Avoiding the Restroom Rush: Urinary incontinence is a common but treatable ailment
Illustration by Stephen Sauer
Urinary incontinence is not often a centerpiece of polite conversation, and many patients are reluctant to bring it up even behind a closed door with their doctor. But the unintentional release of urine affects 25 million Americans, according to the National Association for Continence. It's the elephant in the restroom, you might say. Some people choose to suffer in silence because they are embarrassed; others write it off as an inevitable consequence of childbearing or aging.
It's not, though, and being more forthcoming, at least with your doctor, can be worth the knock to your pride. Incontinence can have sweeping effects, after all, interfering with work and play and everything in between as you fret about leaking. If you're tired of race-walking to the nearest toilet, know that there are treatment options that can help you stray far from the nearest bathroom without worry.
What's your type
There are various types of urinary incontinence, says Steven E. Kahan, MD, JD, a urologist with Core Physicians Urology in Portsmouth and Exeter, and Exeter Hospital, and their causes are not always clear. Stress incontinence, often brought on by pregnancy and childbirth, features urinary leaking brought on by coughing, laughing, sneezing or other movement. Urge incontinence (also known as overactive bladder) can lead to suddenly feeling compelled to go to the bathroom - often on cue after, say, hearing running water or seeing a restroom sign - and sometimes not being able to make it without leaking. Some patients experience mixed incontinence, which is a combination of the stress and urge types. And yet another variety, called overflow incontinence, occurs when the bladder doesn't work properly, leading to over-retention of urine and consequent leaking. "We often see overflow incontinence in people who are or used to be teachers, nurses, pilots, truck drivers - anybody who, over the years, hasn't heeded the call to go to the bathroom," Kahan says. Overflow incontinence can also be caused in men by an enlarged prostate, he says.
Even though urinary problems can plague men, incontinence is often considered a woman's problem, and it largely is, with pregnancy, childbirth and menopause stacking the deck against women. It's most common in older women but can occur at any age. "About a third of all women have some pelvic floor dysfunction symptoms, with incontinence being the most common," says Veronica Triaca, MD, a urologist with Concord Hospital Center for Urologic Care. "It's incredibly prevalent and probably underestimated" since so many patients are reluctant to discuss incontinence with their primary care doctor, she says.
Lowering your risk
Multiple factors can increase your risk of developing urinary incontinence, and unfortunately some are difficult or impossible to avoid, given that triggers in women can stem from genetics, the number of children a woman delivers and whether she delivers vaginally or via cesarean section, Triaca says.
But lifestyle choices also matter. If you want to avoid trouble, be nice to your bladder. Cut back on caffeine, artificially sweetened drinks and alcohol since all three can irritate or stimulate the bladder. Watch your weight and don't smoke. "Smokers have a higher incidence of overactive bladder, probably from the by products of tobacco," Triaca says. Also, limit citrus and spicy foods, which can produce overactive bladder symptoms. "All of these are the bladder's irritants and are things to avoid, certainly if you have the diagnosis of incontinence," she says.
In addition, remember to listen to and take care of your body, Kahan says. If it tells you to take a bathroom break, then take one if possible. Regularly perform pelvic floor exercises such as Kegel exercises, which focus on clenching and relaxing muscles that control the flow of urine. Strengthening the pelvic area muscles will help the body function more optimally and can help lessen or prevent incontinence symptoms, Kahan says. Be sure to learn how to perform the exercises properly.
Treatment for incontinence varies greatly. Often, however, doctors will suggest trying the least-invasive remedy first, when it makes sense to do so. Incontinence patients typically are instructed to change habits involving caffeine, alcohol and other bladder stimulants, then to try physical therapy and medication if necessary, progressively working up, if need be, to surgical intervention. "There are certain situations where we need to be aggressively treating folks, but most often we don't, so we go by a quality of life measure" to determine how best to treat the patient, Triaca says. "It varies according to the severity and the nature of the incontinence," she says.
When surgery is needed, some of the more common incontinence remedies include injecting collagen or another agent to "bulk up" the urethra (the tube that carries urine out of the body); insertion of a urethral sling to support the urethra; and neuromodulation, which involves using a pacemaker-like device to help control symptoms. Also, the FDA has recently approved Botox injections in the bladder, Triaca says, to prevent involuntary bladder contractions that can lead to urinary leaking.
If you're bothered by incontinence, try to overcome the embarrassment factor and seek treatment, experts say. "Many older women, especially, just kind of resign themselves to it, thinking this is a part of aging, and they don't come in [to the urologist] for help," Kahan says. But incontinence is not a normal part of aging, he says. "Oh, no, no, no," Kahan says. "Absolutely not."
You've got troubles
More women than men experience urinary incontinence, but men with an enlarged prostate, which can slow or block the flow of urine, can also suffer from it. Fortunately, treatment has evolved to bring solutions with less risk. For example, a variety of medications are on the market now to relax urinary muscles and allow flow to increase; others are designed to shrink the prostate, says Steven E. Kahan, MD, JD, a urologist with Core Physicians Urology in Portsmouth and Exeter, and Exeter Hospital. Given the increasing medication choices, "many prostate patients who historically would have had surgery [for incontinence] are now fine just on medication," Kahan says.
If medication does not work for a patient for whatever reason, surgery remains an option. But even surgery patients now have a minimally invasive choice called "green light laser treatment" for an enlarged prostate, a recent development that is lower-risk than traditional prostate surgery and performed as an out-patient procedure. "A lot of the complications related to the old procedure just don't happen with the green light laser, and patients like it because they go home the same day," Kahan says. "The results have been great."Edit Module