 Are you reluctant to talk to your doctor about your bladder
control problem? Don’t be. There is help.
Loss of bladder control is called urinary incontinence. It can happen to anyone,
but is very common in older people. At least 1 in 10 people age 65 or older has
this problem. Symptoms can range from mild leaking to uncontrollable wetting.
Women are more likely than men to have incontinence.
Aging does not cause incontinence. It can occur for many reasons. For example,
urinary tract infections, vaginal infection or irritation, constipation, and
certain medicines can cause bladder control problems that last a short time.
Sometimes incontinence lasts longer. This
might be due to problems such as:
- weak bladder muscles
- overactive bladder muscles
- blockage from an enlarged prostate
- damage to nerves that control the bladder
from diseases such as multiple sclerosis or Parkinson’s disease
- diseases such as arthritis that can make
walking painful and slow
Many people with bladder control problems hide the problem
from everyone, even from their doctor. There is no need to do that. In most
cases urinary incontinence can be treated and controlled, if not cured. If you
are having bladder control problems, don’t suffer in silence. Talk to your
doctor.
Bladder Control
The body stores urine in the bladder. During urination, muscles in the bladder
contract or tighten. This forces urine out of the bladder and into a tube called
the urethra that carries urine out of the body. At the same time, muscles
surrounding the urethra relax and let the
urine pass through. Spinal nerves control how these muscles move. Incontinence
occurs if the bladder muscles contract or the muscles surrounding the urethra
relax without warning.
Diagnosis
The first step in treating a bladder control problem is to see a doctor. He or
she will give you a physical exam and take your medical history. The doctor will
ask about your symptoms and the medicines you use. He or she will want to know
if you have been sick recently or had surgery. Your doctor also may do a number
of tests. These might include:
- urine and blood tests and tests that
measure how well you empty your bladder.
In addition, your doctor may ask you to keep a daily diary of
when you urinate and when you leak urine. Your pattern of urinating and urine
leakage may suggest which type of incontinence you have.
Types of Incontinence
There are several different types of urinary incontinence:
Stress incontinence happens when urine leaks during
exercise, coughing, sneezing, laughing, lifting heavy objects, or other body
movements that put pressure on the bladder. It is the most common type of
bladder control problem in younger and middle-age women. In some cases it is
related to childbirth. It may also begin around the time of menopause.
Urge incontinence happens when people can’t hold
their urine long enough to get to the toilet in time. Healthy people can have
urge incontinence, but it is often found in people who have diabetes, stroke,
Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis. It is also
sometimes an early sign of bladder cancer.
Overflow incontinence happens when small amounts of
urine leak from a bladder that is always full. A man can have trouble emptying
his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal
cord injury can also cause this type of incontinence.
Functional incontinence happens in many older
people who have normal bladder control. They just have a hard time getting to
the toilet in time because of arthritis or other disorders that make moving
quickly difficult.
Treatment
Today there are more treatments for urinary incontinence than ever before. The
choice of treatment depends on the type of bladder control problem you have, how
serious it is, and what best fits your lifestyle. As a general rule, the
simplest and safest treatments should be tried first.
Bladder Control Training
Your doctor may suggest you try to get back control of your bladder through
training. With bladder training you can change how your bladder stores and
empties urine. There are several ways to do this:
Pelvic muscle exercises (also known as Kegel
exercises) work the muscles that you use to stop urinating. Making these muscles
stronger helps you hold urine in your bladder longer. These exercises are easy
to do. They can lessen or get rid of stress and urge incontinence.
Kegel Exercises:
The muscles you want to exercise are your pelvic floor muscles. These are the
ones you use to stop the flow of urine or to keep from passing gas. Often
doctors suggest that you squeeze and hold these muscles for a certain count, and
then relax them. Then you repeat this a number of times. You will probably do
this several times a day. Your doctor will give you exact directions.
Biofeedback helps you become more aware of signals
from your body. This may help you regain control over the muscles in your
bladder and urethra. Biofeedback can be used to help teach pelvic muscle
exercises.
Timed voiding and bladder training also can help
you control your bladder. In timed voiding, you keep a chart of urination and
leaking to determine the pattern. Once you learn that, you can plan to empty
your bladder before you might leak. When combined with biofeedback and pelvic
muscle exercises, these methods may help you control urge and overflow
incontinence.
Management
Besides bladder control training, there are several other ways to help manage
incontinence:
Sometimes doctors suggest a small, throwaway patch; a small, tampon-like
urethral plug; or a vaginal insert called a pessary for women with stress
incontinence.
A doctor can prescribe medicines to treat incontinence. Some drugs prevent
unwanted bladder contractions. Some relax muscles, helping the bladder to empty
more fully during urination. Others tighten muscles in the bladder and urethra
to cut down leakage. These drugs can sometimes cause side effects such as dry
mouth, eye problems, or urine buildup. Vaginal estrogen may be helpful in women
after menopause. Talk with your doctor about the benefits and side effects of
using any of these medicines for a long time.
A doctor can inject an implant into the area around the urethra. The implant
adds bulk. This helps close the urethra to reduce stress incontinence.
Injections may have to be repeated after a time because your body slowly gets
rid of these substances.
Sometimes surgery can improve or cure incontinence if it is caused by a problem
such as a change in the position of the bladder or blockage due to an enlarged
prostate. Common surgery for stress incontinence involves pulling the bladder up
and securing it. When stress incontinence is serious, the surgeon may use a wide
sling. This holds up the bladder and narrows the urethra to prevent leakage.
You can now buy special absorbent underclothing. It is not bulky and can be worn
easily under everyday clothing.
If you suffer from urinary incontinence, tell your doctor.
Remember, under a doctor’s care, incontinence can be treated and often cured.
Even if treatment is not fully successful, careful managing can help you feel
more relaxed and comfortable.
References:
National Institute on Aging
U. S. Department of Health and Human Services
National Institutes of Health
August 2002.
Nutritional and Herbal Therapy for Urinary
Incontinence
- Limit or do not consume caffeine, alcohol, sweetener
substitutes, simple sugars.
- Calcium (1,000 mg a day) and magnesium (500
mg a day) taken together may improve urinary muscle control.
- Cranberries can help keep bacteria from adhering to
the bladder and causing infections which make incontinence worse.
- Vitamin C (1,000 mg three times a day) can prevent
bacteria growth in the urine
- The Chinese herbal patent formula,
Jin
Kui Shen Qi Wan,
can help prevent urinary dribbling.
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