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Confronting Incontinence


Personal Business: YOUR HEALTH

CONFRONTING INCONTINENCE

If troubled by a leaking faucet in their home, most people wouldn't hesitate to get it fixed. Yet when a similar plumbing malfunction occurs within their own body, only one in nine does anything about it.

The federal Agency for Health Care Policy & Research estimates that 13 million people in the U.S. suffer from urinary incontinence. Usually left untreated, even though it responds to a range of therapies, loss of bladder control is most common among middle-aged women and the elderly. But it is far from limited to these groups. "We see males as well as females and all ages--from 16 to 99," says Joy Hewitt, a nurse specializing in urinary disorders at the Emory Continence Center in Atlanta.

CAUSE IS KEY. Urinary incontinence, no matter how severe, is not a disease or a natural part of aging. It is a symptom with many possible causes. So understanding the type of urinary disorder an individual has is key to determining an effective treatment.

Stress, urge, and overflow incontinence are the most prevalent kinds. The first occurs when the urethral sphincter (the valve that turns on and shuts off urinary flow) or the surrounding pelvic muscles have been weakened by years of gravitational pull, injury, or such events as childbirth or prostate surgery. "You have stress incontinence if you leak when you sneeze, cough, lift, or exert yourself physically," says Tim Boone, a urologist with Baylor College of Medicine in Houston.

Whereas stress incontinence is anatomical in nature, urge incontinence is neurological. "Something in the brain or nervous system isn't working quite right," explains Thomas Rohner, professor of urology at Pennsylvania State University College of Medicine in Hershey. The urge condition occurs when the bladder contracts suddenly to expel urine, leaving insufficient time to get to the bathroom.

Finally, overflow incontinence results from a blockage--usually an enlarged prostate or growth--that inhibits the bladder from emptying completely. People in this group feel the continual need to urinate but can't release more than a few drops. They also tend to leak small amounts constantly.

Regardless of the type, many techniques can substantially improve if not cure incontinence. The first step is to rule out as culprits a urinary tract infection, constipation, and certain drugs, such as sedatives, diuretics, antidepressants, and some over-the-counter cold tablets. All can cause leaking and are easily remedied with antibiotics, laxatives, or a change in medication, respectively. Also, the National Association for Continence (NAC) reports that some of its members have solved their problems by avoiding caffeine. However, there is no scientific evidence to support such claims.

Strengthening the pelvic floor muscles through contract-and-release exercises (commonly known as Kegel drills), vaginal weights, which are teardrop-shaped devices that are inserted into the vagina, and electrical stimulation, which uses electrodes to strengthen weak muscles, helps both stress and urge incontinence. Beth Shelly, a physical therapist who specializes in pelvic floor dysfunction at Woman's Hospital in Baton Rouge, La., says that most people are unaware of the muscles that control urinary flow and therefore "confuse them with muscles that are in their abdomen and buttocks" when asked to hold and release. Biofeedback therapy works well in training people to isolate and control their pelvic floor muscles. Scheduled voiding and bladder retraining--gradually increasing the time between trips to the bathroom--are other behavioral strategies.

When medication is used, physicians usually prescribe muscle relaxants to inhibit unconscious bladder contractions or drugs that tighten up sagging pelvic muscles. Women with stress incontinence may take estrogen because it stimulates the production of tissue around the urethral wall, creating a better seal against leaks. Women also have the option of inserting bladder supports and tampon-like plugging devices into the vagina to control seepage.

STABILIZE. Failing behavioral and medicinal approaches, surgery is usually indicated. More than three-quarters of patients who undergo surgery to treat their incontinence are cured, according to the Alliance for Aging Research in Washington, D.C. Most surgeries involve "lifting and stabilizing" the bladder or urethra, says David Staskin, assistant professor of urology at Harvard Medical School in Boston. Surgeons essentially tack up these structures by sewing them to fixed ligaments, such as the one found behind the pubic bone.

In the case of overflow incontinence, the obstructing prostate or growth is removed to restore normal urinary function. Another surgical technique involves the injection of collagen around the urethra to bulk it up and thereby increase its capacity to hold back urine. "People should realize that they don't have to put up with incontinence," says Lisa Verdell, director of membership at the NAC. "With all the treatments that are available, there is always something that can be done."EDITED BY AMY DUNKIN By Kate MurphyReturn to top


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