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BY ILENE RAYMOND RUSH
ON A SUMMER trip to visit colleges with
her teenage sons, Nancy Schatz, ;;, had a
sudden need to “go.” With university buildings closed, few bathrooms were open.
Schatz frantically searched the campus,
when suddenly she lost control.
“It was the worst,” says Schatz, who
lives in Cheltenham, Pennsylvania. “I had
issues with urinary incontinence for about
;; years since the birth of my children, but
when I mentioned the problem year after
year to my gynecologist she simply
shrugged as if it were normal.”
A study by Elaine Waetjen, a urogyne-
cologist at the University of California
Davis Medical Center, which analyzed
nine years of data from ;,;;; women ages
;; to ;;, found that ;; percent of women
experienced the problem at least once a
month. About ;; percent had a more
severe problem, leaking several times a
week or every day, says Waetjen.
And, although it is common, half of
women with incontinence do not report it
to their doctors. In a ;;;; survey, the nonprofit National Association for Continence
(NAFC) found that of women who did talk
to their doctor about bladder concerns, ;;
percent were neither diagnosed nor
referred to a urologist or urogynecologist.
“Part of the problem is that continence
is a long conversation, and in an average
eight-minute doctor visit there often isn’t
time,” says Steven Gregg, the executive
director of the NAFC.
There is also embarrassment, which
can make women hesitant to bring up the
issue, particularly with a male doctor.
While doctors have been encouraged to
question midlife and older women about
the condition, many still find the conversation difficult, says Gregg.
Tracking types
There are two types of female urinary
incontinence. Stress incontinence is a loss
of urine that occurs with physical exertion—even laughing, sneezing or coughing
may increase pressure on the bladder.
Other women may feel a strong sudden
need to urinate just before losing urine, a
condition called urge incontinence, or
overactive bladder. Urge incontinence
involves muscles around the bladder,
which put pressure on the organ at inconvenient times or with too much frequency.
Many women experience both conditions, called mixed incontinence.
Exploring treatments
When it comes to treatments for urinary incontinence, much depends on how
much discomfort it causes a woman in her
everyday life, says Waetjen.
“Some women find that having occasional leakage isn’t as important to them
as the effort or risk involved in treatment,” she says. “But even if someone
leaks once a month there are things we
THECOSTCOCONNECTION
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can do to prevent it.”
Behavioral treatments yield about a ;;
percent success rate, according to Uduak
Andy, a urogynecologist at the Perelman
School of Medicine at the University of
Pennsylvania. They include:
Monitor fluid intake. “Despite the
press, women don’t need to drink eight to
;; glasses of water a day,” says Andy.
“Avoid dehydration, but don’t have an
overfull bladder.”
Eliminate caffeine, which can irritate
the bladder. This includes coffee, colas and
iced tea.
Retrain the bladder. Try to increase the
time between bathroom breaks, which
encourages the bladder to store more urine
before you need to go.
Lose weight. “Studies sho w that weight
loss and exercise can help both types of
incontinence,” says Andy.
Perform Kegel exercises. The exercises
strengthen muscles around the vagina and
under the bladder. If women can’t locate
these muscles, there are physical therapists who specialize in pelvic floor rehabilitation and a number of apps that teach
Kegel exercises.
Stop smoking. Smoking can promote
coughing and urinary leakage, and nicotine can cause bladder spasms.
If behavioral approaches don’t alleviate urge incontinence, there are medications that block signals to the brain that
trigger abnormal bladder contractions.
Other alternatives include neural stimulators to reduce bladder irritability, bulking
agents and Botox injections.
For stress incontinence, there is a
device called a pessary that offers pelvic
support as well as an over-the-counter
tampon-like device designed to prevent
bladder leaks. If none of this helps, there
are several surgical procedures, including
a sling to support or lift the urethra.
Four years ago, Schatz visited a women’s clinic, where she was diagnosed with
mixed incontinence and given a behavioral regimen to follow. But despite occasional leakage, she abandoned the
program and decided she could live with
her condition by exercising, doing Kegels
and restricting her fluid intake.
“If it got in the way of my other activities, I’d be willing to follow a program,” she
says. “But as it is, I try to accommodate it,
with pretty good results.” C
Ilene Raymond Rush of Elkins Park,
Pennsylvannia, writes regularly on health.
Dealing with incontinence
Controlling the leaks
FOR YOUR HEALTH
OUR DIGITAL EDITIONS
Click here to watch a video from the
National Association for Continence.
(See page 9 for details.)
