Incontinence

Incontinence

Age Is Not the Factor

Do you leak when you sneeze or dribble if you jump?

What about that uncontrollable urge triggered by the sound of gushing water?

Quickly you cross your legs, clutch your gut and try to console yourself: "I'm not incontinent," you say. "I'm too young, too healthy. Besides, it only happens occasionally."

The truth is, age has nothing to do with this kind of incontinence. Doctors say that as many as half of all women younger than 45 know what it's like to accidentally wet themselves. The causes range from childbirth and smoking to everyday stress on weak pelvic or abdominal muscles.

You might think women in great shape wouldn't have a problem holding their urine. But many of them do.

Ingrid Nygaard, M.D., who does research on incontinence in young women at the University of Iowa in Iowa City, found leaking can be a real problem for female athletes. She says gymnasts especially report sudden, uncontrollable urine loss, and not only in the gymnasium.

Incontinence is also a problem for women who play basketball, tennis and field hockey and take aerobics classes, Dr. Nygaard says. These activities exert intense pressure on the pelvic floor muscles when the heels of a woman's feet hit the ground, she says.

If sports and working out don't make you incontinent, there is always a chance childbirth will. "Childbirth is a woman's biggest risk factor," says Dr. Nygaard.

It's not how many children you have but how your body reacts to the growing weight and pressure of a developing fetus or the trauma of vaginal delivery, says Joseph Montella, M.D., director of urogynecology at Jefferson Medical College in Philadelphia. He finds that a woman who's gone through ten births could have complete bladder control, while another develops incontinence after one child. The cause is usually a resulting weakness in the muscles that open and close the urethra, the tube that empties urine from the bladder.

"It could be a hereditary muscle weakness," he says, or an earlier muscle strain developed from sports, lifting or bending.

You seldom hear men complain about incontinence because they seldom leak until they reach their later years. Doctors offer a simple explanation: Men are designed not to.

"Males have a longer urethra. And they have thicker muscles to hold it shut," Dr. Nygaard says. And obviously, the physical stress of childbirth isn't a factor for men.

In both men and women, the bladder--when full--should hold around 12 ounces of fluid, enough to fill a soft drink can. A woman's ability to actually hold that much urine depends on the strength of the pelvic muscles around her bladder.

Why the Floodgates Open

Pelvic muscles help control the sphincter muscles at the spout of the bladder. You could think of the sphincter as a faucet. When the sphincter is open, liquid flows out. When the sphincter is closed, the bladder is shut. Sometimes the sphincter can't close all the way because the muscles surrounding it are stretched. It's like having a faucet that's never quite turned off. The result: Your bladder leaks, either constantly or at the slightest aggravation--a cough, a sneeze, a laugh.

When the muscles surrounding your bladder are causing your problem, you have what doctors call stress incontinence. It's the most common type of incontinence in women ages 30 to 50.

In older women, incontinence can be triggered by a stroke, medication, arthritis or depression. The most common form in older women is called urge incontinence.

"It's a sudden need to urinate that often can't be controlled," says Catherine DuBeau, M.D., an instructor at Harvard Medical School and a gerontologist at the Continence Center at Brigham and Women's Hospital in Boston.

National health officials report that some six to eight million women experience bouts of some type of incontinence every year. Urogynecologists--physicians who specialize in women's incontinence--say that up to 80 percent of all cases can be helped or cured with treatment or therapy. Once women begin behavioral therapy, they usually regain control of their bladders in 3 to 12 weeks, doctors say. Very few women require surgery.

Curing incontinence is usually not a problem. The problem is finding the women who need a cure.

"It's socially unacceptable," says Kristene E. Whitmore, M.D., chief of urology and director of the Incontinence Center at Graduate Hospital in Philadelphia. "Women feel it's taboo to say they leak," even to a doctor.

When a woman finally decides to get medical help, it's usually after seven years of leaking, says Katherine F. Jeter, Ed.D., who founded Help for Incontinent People (HIP), a nonprofit information advocacy organization for people with incontinence, in Spartanburg, South Carolina.

"Many women really believe incontinence is their lot in life," says Dr. Jeter. "They think this is the price they must pay for having children."

Dr. Jeter estimates that her organization receives 3,000 letters and calls each month from women who have finally decided they don't have to live with incontinence. Most women tell her that for years they dealt with their problem by using sanitary napkins. It's a typical response to incontinence.

"About 38 percent of all menstrual products are used for incontinence," says Dr. Whitmore.

For many women, leaking becomes progressively worse after menopause, when they lose their natural estrogen supply. "Estrogen keeps muscles surrounding the bladder from drying out," explains Dr. Montella.

How to Overcome Stress Incontinence

When a sneeze might mean a sudden leak, Peggy Norton, M.D., a urogynecologist at the University of Utah Medical Center in Salt Lake City, who wrote a physicians' guide to incontinence, says that crossing their legs helps many women reduce leakage temporarily.

