Therapy, training can help incontinence

It happens to a lot of us, women in particular. We’re standing at the front door, key in hand, and all of a sudden we have to pee. NOW. We cross our legs. We do our Kegels. We pray we can get the door unlocked in time, make it to the bathroom in time, stay dry.

Or we’ve decided we need more exercise, and one of the things we love doing is bouncing on the trampoline. But it’s bounce, squirt, bounce, squirt. Not fun.

If we’re smart, we’ve got an incontinence pad tucked in our panties, a product that wasn’t available 10 years ago. It’s one of the advantages to being a baby boomer: If there’s a product we need, someone’s going to make it.

In another example of how nature sometimes picks on one sex more than the other, 85 percent of those who suffer from incontinence are women. The reason is simple: The urethra, the tube that connects the bladder to the outside world is a lot shorter in women. It also sits in direct contact with the vagina, and when babies are born, damage can happen.

We physician group incontinence into three major types: stress, urge and a mixed type. Those with stress incontinence leak with exertion—exercise, coughing, sneezing, laughing or lifting. Urge incontinence is that feeling that you’ve got to go immediately, and the urine starts leaking out before you make it to the bathroom. Many sufferers have both.

Gender (female) and genetics (some women just don’t have strong tissues) predispose to stress incontinence. Childbirth and hysterectomy might turn the theoretical into the actual. Then there are outside factors that can make the situation worse.

Obesity increases pressure on the bladder. Lung disease, because of increased coughing, increases pressure on the bladder as well. Smoking makes things worse (are you surprised?) because of smoker’s cough and the direct effect of nicotine on the bladder.

Menopause contributes to the problem, but recent studies show that estrogen replacement doesn’t seem to help, and it might make things worse. Chronic constipation can be a factor.

Urge incontinence, or overactive bladder (OAB), happens when the bladder muscles inappropriately contract. Damage to the bladder muscles can come about from trauma (childbirth), aging, atrophy (menopause), or loss of nerve function due to nerve injury. Illnesses like diabetes, congestive heart failure and multiple sclerosis can contribute to incontinence, and so can some drugs like diuretics, some hypertension medications, alcohol and caffeine.

The best starting point in attempting to control both kinds of incontinence is behavioral therapy. We recommend diet modification: restricting fluid intake at night to cut down on nighttime trips to the potty; eliminating bladder irritants such as alcohol, caffeine (no lattes?), nicotine and citrus fruits; and increasing dietary fiber to reduce constipation and straining.

Bladder training helps: Schedule trips to the bathroom every two to three hour, say, to keep the bladder relatively empty. And there are always those Kegel exercises, which, if nothing else, might help you hold on until you get to the bathroom.

Many physical therapists have programs for improving pelvic muscle tone, if the Kegels don’t work.

The best success seems to be with a combination of behavioral changes and medication. Two commonly used medications are Ditropan and Detrol. Both are available in extended-release capsules that cut down dosing to once a day and also reduce the major side effect of dry mouth. These medications don’t lead to a cure, so if they work, there’s a good chance you’ll be taking them forever.

Surgery doesn’t work for OAB, but it often can provide relief to women with stress incontinence caused by stretching of the tissues that support the bladder and rectum. (Blame the kids.)

So it is really worth talking to your health-care provider if incontinence is a problem. With help, you may be able to unlock the door, put down your groceries, pet the dog and then go to the bathroom.