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From Incontinence to In Control

A gray hair, a wrinkle. Reluctantly, we accept these as inevitable signs of aging. Unfortunately, many people mistakenly believe urinary incontinence (the involuntary loss of urine) is also an inevitable and irreversible consequence of aging. If properly diagnosed, 80% of urinary incontinence cases can be treated, managed or even cured. Yet, few people ever get the help they need, embarrassed and unaware that bladder control problems are highly treatable.

The Symptoms

Simple acts like laughing, coughing, walking, sneezing, riding a bike and playing with grandchildren can bring sudden, involuntary wetness, odor and embarrassment. Forced to stay close to bathrooms, individuals with incontinence avoid travel, limit sexual relationships, curtail physical activities and refuse social invitations. Intimacy becomes difficult and skin irritations are common. Isolation, depression and low self-esteem can ensue.

It doesn't have to be that way. For those who have the courage to seek help and educate themselves, there is hope. And your condition never needs to be a source of public embarrassment.

The reality is that the only person you have to tell is your physician. Don't live with this problem and buy a diaper. Incontinence is not a normal part of aging.

What Causes Urinary Incontinence?

A number of factors contribute to short-term urinary incontinence, including urinary tract and bladder infections, constipation, excessive consumption of caffeinated drinks and medication side-effects. Common long-term causes include vaginal childbirth, excessive weight gain, injuries, neurological disorders, surgical procedures and a family history of urinary incontinence.

Who is Most Susceptible?

An estimated one in five men and one half of all women will experience urinary incontinence at some time during their lives. Of the estimated 19 million North American adults with urinary incontinence, 80 percent are women over 40. Men who develop incontinence are usually 60 years of age or older. But men and women of all ages, even children, can develop problems with urinary control.

In men, incontinence often occurs as a result of benign enlargement of the prostate, prostate surgery or neurological disorders. In women, vaginal childbirth is the most common cause of incontinence.

Women who've never had babies can have this problem as a result of repeated heavy lifting, chronic cough, time and gravity.

Together, these factors contribute to the loss of muscle tone in the pelvic floor. However, damage to the pelvic floor during vaginal delivery is the major reason for incontinence in women who have given birth.

In some cases, a woman's nerves and muscles of the urethral valve itself are damaged causing incontinence.

Is All Urinary Incontinence the Same?

Four of the most common types are:

Stress Urinary Incontinence
A common form of incontinence and the most curable, it is brought on by childbirth, aging, pelvic or prostate surgery. Abdominal pressure or stress exerted on the bladder results in urine leakage.

Urge Urinary Incontinence
Individuals feel sudden and overwhelming urges to void and suddenly leak urine. Common causes include bladder infection, bladder nerve problems or strokes.

Overflow Urinary Incontinence
This form of incontinence occurs when the bladder does not empty properly, and becomes so full it simply overflows. Usually associated with frequent or constant dribbling, overflow urinary incontinence can be caused by an enlarged prostate, damaged bladder, diabetes, bladder stones or other forms of obstruction.

Mixed Urinary Incontinence
Many individuals experience both stress and urge incontinence at different times or under different circumstances. The causes of the two forms may or may not be related.

How is it Diagnosed?

The most important thing to do is see your doctor for a complete medical exam and consultation. To help your physician make an accurate assessment, you can keep a voiding diary for several days before your visit. It's also helpful to provide your doctor with personal and family medical histories, a list of any prescription and over-the-counter drugs you're taking and a history of accidents and injuries. In addition, your doctor may recommend diagnostic tests.

Almost all patients suffering from urinary incontinence can be cured or significantly improved with proper diagnosis and treatment.

How is it treated?

Depending on the form and severity of your incontinence, a number of treatments are available to you, such as:

  • Physical Therapy -- Certain exercises can strengthen the sphincter muscles and improve bladder control. Kegel exercises, for example, can strengthen the pelvic floor muscles that support the bladder in women.

  • Medication -- Some prescription medications can relax the bladder or tighten the sphincter muscles. Estrogen, for example, can sometimes improve the thickness and tone of a woman's pelvic muscles and vagina. Several new incontinence medications are now available.

  • Injections -- Collagen can be injected around the urethra to add bulk and increase resistance to urine flow. It can be performed as an outpatient or in-office under local anesthesia, with most patients returning to full activity the next day.

  • Surgery -- For some people, surgery is the best option. A Burch Bladder Suspension is considered major surgery and requires a two- to three-day hospital stay. Recovery time can take six weeks. Another less invasive form of this procedure is called a Laparoscopic Burch Bladder Suspension. Done with a laparoscope (similar to a tiny, lighted telescope), this procedure requires only small incisions, about the size of a blouse button. Most patients go home the same day and recover in less than one week. For women with a weakened urethral valve, a urethral sling procedure may be needed.

So, despite the pervasive advertisements for incontinence products, don't be lulled into thinking the condition is normal. See your physician and improve the quality of your daily life.

Source: Central DuPage Hospital Neighbors September, 1998 pp. 8-9

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