September 13, 2018

Urinary Incontinence

Treated and controlled

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It’s a problem usually associated with older adults but it can strike at any age. It affects millions of Americans, but it’s most common in people over 50 years old, especially women. But it can also affect younger people, especially women who have just given birth.  As difficult as urinary incontinence is to discuss with a medical professional, most people dealing with this problem should know that it can be treated and controlled, if not cured. Urinary incontinence involves the loss of control over the bladder, where the body stores urine. During urination, the muscles in the bladder contract or tighten. This forces urine out of the bladder and into a tube called the urethra that carries urine out of the body. At the same time, the muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move. Incontinence occurs if the bladder muscles contract or the muscles surrounding the urethra relax without warning.

Coughing, sneezing, laughing

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There are several types of urinary incontinence. Stress incontinence happens when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is the most common type of bladder control problem in younger and middle-age women. Urge incontinence happens when people can’t hold their urine long enough to get to the toilet in time. Healthy people can have this form of incontinence, but it is often found in people who have Parkinson’s disease or multiple sclerosis. Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Functional incontinence happens in many older people who have normal bladder control but have a hard time getting to the toilet in time because of arthritis or other disorders that make moving quickly difficult.

A symptom, not a disease

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Urinary incontinence isn’t a disease, it’s a symptom. It can be caused by a number of things, from things you eat or drink every day to certain medical conditions or physical problems. Alcohol and caffeine, for example, may act as diuretics, stimulating your bladder and increasing your volume of urine. Chocolate, chili peppers and foods that are high in sugar or acid can do the same thing. A urinary tract infection can irritate your bladder, leading to a strong urge to urinate and possible incontinence. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman’s reproductive system, such as a hysterectomy, may damage the supporting pelvic floor muscles, which can lead to incontinence. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of the treatments for prostate cancer.

Avoid certain foods and drinks

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Preventing episodes of urinary incontinence is not always possible but there are certain things that can reduce the likelihood or severity of these episodes. Constipation and chronic straining during bowel movement can weaken the muscles and nerves and stretches the connective tissues of the pelvic floor, causing women to develop incontinence.  A diet with plenty of fiber and fluids, as well as regular exercise is important for maintaining healthy bowel function.  If constipation persists despite these measures, further evaluation and treatment is recommended. Avoiding certain foods and drinks may help prevent or limit incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do. And avoid heavy lifting and learn how to lift safely by using leg and arm muscles.

Combination of treatments

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Treatment for urinary incontinence depends on the type of incontinence, the severity of the problem and its underlying cause. A trained physician can recommend the approaches best suited to the patient’s condition. Often a combination of treatments is used and most people treated for incontinence see a dramatic improvement in their symptoms. Treatment options fall into four categories, behavioral techniques, medications, devices and surgery. In most cases, the physician will suggest the least invasive treatments first, such as behavioral techniques like Kegel exercises and weight loss if you are overweight and moving on to other options if these techniques fail. The success of treatment depends most of all on the right diagnosis. If you are suffering from incontinence, talk to your doctor about the specifics and possible complications of treatment. Ask questions and express any concerns to find out which treatment is right for you.

Trusted by thousands of listeners every week, T. Glenn Pait, M.D., began offering expert advice as the host of UAMS’ “Here’s to Your Health” program in 1996. Dr. Pait began working at UAMS in 1994 and has been practicing medicine for over 20 years.