak small amounts of urine throughout the day? Does your bladder never seem to feel empty? Do you have to go often, day and night? That's overflow incontinence.

What Can You Do?
Many women with incontinence are afraid to leave home, not wanting to stray far from the bathroom. But you don't have to let incontinence tie you to the house. Start by trying these practical steps to control incontinence:

  • Strengthen the pelvic floor muscles with Kegel exercises. To learn how to do it, hold the flow of urine when you urinate, then release a little urine, and then hold the flow again. (Once you understand how to tighten those muscles, you should no longer do Kegels when you urinate. However, you can do them at your desk, while reading, at any time of day or night.) Hold each Kegel for 10 seconds, then relax for 10 seconds. Do 8-10 sets of 20 or 30 Kegels every day. Be patient: it may take two to six months before you feel the results.
  • Train your bladder: Go to the bathroom on a set schedule, working up to once every four hours.
  • After you empty your bladder, wait 60 seconds, then try to empty it again.
  • Quit smoking. Smoker's cough can weaken the pelvic muscles and nicotine can interfere with bladder function.
  • Lose excess weight. Those extra pounds put extra strain on pelvic floor muscles.
  • Avoid spicy, greasy, or artificially sweetened foods and caffeinated, carbonated, alcoholic, or citrus beverages, all of which can be irritants to the urinary system.
  • Don't stop drinking fluids, however, in an attempt to control your incontinence. Drink plenty of water, unless your physician tells you otherwise.

If these steps don't provide relief, ask your doctor about medications, a pessary, or surgery.

Medications
Medications can often help with urge incontinence. They work to relax the bladder muscles, preventing the contractions that create the urge to void. They are not useful for stress or overflow incontinence, however, and the drugs can have side effects, including constipation, dryness of the mouth, and blurred vision.

Pessary
A pessary—a plastic device that slips into the vagina to support the bladder—can help in some cases of incontinence caused by a cystocele (hernia of the bladder) or vaginal prolapse (dropped vagina).

Surgery
Surgery can remove physical blockages of the urethra, allowing the urine to flow freely. Injections of collagen (a natural protein) can add bulk to the tissue around the urethra, narrowing the passage and increasing the resistance to flow.

If stress incontinence is the problem, surgery can help by correcting the position of the urethra or by supporting or replacing weakened pelvic muscles. Small bladders can be enlarged, and artificial sphincters (the muscle that keeps the opening closed until you are ready to urinate) can be implanted. In older patients, a catheter (thin tube) can be placed to help with bladder drainage.

Interstim, a recently approved procedure, can be used in patients with severe frequency and urge incontinence that does not respond to medication. A device about the size of a stopwatch is surgically placed under the skin of the buttocks. It generates mild electrical pulses that travel along a thin implanted wire to the sacral nerves, which control bladder function. The physician can adjust the strength of the pulses to the level that helps the patient most effectively.

If incontinence is a problem for you, don't suffer in silence. Even if you are getting older, incontinence is not an inevitable part of aging. Talk to your physician (gynecologist, urologist, or primary care doctor) to find out how your incontinence can best be treated.

For a referral to a physician, call Bridgeport Hospital Physician Referral at 203-384-4444. Out of area, call 888-357-2396.