In women who have given birth vaginally, the most common type is stress incontinence–leakage caused by the physical stress of coughing, laughter or sudden movement. Stress incontinence occurs because the urethral sphincter (the muscle that opens and closes the urethra) or the pelvic-floor muscles have been weakened. The other common form–“urge incontinence”–involves an overactive bladder muscle. If you’re sprinting for the bathroom more than seven times a day, you probably have urge incontinence. It’s often associated with aging or sometimes with an underlying illness, but some women develop it when they consume acidic substances, such as citrus, tomato or pineapple.
Whatever the type or the cause, urinary incontinence can be devastating. Women who suffer from it often become isolated and depressed. They may stop traveling, or decline social invitations. Some sufferers give up physical activities, gain weight and begin to see themselves as old and disabled. Fortunately, it doesn’t have to be that way. With help from your doctor, and a little trial and error, you can devise a strategy for managing the condition.
Fluid management. Give up that old advice about drinking eight glasses of water every day. You don’t need that much liquid–and your bladder doesn’t need the pressure. Drink just enough to quench your thirst. Cut back on caffeine and alcohol, especially before bed or when you’re not near a bathroom, and avoid acidic fruits and drinks.
Bladder training. Emptying your bladder the minute it complains can actually make it more demanding. So train your bladder to go less often. For a day or two, keep track of how often you urinate. Then try extending the usual interval by 15 minutes. And once you’re comfortable with the new interval, extend it by another 15 minutes. Over several weeks or months you may find you can wait three hours or more, and have fewer episodes of urgency or leakage.
Pelvic-floor training. Kegel exercises are not just for pregnant women. Done correctly, they can strengthen the pelvic-floor muscles that support the bladder and urethra. To locate your pelvic muscles, pretend you are trying to avoid passing gas in an elevator. At the same time, squeeze the way you would to compress a tampon. Once you’ve learned to exercise these muscles in short, quick contractions, try extending the contractions up to a maximum of 10 seconds. One simple regimen is to do 10 contractions before getting up in the morning, 10 standing after lunch, 10 in the evening while sitting and another 10 before falling asleep. Whether you suffer from stress incontinence or urge incontinence, flexing these muscles can help you avoid accidents.
Medications. Drugs known as anticholinergics can help alleviate urge incontinence by stabilizing the overactive bladder muscle. The most common ones are oxybutynin (Ditropan) and tolterodine (Detrol). They’re effective in about 40 percent of women, but can cause dry mouth and other side effects. The new slow-release versions are easier to tolerate. Other medications can worsen urinary incontinence. Diuretics may rapidly fill the bladder, for example, and the blood-pressure drug terazosin (Hytrin) may relax the bladder outlet muscle. Talk with your doctor if you suspect these treatments are causing trouble.
Surgery. This is also an option, primarily for stress incontinence. In one common procedure, the surgeon implants a strip of synthetic mesh to support the urethra when the surrounding muscles can’t. The “urethral sling” goes in through two small incisions in the lower abdomen and stays in place without sutures as your body covers the mesh tape with scar tissue.
Electrical stimulation. This procedure desensitizes the bladder muscle and may help improve urge incontinence. It can be done in a doctor’s office or at home.
Given all these options, almost anyone can find some relief. So work with your doctor to find an approach that suits your preferences. Incontinence doesn’t have to rule your life.
