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May 10, 2004
When
you gotta go, you gotta go. But what if you're sitting in
the front pew at your daughter's
wedding? Or on an airplane
with the seat-belt light glowing? If you find you don't always
make it to the bathroom in time, or you leak urine when you
jump, cough or laugh, you are among millions of women who struggle
with urinary incontinence. One woman in three suffers at least
occasional incontinence, but embarrassment has long kept most
of them from acknowledging the problem. Thankfully, that is
now changing. Incontinence is getting the attention it deserves — and
many women are discovering they can beat it.
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.
Adapted from "Better Bladder and Bowel Control," published
by Harvard Medical School. The booklet is available through
health.harvard.edu/NEWSWEEK.
© 2004
Newsweek, Inc.
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