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Many Causes, And Cures, For Incontinence,0,5768186.story?coll=ny%2Dhealth%2Dheadlines

March 18, 2003
Dr. Allen Douma

Q. I'm female and had a bladder infection this past summer after sex. Since then, after sex, I am incontinent of urine but do not experience burning. This lasts for four to seven days, with almost no control of my bladder. The loss of control fades over about a month. This is the first time I have ever had a bladder infection. Is this a type of infection or has something changed anatomically and is aggravated by sex? What is the cause and what should I do?

A. Urinary incontinence, the involuntary loss of urine, can occur in many younger people because of conditions such as pregnancy, trauma to the opening of the urethra (the tube from the bladder to the outside) and multiple sclerosis. But it usually occurs in older people with no other medical condition.

There are four types of urinary incontinence:

Total incontinence (perhaps your type), due to a complete lack of functioning of the urinary valve; it is usually caused by injury or genetic defect.

Stress incontinence, often caused by problems in women related to childbirth, menopause or decreased hormone levels.

Urge incontinence, caused by poorly functioning valves that don't close tightly.

Overflow incontinence, caused by long-term urinary retention as a result of pressure on the urethra, seen more often in men with enlarged prostates.

For people with chronic incontinence, without a correctable reason, self-care measures include voiding at regular intervals according to a schedule and moderation of fluid intake.

Also, relaxing while urinating helps to empty the bladder. Absorbent pads are a good idea as a backup.

Women taught pelvic muscle control exercises, especially when using biofeedback, can obtain an 80 percent reduction in incontinent episodes.

Oxybutynin (Ditropan) and tolterodine (Detrol) are medications that have been shown to help a large percentage of women. They do not cure the problem but help keep it under control.

Finally, surgery may correct the problem if nothing else works. It is the most effective treatment for stress incontinence. Between 75 and 85 percent of people having that surgery are cured.

A new approach - the FemSoft Insert - has recently been approved, in which a disposable, fluid-filled sleeve is inserted into the urethra to prevent leakage. It is removed when you urinate.

However, your incontinence appears to be based on trauma to the urethra, its valve or the surrounding muscles, during intercourse. This can occur without your being aware of the damage.

I strongly suggest that you see a doctor and be examined while you're having the problem. And it probably would be helpful if you can time the office visit to shortly after having intercourse.

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