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House Call: Dealing with incontinence

Do you find yourself frequently getting up during the night to urinate? Or maybe when the urge hits you it is very sudden and strong. When this happens and you are not able to hold your urine, we call it “urinary incontinence” or loss of bladder control. It can happen to anyone, but it is more common as we age. It can be a symptom of a medical condition, a physical problem, or even everyday habits. There are four type of incontinence, and you can develop one or a mixture of two or more.

Stress incontinence. Leaking urine when you cough, sneeze, laugh, exercise, lift something heavy, or exert pressure on your bladder in some other way.

Urge incontinence. Experiencing sudden, strong urges to urinate and then an involuntary loss of urine.

Overflow incontinence. Dribbling urine frequently because your bladder is full, but you can’t feel it.

Functional incontinence. Having an impairment (physical or mental) that makes it difficult to get to and use a toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

No matter what kind of incontinence you experience, it can be uncomfortable, inconvenient and embarrassing. The good news is that many of the underlying conditions that cause incontinence can be treated. There are exercises you can do and lifestyle changes you can make to prevent incontinence and improve your ability to control your urine. I recommend maintaining a healthy weight, practicing pelvic floor exercises, avoiding bladder irritants, such as caffeine and alcohol, eating more fiber and not smoking. I commonly find that patients who suffer from frequent or uncomfortable urination and who don’t have a bladder infection improve if they cut back on caffeine. If that doesn’t help, then other testing may be needed.

Stress incontinence is more common in women, and particularly in women who have had babies. It’s caused by stretching and damage to the pelvic floor muscles during childbirth. It often improves with specific exercises that your doctor can explain to you. Sometimes a few visits with a physical therapist to coach you are needed.

Treatment depends on what is causing your incontinence. Your doctor will take a medical history and do a physical exam. The information gathered and your symptoms are usually enough to give your doctor a good idea about what is causing your incontinence. You will likely also need a urinalysis. Your doctor may ask you to keep track of several things for a few days: how much you drink and urinate, when you urinate, whether you had an urge to urinate and the number of incontinence episodes. There are also tests that can help determine the cause of your incontinence, like checking to see how much urine is left in your bladder after you try to empty it, urine flow (urodynamic) testing, and pelvic ultrasound.

You may have to take more than one approach to resolve your incontinence. Treatment can involve behavioral techniques, pelvic floor muscle exercises, medication, medical devices, biofeedback, and in some cases surgery. Your doctor will discuss your options with you and together you can decide on the treatment plan that best suits you. Some treatments may take some time before you start to notice a difference, so try to be patient and stick with it before asking your doctor to try something else.

With the right combination of treatments, you can improve or even get back to being accident free, so talk to your doctor and see what he or she recommends.

Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.


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