Dealing with incontinence

ASK THE EXPERT

Ask The Expert -- Warren T. Oberle Mercy Hospital

December 15, 2008|By Holly Selby | Holly Selby,Special to The Baltimore Sun

Millions of women may suffer from incontinence, which can interfere with their everyday lives. But many are too embarrassed to report their symptoms or think that nothing can be done to ameliorate the condition, says Dr. Warren T. Oberle, a urologist with the Urology Specialists of Maryland at Mercy Hospital.

Incontinence, however, is treatable in the majority of cases.

How is incontinence defined?

Incontinence is unwanted leakage of urine. There are two types: One is called urgency incontinence and occurs when the bladder squeezes in, and the woman doesn't make it to the bathroom on time. And the second kind is stress urinary incontinence. This usually occurs when the pelvic floor musculature weakens with age or childbirth. So when the woman coughs or laughs or moves in other ways, there is leakage.

Who is at risk for incontinence?

All women, and sometimes there is no clear reason why they might be incontinent, especially with urgency. With stress incontinence, age and childbirth are the contributors, but urgency incontinence can happen to women of all ages. Estimates of how many women suffer from urgency incontinence have ranged from 12 percent to up to a third of women, but nobody really knows.

Why some women have urgency is not clearly understood - there are probably many reasons. But if a woman is incontinent, she certainly should be checked out by a physician to be sure she doesn't have a urinary tract infection.

Are there other symptoms associated with incontinence?

Not necessarily. With urgency incontinence, there also can be frequency and sometimes discomfort when urinating, but usually there are no other symptoms. It is typically diagnosed when the woman reports it.

Is there any way to prevent incontinence?

It can be treated with behavior modification: good urinary habits such as not holding your urine for prolonged periods of time and not hovering over the toilet. But those things are really aimed at decreasing urgency. As far as stress urinary incontinence goes, that is usually a physiological change in the tissue.

How is incontinence treated?

Stress urinary incontinence is treated with Kegel exercises, which are devised to strengthen the musculature of the pelvic floor or with some relatively simple surgical procedures in which the pelvic floor is supported.

And how is urgency treated?

Urgency can be treated with behavior modification, and there are many medicines available to help with the symptoms of urgency and urgency incontinence. There also is neurostimulation in which the nerves can be modulated. With this, a neurostimulator, which effectively is like a pacemaker, uses electrical impulses that can calm the nerves. But this is used much less frequently [than other treatments]; most women are treated with medicines.

There could be some women who are sensitized to aspects of diet like caffeine, and they can be helped with diet modification, but this isn't true for everyone.

Is there anything else you would like to add?

The most important thing to say is that incontinence is treatable. Urinary incontinence keeps a lot of women from doing everyday activities like going to the grocery store or visiting with friends. But it is very treatable in the vast majority of cases and usually pretty simply.

Holly Selby is a former editor for The Baltimore Sun.

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