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You don't have to live with incontinence

2:15 a.m. PDT Saturday, June 14, 2003
Anthony Stone, M.D. -- UC Davis Medical Center
The Sacramento Bee

Incontinence is the inability to hold urine until you can reach the bathroom. Women may experience incontinence at any age, but it is most common in postmenopausal women. It affects about 35 percent of women over age 65.

Many women with incontinence are embarrassed about it and do not mention it to their doctor. Instead, they tolerate the problem by wearing protective undergarments and avoiding certain activities.
You may think that incontinence is just a normal part of aging, but the condition is usually treatable. By discussing it with your doctor, you can learn about your options and begin to enjoy life without having to wear protection.

The types of incontinence

Urine is held in a part of your body called the bladder. The urethra is the tube that allows urine to pass out of your body. If the bladder muscles contract without your permission or the muscles around the urethra relax suddenly, you will experience leakage of urine.

The two primary types of incontinence are stress incontinence and urge incontinence. Women may experience one or both types.

Doctors usually diagnose incontinence based on a woman's symptoms. Tests may be used to evaluate how the bladder behaves as it fills with urine. The key factor in both types of incontinence is the way a woman's pelvic floor muscles work. Therefore, the goal of treatment is to cause the pelvic floor muscles to react properly.

Treating urge incontinence

The simplest treatment for urge incontinence are Kegel exercises. These exercises strengthen the pelvic floor muscles so they react properly, turn off the urge sensation and allow you to hold urine longer. Your primary care doctor, gynecologist or urologist can teach you how to do Kegels.

If Kegels do not resolve the incontinence, your doctor may prescribe medication that will prevent the bladder muscles from contracting inappropriately. Newer medications are timed release and have fewer side effects than those available several years ago. Medications and regular pelvic floor exercises effectively alleviate urge incontinence in 80 percent of women.

If urge incontinence continues even with the use of exercises and medication, two other procedures may prove effective:

Treating stress incontinence

Regular Kegel exercises are often sufficient to alleviate stress incontinence. If they do not resolve the problem, another option is a simple, 30-minute operation that is performed in an outpatient setting. The procedure involves implanting special tape around the urethra. The tape is made of polypropylene, a material that will not degrade in the body. The tape restores the normal support to the bladder outlet. The results of this surgery have been excellent, and it has the advantage of allowing a return to normal activity soon after the procedure. Until recently, medications have not been effective in treating stress incontinence; however, a new drug may offer minor improvements.

Deciding if you need treatment

How do you know if you have incontinence? If you have to rush to the bathroom often, or if you have a leakage episode more than once a week, you should mention it to your doctor.

If you do not have leakage problems, but have to urinate frequently, you may also want to seek evaluation. Frequent urination is defined as more than eight times a day or more than three times during the night. The problem is sometimes treatable with medication.

Some primary care doctors are unaware of new advances in treating incontinence. If your bladder control problems are affecting your quality of life and limiting your activities, mention it to your doctor. If he dismisses it as something you just have to live with, ask for a referral to a urologist or urogynecologist. Incontinence is not a problem that you have to endure.

What you should know about male incontinence

Although it's most common in women, men also experience incontinence. They may awaken often in the middle of the night to urinate. They may also have to urinate frequently during the day or rush to the bathroom. These symptoms are usually caused by an enlarged prostate. Many men fear having the problem evaluated because they think it might indicate prostate cancer. But women can reassure their partners by explaining that an enlarged prostate is not the same as prostate cancer, and it can usually be treated with medication. In general, urologists recommend that men have a regular 'prostate check' after age 50.

About the Writer

Anthony Stone, M.D. is a Professor of Urology at UC Davis Medical Center and Vice Chair of the Department of Urology. He is an expert in male and female urinary incontinence and has co-edited three books on urological conditions.

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