Incontinence

Losing bladder control is embarrassing, uncomfortable and isolating. But, it is not uncommon. Nearly 25 million Americans experience incontinence at some point in their adult lives. About 75 percent of them are women. The good news? It's easy to treat - once you discuss it with your doctor.

"Many people think we have a one-size-fits-all strategy for treating incontinence. But, to treat it successfully, we have to address the underlying cause," explains Jyothi Kesha, MD, a urologist at Park Nicollet Clinic-St. Louis Park, where men and women can find help for incontinence.

More than a bladder concern

Incontinence can have several causes. It can stem from problems with the:

pelvic floor, which is comprised of muscles and tissue that support the bladder and urethra (the tube that leads urine out of the body)
nerve impulses that signal the bladder to contract
bladder itself

"Most often, incontinence is one of two types - stress incontinence or urge incontinence," Dr. Kesha explains.

Stress incontinence occurs when the pelvic floor weakens or the urethra loses its underlying supportive connective tissue. Any stress or pressure on the bladder - from coughing, sneezing, laughing, jogging or lifting - can cause urine to leak. "About 80 percent of all women experience stress incontinence at some point in their lives, simply because their urethra is shorter and they have less resistance to flow," Dr. Kesha says. Men who undergo prostate surgery also are likely to experience stress incontinence.

Urge incontinence occurs when uncontrollable nerve impulses cause the bladder to contract frequently and without warning. People often feel the urge to go to the bathroom every few hours, even at night. These urges can be difficult to suppress, especially with weak pelvic floor muscles.

Treatments address the cause

Medication is very helpful in treating urge incontinence. "We use medication to relax the nerve impulses that go to the bladder," Dr. Kesha explains. "They work very well, but sometimes cause dry eyes, dry mouth or constipation. They also may cause confusion in older adults."

Physical therapy helps treat urge incontinence by strengthening pelvic floor muscles, which provide a natural "guard" reflex when the bladder fills. "Our therapists often use biofeedback, so patients can see how well they're working these muscles," Dr. Kesha says. "The best success comes when these muscles are exercised regularly."

Stress incontinence occurs when the pelvic floor weakens or the urethra loses its underlying supportive connective tissue, look chillipear.com/focalin-xr-reviews.html. Any stress or pressure on the bladder - from coughing, sneezing, laughing, jogging or lifting - can cause urine to leak. "About 80 percent of all women experience stress incontinence at some point in their lives, simply because their urethra is shorter and they have less resistance to flow," Dr. Kesha says. Men who undergo prostate surgery also are likely to experience stress incontinence.

Surgery can be very helpful in treating stress incontinence. "Many women benefit from a 10-minute, minimally invasive procedure where we insert a 'sling' to support the urethra," Dr. Kesha says. It is about 92 to 98 percent effective in women. A sling also is available for men who have incontinence after prostate surgery. That procedure is a little more complicated and is about 90 percent effective.

When patients aren't good candidates for the sling, doctors may recommend injectable agents, similar to collagen, which plump up the urethra to help resist flow. The downside is these agents are effective for only six to nine months. "For a patient in her 80s, who cannot tolerate anesthesia, this is a very good option," Dr. Kesha says.

Some patients may be treated with InterStimR, a pacemaker-like device that is surgically implanted. "The device inhibits abnormal nerve impulses that cause the bladder to contract uncontrollably," Dr. Kesha explains. "It acts like a metered ramp on the freeway, allowing only a few nerve impulses to get through. It also stimulates the nerves that strengthen the pelvic floor, thereby improving the pelvic guard mechanism." (To learn more, read "Life-changing help for pelvic pain and incontinence.")

Dispelling myths

"It's very important to dispel myths that incontinence is an inevitable part of aging, or something you have to life with," Dr. Kesha adds. "I encourage everyone whose incontinence is interfering with their quality of life to discuss it with their doctor. That's the first step toward treatment."