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    Incontinence

    Losing control of your bladder? Don't be discouraged. Our well-tested tips can help!

    Urinary incontinence, the inability to hold your urine until you get to the bathroom, is a common problem, affecting at least 13 million people in the United States. Women are twice as likely as men to experience some loss of bladder control, because of pregnancy, childbirth, menopause, and the very structure of the female urinary tract. But make no mistake, this uncomfortable condition affects both sexes, due to certain illnesses or the physical problems of aging.

    The good news: Urinary incontinence is often temporary, usually treatable-and sometimes even curable.

    But what causes incontinence? Perhaps it will help to understand the inner workings of the body a bit better. The body holds urine in a balloon-like structure called the bladder. This connects to the urethra, the tube through which urine leaves the body.

    When we urinate, bladder-wall muscles contract and force urine into the urethra. Sphincter muscles around the urethra relax to let urine pass from the body. When something goes wrong with this process-such as bladder muscles contracting suddenly or sphincter muscles relaxing suddenly-involuntary urine loss may occur.

    There are several kinds of urinary incontinence. Some people have one type; others have a mixture of kinds. These include the following:

    Stress incontinence is diagnosed when urine leaks unexpectedly as a result of simple physical movement such as sneezing, coughing, laughing, or exercising. Stress incontinence is often the result of childbirth, loss of pelvic muscle tone, or gynecological surgery. Other sufferers include postmenopausal women, whose lower estrogen levels can cause vaginal tissue to thin and weaken.

    Urge incontinence is marked by a sudden, uncontrollable loss of urine, caused by involuntary bladder-wall contractions. Caffeine, bladder infection, and certain medications may exacerbate the problem.

    Functional incontinence is the result of thinking, movement, or communication problems (like those related to Alzheimers disease) that may prevent a person from reaching the toilet in time.

    Overflow incontinence happens when a physical problem-such as a blockage or scar tissue-prevents the bladder from emptying completely.

    Total incontinence occurs when the sphincter doesn't work at all, usually due to injury or genetic defect. This may be repairable by surgery.

    Temporary incontinence is due to other health problems, such as a urinary-tract infection, constipation, or a reaction to certain drugs.


    Pointers on Prevention

    Do not cut down on overall fluid intake, but do limit what you drink before leaving home or going to sleep.

    Practice double-voiding: emptying your bladder as much as possible, relaxing for a minute, and trying again.

    Strengthen your urinary sphincter and pelvic floor muscles to help avoid, cure, or improve stress incontinence. Locate these muscles by stopping the flow when you urinate. To exercise them, squeeze them for three seconds, then relax them for three seconds. Repeat 10 to 15 times and do at least five sets each day. Those who have difficulty isolating the muscles may benefit from biofeedback training to enhance awareness of muscle contraction. Another option: small weights inserted into the vagina, which you try to retain for increasingly long periods of time.

    Limit or eliminate caffeine (in coffee, cola, tea, and chocolate) and alcohol.

    Lose weight if appropriate. Extra weight places pressure on the bladder.


    Medical Help

    A variety of treatments are available and a combination may be used, depending on what type of incontinence you have. Options include:

    Tolterodine (Detrol) tablets, a new prescription tablet for urge incontinence that may reduce the number of times a person needs to urinate in a day by as much as 21 percent. n Estrogen, taken orally, via skin patch, or as a cream.

    Other medications, including oxybutynin (Ditropan), propantheline (Pro-Banthine), and imipramine (Tofranil).

    The CapSure Shield, a nipple-shaped prescription device that creates a vacuum when placed over the urethral opening.

    The Impress Softpatch, a pad-like shield that blocks urine leakage when placed over the urethral opening.

    Pessaries, plastic prescription devices, are inserted into the vagina to support and raise the bladder neck.

    The Reliance Urinary Control Insert, a small disposable balloon that is inserted in the urethra, then inflated using a small applicator.

    Nerve stimulation using Interstim Continence Control Therapy. Implanted into the abdominal wall, it sends impulses to the nerves to help control bladder contractions associated with urge incontinence.

    Neocontrol therapy, which uses pulsating magnetic fields to create strong pelvic floor muscle contractions-and to strengthen those muscles.

    The Contigen Bard Collagen Implant, an injection of collagen protein, is sometimes placed into tissues around the urethra to bulk it up and make it close more tightly.

    Surgery may be advised when anatomical problems contribute to incontinence.

    Self-Care Strategies
    To help control an existing problem:

    Cross your legs to stop urine leakage from coughing, sneezing, or laughing.

    Insert a tampon when exercising.

    Retrain your bladder by urinating on a schedule that gradually increases the time between trips to the bathroom.

    Wear clothing that is easy to remove such as pants with an elastic waistband.

    Use absorbent undergarments or a pad to help capture leaking urine.

    Take good care of the skin around the genital area. Feminine hygiene products may help control any odors.

    Six Typical Tests
    If you see a doctor for urinary incontinence, he or she will usually ask about your symptoms, medical history, recent surgery and illnesses, and the medications you use. You can also expect an examination for medical conditions that may cause incontinence and a test to measure how much urine remains in your bladder after urination. Other common tests include:
    Blood Tests
    Purpose: Examines the blood for levels of a variety of substances that may point to causes for incontinence.
    Cytoscopy
    Purpose: A small tube with a tiny camera at the end is inserted into the bladder so the doctor can see the urethra and bladder. Stress Test
    Purpose: Looks for urine loss when stress is placed on bladder muscles (via coughing, lifting, or exercise).
    Ultrasound
    Purpose: Uses sound waves to check the kidneys, ureters, bladder, and urethra.
    Urinalysis
    Purpose: Checks urine for signs of infection, blood, or other problems. Urodynamic Testing Purpose: Examines the function of the bladder and urethral sphincter.

    Source: National Institute of Diabetes and Digestive and Kidney Diseases


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