Raphael Cooper, M.D. [June 14 2012]
Sometimes all it takes is a laugh or a sneeze to trigger an unsettling problem that tends to increase with age and, for women, can be prompted by childbirth. The problem is incontinence, an uncontrolled loss of urine. It's an issue that isn't always easy to talk about but one that is often treatable.
There are two main kinds of incontinence: stress incontinence and urge incontinence. Stress incontinence is more common in females, especially after childbirth, and in women is triggered by the stretching of pelvic muscles which support the bladder and urethra. Aging increases stress incontinence likelihood, as does menopause for women since lower estrogen levels also affect bladder control. Urine loss may be very minor or heavy to the point that clothes may moisten if there is no panty lining or pad.
With urge incontinence, one simply can't make it to the bathroom quickly enough to urinate; urine comes out spontaneously. While urge incontinence is more common in women, men are more likely to have this type of incontinence vs. stress incontinence. The incidence of urge incontinence increases for both men and women with every decade in life. The culprit is an overactive bladder; nerves that stimulate the bladder are sending inappropriate signals to suddenly release urine.
In males, urinary incontinence is often related to enlarged prostate or previous prostate surgery or pelvic radiation.
Now that you have some basic information about these two types of incontinence, it's good to know varied treatments are available.
• Surgery. For women, a common procedure for stress incontinence is tension-free vaginal tape (TVT) surgery. This surgery adds support to the urethra by placing a thin mesh sling underneath it, thereby reinforcing the supporting muscles and ligaments. This outpatient procedure, available for about 20 years, has an 85 percent cure rate for women. There are also slings available for men.
• Medicine. A common treatment for urge incontinence is anticholinergic medication, which blocks inappropriate signals sent from the spinal cord to the bladder, preventing uncontrolled bladder contraction. This medicine can be taken long-term.
• Kegel exercises. These exercises strengthen the pelvic floor muscles and are an option for men and women. How it's done can best described as tightening your buttock muscles for five or 10 seconds and then relaxing; repeat for a few minutes. These exercises should be done several times daily on a regular basis.
For either type of incontinence, it's best to drink a moderate volume of liquid, being careful not to dehydrate yourself. Also limit caffeine to at most one cup a day as caffeine is a diuretic and tends to contribute to dehydration. Any caffeine can cause more urgent or frequent urination. Avoid diet sodas as they can irritate the bladder.
Dr. Raphael Cooper is a member of The Hospital of Central Connecticut (HOCC) medical staff. For referrals to HOCC physicians, please contact our free Need-A-Physician referral service by phone at 1-800-321-6244 or online, www.thocc.org.