An Embarrassing Problem

Posted on Wed., March 3, 2010
By Sonika Shah, MD

A 51-year-old teacher and mother of two musters the courage to mention she has been wearing absorbent pads for the past few years. Urinary incontinence, or the involuntary leakage of urine, frustrates millions of Americans. Although urinary incontinence becomes more common with increasing age, affecting twice as many women as men, it is not normal at any age.

Don't be embarrassed to inform your health care provider. Your provider will take a history, perform a physical exam and order urine tests. Bring a seven-day dairy detailing what and how much you drink, how often you urinate, and how frequently you leak to offer useful clues to the type of incontinence. In addition, provide a complete list of your medications, including over-the-counter medications.

Stress incontinence is the most common bladder control problem in women. It results when the muscles and tissues supporting the bladder or the urinary sphincter, a ring of muscles surrounding the urethra, weaken. Urine leaks accidently when there is increased pressure against the bladder—such as coughing, sneezing, laughing, jogging or heavy lifting—and the sphincter does not stay closed. These muscles can lose strength through weight gain, sports injuries, prostate cancer treatment in men, menopause, multiple pregnancies, and vaginal childbirths.

Things you can do:

Pelvic muscle (Kegel) exercises can improve or even cure stress incontinence by strengthening the muscles that control urine flow. They are simple, effective and can be done discretely anywhere, anytime.

Locate the muscles that control the flow of urine by pretending to stop the flow of urine or hold back gas.
Practice squeezing these muscles. If your abdomen, buttocks or legs move, you are not using the right muscles.
Hold the pelvic muscle contraction for 8-10 seconds, and then relax.
Repeat the exercise 10 times per session.
Perform at least three Kegel exercise sessions daily.

Avoid caffeinated beverages, including coffee, tea, soda, and cocoa. Caffeine not only over-stimulates the bladder but is also a diuretic, which causes the kidneys to create more urine.
Stop smoking. Nicotine irritates the bladder and chronic coughing caused by smoking weakens bladder support muscles.
Lose weight if you are overweight. Those extra pounds can put a lot of pressure on your bladder.
Urinate on a regular schedule (i.e. every 3-4 hours during the day), whether or not you feel the urge.
Check your medications. Some high blood pressure medicines relax the bladder muscles and diuretics or "water pills" create more urine.
Eat high-fiber foods. Constipation contributes to incontinence by placing extra strain on bladder muscles.

Medical treatments include:

Certain anti-depressant medications limit leaks by tightening sphincter muscles.
Biofeedback therapy assists Kegel's exercises in targeting and isolating pelvic floor muscles.
Continence pessaries, flexible devices worn in the vagina, help support the urethra to reduce stress incontinence.
Bulking agent (e.g. collagen) injections into the urethra lining create resistance against the flow of urine.
Vaginal estrogen may improve stress incontinence symptoms in postmenopausal women.
Surgical options designed to help keep the bladder in place are also available.

Take steps now to reduce your risk of developing incontinence. Maintain a healthy weight, avoid smoking and most importantly, perform daily Kegel exercises.

Dr. Shah is a board-certified internist with Contra Costa Regional Medical Center in Martinez.