Urine Incontinence — It’s Nothing to Sneeze At

One of life’s most embarrassing experiences is not being able to control your urination and soiling your clothes forcing you to leave any situation where you are engaged with others. It is one of the last medical conditions to remain in the closet as many men and women fail to seek medical attention for this common problem.
This blog will discuss the 4 types of urinary incontinence and what treatment options are available for this common problem.

Urge Incontinence occurs in women with an overactive bladder who may not be able to get to the toilet in time to prevent leakage, even though they tighten up all of their pelvic muscles, because they can’t control the bladder and keep urine in. Overactive bladder that leads to urge incontinence affects about 17 percent of women, but it increases to over 50 percent after menopause. Overactive bladder isn’t a normal part of aging.

Stress incontinence is a much more common type of incontinence. Menopause contributes to this problem, but stretching and tearing of the pelvic muscles during childbirth definitely sets the stage. The reduced muscle tone causes the urethra to sag. When pressure builds up in the abdomen from a cough, sneeze, laugh, jump or lift, internal organs put pressure on the bladder and a small amount of urine may escape.

Overflow incontinence occurs when more urine collects in the bladder than the bladder can hold and the excess urine leaks out. It can be caused by blockage of the urinary tract or nerve damage caused by conditions such as diabetes, stroke, or injury.

Functional incontinence is not really a problem with the urinary tract. It happens to people who can’t move quickly, who have eye problems or who suffer from confusion or memory loss. They simply can’t get to the bathroom in time.

Certain prescription drugs such as diuretics and some tranquilizers, and smoking and eating spicy foods or artificial sweeteners, or drinking alcohol and caffeine can irritate the bladder and worsen incontinence.

Mixed incontinence is a combination of both stress and urge incontinence.

Today, there are many more options to consider, from medications, pelvic floor physical therapy, and surgery. The first step is to have a work up to diagnose the underlying problem so that an appropriate treatment plan can be put into place. Sometimes more than one treatment is needed.
Treatment options include:
1. Bladder training — This approach teaches you to urinate only at scheduled times and waiting longer between trips to the bathroom. Start by going to the bathroom every 30 to 60 minutes while you are awake, even if you don’t have to go. After about one week, slowly increase the time interval by 30 minutes every week.

2. Kegel exercises — Dr. Arnold Kegel, a gynecologist at the University of Southern California, developed the exercises to strengthen pelvic floor muscles in 1948. Kegel exercises are often the first line of treatment for the millions of women in the U.S. suffering from unexpected bladder leakage due to coughing, sneezing, laughing or exercise. This if defined as stress incontinence but many women experience frustration because they unknowingly don’t perform the Kegels effectively, which leads to no improvement in symptoms. Most men or women need to do the exercises for 3-6 months before any changes will occur.

3. Pelvic Floor Electrical Stimulation with Biofeedback Therapy — This treatment uses computer graphs and sounds you can hear to show you which muscles you are exercising so you can perfect the exercises. Physical therapists and other professionals specially trained in problems related to women’s health teach exercises for the pelvic floor, trunk, back and extremities that can help strengthen the pelvic muscles and improve bladder control. The physical therapist may use devices that use mild, comfortable, electrical stimulation to train the bladder muscles when and how to squeeze.

4. InTone is a new FDA listed Class II Medical Device for home use that has been shown to effectively strengthen the pelvic floormuscles and helps to prevent embarrassing leakage without surgery or medication and can be done in the privacy of home. InTone is like a personal trainer for Kegel exercises.

5. Medications — Estrogen can be very helpful in improving the symptoms of some cases of incontinence. Studies have demonstrated improvement in 40- 70 percent of women. I have found that estrogen cream (one fourth to half an applicator) works better than either tablets or patches for this particular problem. Medications called smooth muscle relaxants (examples are oxybutynin and tolterodine) can also help if the problem is caused by abnormal bladder contractions.

6. Pessaries — These donut-like plastic or rubber rings are similar to a diaphragm used for birth control. They are fit into the vagina to lift and offer added support for the bladder when the pelvic muscles are weak.

7. Surgery — There are many operations that have been developed to support the bladder and improve or correct incontinence. Women don’t need to have a hysterectomy in order to control urinary incontinence. Most of these operations for incontinence can be performed as one-day surgeries.

8. Botox– If you don’t respond to oral medications, you may be a candidate for Botox injections directly into the bladder muscle. This, too, can be done as a one-day stay procedure and usually produces relief of symptoms of frequency of urination and urgency of urination with urge incontinence

Bottom Line: Women don’t have to suffer in silence. Successful treatment options are available and most women can be helped and made more comfortable and reduce their embarrassment.

Dripping and Depends-Loss of Urine After Prostate Gland Surgery

You Don’t Have to Depend On Depends!

Prostate cancer is the second most common malignancy in men. Many men will choose to have surgery on their prostate gland and have the entire gland removed if the disease is confined to the prostate gland. Unfortunately, the sphincter, or muscle that controls urination, is often injured at the time of surgery or is included in the surgical specimen. As a result men will have problems with urination after the surgery.

There are three types of urinary incontinence may develop after prostate cancer treatment. These are stress incontinence, overflow incontinence, and urge incontinence.

If you have stress incontinence, you leak small amounts of urine when you cough, sneeze, exercise or put pressure on your bladder. Kegel exercises may help strengthen the muscles in your pelvic floor. This allows you to delay urinating until you reach a toilet.
You may have thought that Kegel exercises were something only women do. In fact, the muscles that are strengthened with Kegel exercises are the same in both sexes. (For more information on Kegel exercises, please refer to my website, http://www.neilbaum.com)

Urge incontinence occurs when your bladder suddenly contracts and expels urine. You get an urge to urinate even though you know you emptied your bladder not long before. You urinate, and then get the urge again a half-hour later. Urge incontinence often comes in waves. It may not bother you all morning, for example, but it becomes insistent mid-afternoon. In the course of a few hours you may feel the urge four or five times.

Bladder retraining helps by increasing the amount of urine your bladder can hold. In this technique you suppress your urge and gradually prolong the time between trips to the toilet. This really works, but now and then there’s a crisis. You’ve ignored the urge, and ignored it again, and suddenly you’re pretty sure you aren’t going to hold it and need to dash to the bathroom. The trick is to know when your bladder is at its limit and go to the bathroom just before you have to make that mad dash.

Prescription medications, particularly oxybutynin (Ditropan), tolterodine (Detrol) and some antidepressants, can be effective. The antidepressants aren’t treating depression: They calm the sensations that come from your bladder.

Overflow incontinence results when your bladder cannot empty completely. As a result, urine dribbles out. Alpha blocker drugs help to more fully empty the bladder.

Even if your incontinence can’t be cured, it can be managed. Absorbent underwear and highly absorbent disposable pads can be worn with everyday clothing. A condom-like device can be fitted over your penis and connected to a drainage bag. There is also a rubber clamp that can be used to compress the urethra or the tube that transports urine from the bladder through the penis to the outside of the body. Also there is a ring that can be applied to the penis that will gently compress the urethra and prevent urine loss.

Bottom Line: Fortunately, most men who have prostate gland surgery will be able to control their urination. The few who have problems with urination can be helped with exercises, medications, devices, and only rarely will need additional surgery to correct the problem.