Reducing the Embarrassment of Incontinence

Fear of bladder accidents can isolate you from work, friends, and family. You may feel so alone, but you’re not. About 25 million American adults — most of them women — deal with the same problem. Incontinence is not a normal part of aging, nor is it something you just have to live with.

First Steps

It’s hard to admit incontinence to yourself, let alone tell your doctor. That’s why women wait, on average, six years before getting diagnosed. Take the first step and call your primary doctor. You may be referred to a urologist, gynecologist, or urogynecologist, who treats urinary conditions. At your first visit, ask your doctor whether your diet, health conditions, or medications could be causing the problem.

Before your doctor can treat incontinence, he needs to know what type it is and what’s causing it. Menopause and childbirth (in women), prostate problems (in men), medication, and obesity can all contribute to incontinence. When a cough, laugh, or sneeze releases urine, it’s likely stress incontinence. With urge incontinence, you feel a sudden need to go before leakage happens. Overactive bladder (OAB) is marked by urinary frequency and urgency. Stress and urge incontinence are the most common types of urinary incontinence. People may also have a combination of the two.

A few routine changes can help prevent leaks and get you back to your favorite activities. Don’t stop drinking fluids — you’ll become dehydrated. Limit each drink to 6 to 8 ounces, and stop drinking two to four hours before bedtime. Avoid caffeine, alcohol, and artificial sweeteners, which can increase the urge to go. If you’re overweight, losing weight will ease pressure on your bladder. And stamp out cigarettes — smoking can affect the bladder, too.

Your Options: Kegels

Preventing leakage could be as simple as squeezing muscles you already use several times a day. Kegel exercises work the pelvic floor muscles — the same ones you use to start and stop the flow of urine. To do a Kegel, you squeeze and hold these muscles for about 10 seconds. Then release. Do about 10 to 20 Kegels a day. Not sure what to squeeze? Biofeedback sessions can help you find the right muscles.

Your Options: Bladder Retraining

Putting your bathroom visits on a schedule can help you gain more control over your bladder. In bladder retraining, you go to the bathroom only at regular intervals — for instance, every two hours. If you have to go before your scheduled time, use Kegels or relaxation techniques to hold it in until the urge passes. Over time, you’ll train yourself to go less frequently, with longer and longer intervals between bathroom breaks.

Your Options: Medicine

Some drugs can treat incontinence related to overactive bladder. Anticholinergics help control bladder contractions. A tricyclic antidepressant may sometimes be prescribed to help relax the bladder muscle. Side effects from these drugs can include dry mouth, fatigue, and blurred vision. Some people may not be able to take these medications, however. Men with incontinence problems related to an enlarged prostate may get help from alpha blockers, which relax muscles of the prostate and bladder neck, and 5-alpha reductase inhibitors, which help reduce prostate size.

Your Options: Other Treatments

For stress incontinence, a pessary device inserted into the vagina presses against the bladder neck and urethra so you have less leakage. Injections of collagen and other bulking substances can thicken tissues around the bladder neck to narrow its opening. Sling or suspension surgery lifts the urethra and bladder neck back into place. For urge incontinence, painless nerve stimulation therapy may discourage nerves from signaling a full bladder too soon.

Men and Incontinence

Men can experience incontinence as a result of illness or injury. Sometimes men develop overflow incontinence because of an enlarged prostate gland. The prostate might squeeze and block the regular flow of urine from the bladder. While bladder retraining, lifestyle changes, and Kegels work for men too, medicines or surgical treatments may help. Surgical options include artificial sphincters or male slings, which support the urethra and keep it closed when necessary.



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