A more permanent cure calls for more effort.

"Incontinence treatment doesn't hurt," says Kathryn Burgio, Ph.D., a behavioral psychologist who is researching incontinence at the University of Alabama in Birmingham. "It's not even uncomfortable." Here are some suggestions.

Practice your Kegels. Dr. Burgio recommends these exercises as the place to start. With Kegel exercises, you squeeze your internal pelvic muscles, hold for a slow count of three, then release. It feels like you are trying to start and stop the flow of urine.

Just make sure it is pelvic muscles that you are contracting. Test yourself when you are on the toilet. If you can stop or even slow the flow of urine, you are contracting the correct muscles.

Don't develop the habit of practicing Kegel exercises on the toilet, though, advises Dr. Montella. If you are constantly stopping and starting your urine flow, you may not completely empty your bladder, and that could compound your urinary problems.

"Do ten pelvic exercises three to five times a day," he says. If that seems like a lot, spread them out over the course of the day. Do Kegels every time you stop at a red light, for instance, or as you stand at the bus stop.

Don't drown your bladder. Your body only needs 50 to 70 ounces (between six and nine cups) of water a day, unless it is really hot outside or you're heavily exerting yourself, says Dr. Norton. But don't drink it all at once. A full bladder is a stretched bladder, and that could mean a leak.

Hold it in the shower. If you start the habit of urinating in the shower, Dr. Norton says, you'll train your bladder to respond to the sound of gushing water. "It may explain why every time you hear water running you start to leak urine."

Double do it. To guard against leaks, some doctors suggest double-voiding. When your bladder feels empty, bend forward and push. Stand up, sit down and try to void again.

Eat and drink with care. Avoid tomato-based foods, spicy foods, chocolate, citrus fruits and artificial sweeteners, which are acidic foods that irritate the bladder. Caffeine and alcohol are diuretics and may also stimulate incontinence, says Dr. Nygaard.

Try to eat more fiber, she says. Fiber fights constipation, and constipation can make your incontinence worse.

Stay away from cigarettes. In a study of 606 women at the Medical College of Virginia in Richmond, researchers found that former and current smokers were more than twice as likely to suffer from stress incontinence as those who had never smoked. Nicotine irritates the bladder, plus smoke makes you cough--and a cough may make you leak. So stop smoking, and try not to inhale second-hand smoke.

Get information. Call Help for Incontinent People toll free at 1-800-BLADDER. The organization mails out self-help packets that explain what causes the problem and how to begin getting help. HIP maintains an ever-increasing library about all aspects of incontinence. The Simon Foundation in Wilmett, Illinois, also offers advice on incontinence; call 1-800-23S-IMON.

Lend support. Dr. Nygaard encourages women to use tampons or even a diaphragm. If women leak only during a workout, sometimes a tampon or diaphragm can help to support the bladder during an exercise session.

"It's okay to wear a tampon for a short term," says Dr. Nygaard. "Some women only wet during exercise." To alleviate some of the pressure on the bladder caused by exercise, Dr. Nygaard advises women to land on the balls of their feet instead of their heels, but that usually won't completely solve the problem.

Getting Professional Help

Sometimes you can regain continence only with the help of a doctor. Ask your family physician to refer you to a urogynecologist or a urologist. Help the doctor diagnose your problem by writing down what you eat, how much you drink and exactly when you leak. Give a good medical history and list all of the medicines you take.

Doctors have recently developed several types of incontinence therapy. Most don't require a hospital stay. The following therapies to help build muscle tone are usually done under medical supervision in an outpatient clinic or a doctor's office.

Vaginal cones. These tampon-shaped weights are inserted in the vagina, where they'll remain as long as you squeeze the right pelvic muscles. Cones come in various sizes. You start with the smallest and lightest, then once your muscles are able to hold onto the cone for at least 60 seconds, you move up to a heavier size, which will further strengthen your muscles.

Electric stimulation. This technique helps you identify the muscles you need to exercise. A low-grade electric current painlessly promotes contraction in the pelvic muscles. A stronger current brings on a stronger contraction. Several repetitive "shock" sessions can rebuild and strengthen pelvic muscles.

Biofeedback. This helps you gauge pelvic muscle development. Electric monitoring probes inserted in the vagina measure the strength of a pelvic contraction. Doctors often use biofeedback with electric stimulation.

Other treatments include collagen injections, which were first used by cosmetic surgeons to give women fuller lips. Urologists found this fibrous protein also causes swelling around the bladder, which stops leaks. Usually several injections, done under local anesthesia, are necessary.

Sometimes the muscles supporting the bladder are so weak that the bladder neck falls out of place. This allows urine to pour out of the body any time you make a sudden move. Surgeons can repair the fallen bladder neck by stitching it back into place, Dr. Whitmore says. But "surgery has a failure rate of 25 percent," she says. So it's always better to try behavior therapy first.