Most women know that loss of bladder control (urinary incontinence or UI) is common, affecting women of every age and over 200 million people worldwide. In the U.S. alone, it's estimated that incontinence costs $16.3 billion annually, three-quarters of which is spent on the management of incontinence in women. Roughly one in five women with UI also experiences loss of bowel control. Incontinence is life-altering — yet studies indicate that women wait seven years on average before consulting a doctor. Feelings of embarrassment and stigma — along with a fear of treatment — keep women from enjoying life; they're afraid to travel, go to a movie or even take a walk, all because of their misbehaving bladder.
The under-reporting of incontinence is partly due to myths such as that UI is caused by aging, being female, having several children or worst of all, that nothing can be done. None are true. Today, there's more hope than ever as new treatments, devices and more feminine absorbent products become available.
Understanding the Urinary System
Most people don't realize how amazing the urinary system is. It's composed of two kidneys, the ureters, bladder and urethra. The kidneys filter waste and remove it in urine. Urine travels down the ureters (thin, hollow muscular tubes) to the bladder muscle to be stored, then is emptied through the urethra to the outside. As the bladder fills, it expands, while the urethral sphincter remains closed to prevent leakage. When you go to the bathroom, the brain signals the sphincter muscles to relax and the bladder muscle to contract. When finished, the sphincter contracts, the bladder relaxes and the cycle begins again.
Taming a Misbehaving Bladder
Stress urinary incontinence (SUI), urge, and mixed incontinence are the most common types in women. SUI occurs during activities such as sneezing, lifting, or exercising, while urge incontinence is associated with sudden onset of urgency and involuntary bladder contractions. Approximately one third of women with incontinence have mixed incontinence, SUI and urge combined. Overactive bladder (OAB) refers to the symptoms of frequency, urgency, and nocturia (urinating at night), with or without incontinence.
The National Institutes of Health recommend that treatment for incontinence begin with the least invasive optionsfirst. For SUI, pelvic muscle training may be initiated including Kegel exercises, electrical stimulation and biofeedback; for some, elective surgery may be suggested. Options to address urge incontinence include: fluid management; bladder training to suppress urge; medications; botulinum toxin injections; and neuromedulation. Fortunately, some treatments may improve both stress and urge. Women with mixed incontinence may elect to treat the symptom, which is most bothersome first. "Treatment should be individualized based on your symptoms, goals, and overall medical condition," states urologist Jerry Blaivas, M.D. in his informative book, Conquering Bladder and Prostate Problems.
Some causes of bladder control problems — including diuretics, urinary tract infections, stool impaction or poorly controlled diabetes — are reversible. There are also lifestyle changes you can make. Maintaining an ideal weight, not smoking, alleviating constipation and restricting your intake of alcohol and caffeine (coffee, soda pop, chocolate and tea) will all make for a happier bladder. In addition, many have found avoiding spicy foods and acidic fruits to be beneficial.
If you own a misbehaving bladder and have not sought treatment, remember the following:
- Incontinence is a symptom, you need to know the cause
- Doctors and nurses (used to treating bladder problems) will put you at ease
- Treatments for incontinence are elective, so seek out a specialist who is interested and knowledgeable about the subject (urologist, urogynecologist or gynecologist)
Taming your bladder is about quality of life ... yours!
To learn more about the Simon Foundation for Continence, visit: www.simonfoundation.org.
— Cheryle Gartley
