Talking the essentials: Protecting yourself from incontinence

• By Charles Thompson, M.D.
• January 15, 2018

Original article posted by the Lubbock Avalanche-Journal http://lubbockonline.com/

The late Joan Rivers was famous for the phrase, “Can we talk, here?” especially when it came to socially uncomfortable topics. Well. let’s talk about a very uncomfortable topic — urinary incontinence. The definition of urinary incontinence is the involuntary leaking of urine. This is an embarrassing and sometimes socially paralyzing problem that affects both men and women and is a huge societal cost. The cost of doctor visits, sanitary pads, medications and adult diapers alone is more than $19 billion per year in the U.S.

Your grandmother may have explained to you that leaking urine is a normal thing for women. Although incontinence can be a natural consequence of childbirth or aging, incontinence should not be thought of as any more normal than getting cavities in your teeth is a normal consequence of eating. The good news is that the average person can do something about both issues.

There are generally three types of incontinence: stress incontinence (leaking with activity, coughing, sneezing, lifting, etc.), urge incontinence (leaking due to having an overwhelming sensation to void, which is difficult to suppress) and mixed incontinence (leaking for both of the above reasons).

Stress incontinence is generally from an anatomical alteration, which decreases the support of the bladder or urethra. Pressures applied to the bladder are then able to overcome the urethral sphincter and urine leaks out. We often associate this problem with childbirth, but this also can happen in women who are weight lifters, farmers who carry heavy things, gardeners who squat a lot or women who are overweight. Anatomical issues often have to be repaired surgically, but most women can actually help this problem themselves by exercise. 

Kegel exercises help strengthen the pelvic support ligaments and muscles by specific contractions of those special pelvic muscles. It does take a long time, but Kegel exercises have been shown to improve stress urinary incontinence by up to 80 percent when done for a year. General exercise also is good for the bladder since it promotes weight loss, and as little as a 10 percent weight loss can improve stress urinary incontinence by 50 percent.

Urge incontinence often is accompanied by urinary frequency, and it makes you feel like you have to go immediately. In this circumstance, it’s the bladder itself that contracts causing the sensation. Sometimes, urge incontinence is a neuromuscular problem that needs special evaluation by your doctor, but again self-evaluation and treatment can be tried first. About half of my patients that have urge incontinence have a fluid management problem.

There is a rule that will always apply: what goes in, must come out. Simply stated, the more you drink, the more you go. This is confusing to many because they are given advice by weight loss programs, personal trainers and health care personnel to drink lots of water all the time, yet they can’t figure out why they have to go to the bathroom every hour and get up five times per night. Simply limiting water intake to two liters per day can drastically improve urinary frequency/urgency. Limiting caffeine also is a worthwhile strategy, since caffeine is not only a diuretic, but also a bladder irritant.

Medications, including over-the-counter meds, need to be evaluated with the help of your doctor, since some will increase urination. Bladder irritants include citric juices (cranberry, apple and orange), artificial sweeteners and spicy foods. Sugar can be a source of increased urine production, especially for diabetics. There are several different medications, including topical estrogen (by prescription only) and oxybutynin, among others, which can suppress the unwanted bladder contractions that may keep you running to the bathroom. Oxybutynin is actually in an over-the-counter patch, which controls side effects better than the prescription form of the drug.

In summary, urinary incontinence is an uncomfortable, but treatable, problem for many people, but especially women. Although we are finding out more about it and getting new treatments for incontinence every year, there are many strategies that women can employ themselves to ease the burden of the unwanted leak. Try the above strategies to stay dry before seeing your doctor.

Charles Thompson, M.D., is a female pelvic medicine and reconstructive surgeon at Texas Tech Physicians and an assistant professor in the Texas Tech Health Sciences Center School of Medicine’s department of obstetrics and gynecology.