Dr. M.J. Bazos, MD.
Patient Handout
URINARY
INCONTINENCE
About Your
Diagnosis
Urinary incontinence is the uncontrollable loss
of urine. The two most common types of incontinence are “stress
incontinence” and “urge incontinence.” If you lose urine in a
spurt or gush with a cough or sneeze, you probably have stress incontinence. If
you lose urine on the way to the toilet because you waited too long or run to
the toilet frequently (every 1–2 hours), you probably have urge
incontinence. Stress incontinence can be caused by childbirth or growing older.
Urge incontinence can be caused by medication, too much caffeine or alcohol, or
growing older. Many women notice bladder problems worsen at the time of
menopause. Urinary incontinence is very common. It is estimated that up to 60%
of women have incontinence. The type of urinary incontinence can be diagnosed
with “urodynamic testing.” Fortunately, most cases of urinary
incontinence can be cured or at least improved
significantly.
Living With Your
Diagnosis
If you occasionally leak a
very small amount of urine with a cough or sneeze, or on the way to the toilet,
you have very mild incontinence and you may not be interested in treating it.
Usually, treatment requires some time and effort. If you leak daily and/or wear
a pad for protection, you have
mildto-
moderate incontinence and may
definitely be interested in treatment options. If you can soak a pad when you
lose urine and do it frequently (several times each day), you have severe
incontinence. If you have moderate or severe incontinence, you may have found
yourself restricting your activities or not going out as much as
previously.
Treatment
Fortunately,
there are many treatment options available for urinary incontinence.
Strengthening the pelvic floor muscles is usually the first step to cure stress
incontinence. Contracting the pelvic floor muscles is called “Kegel”
exercise. A Kegel is done by pulling in the pelvic floor muscles; it should feel
like you are pulling in your rectum or “sucking up water with your pelvic
floor.” Make sure you are performing the Kegel exercises correctly by
having someone observe you who knows what a correct Kegel is. Usually,
40–50 Kegels are recommended each day, i.e., 10 Kegels in a row, 4 or 5
sets each day. Also, it is very important that you try to Kegel (tighten your
pelvic floor muscles) when you cough, sneeze, or lift something. If Kegel
exercises do not seem to help, you may be referred for physical therapy to help
improve bladder control. Specialized physical therapy for the pelvic floor
muscle includes biofeedback and/or functional electrical stimulation. This type
of physical therapy is usually done in special centers. More recently, special
types of pessaries have been designed to treat stress incontinence. Sometimes
pessaries are very useful for women who only lose urine during certain
activities such as jogging, aerobics, and horseback riding, but are otherwise
fine. These incontinence pessaries can be placed before the activity and then
removed after the activity or left in all day. Usually, the first step in
treating urge incontinence is bladder training. Bladder training is done by
voiding (emptying your bladder) at certain intervals. The intervals are
gradually lengthened. The goal is to be able to go 3 hours before voiding during
the daytime without any episodes of leaking. Sometimes medication is prescribed
to help with the bladder training. Medications used to treat
urge
incontinence may cause some dryness of
the mouth or eyes. This side effect is expected and as long as the dryness is
tolerable, the medication can be continued. Surgery can also be used to resolve
stress incontinence. There are a variety of different types of surgical
procedures. The type of surgical procedure that is best for you should be
discussed by you and your specialist. The specialist may be a gynecologist or a
urologist.
The
DOs
• Do your Kegel exercises as
directed. Sometimes a good place to remember to do them is in the car every time
you come to a red light or stop
sign.
• Take your medication (if one
is prescribed) as directed.
The
DON’Ts
• Avoid drinking
lots of liquids with caffeine in it such as coffee, black tea, and sodas with
caffeine (Coca Cola, Pepsi). Caffeine is a diuretic; it makes the kidneys
produce more urine at a faster-thannormal rate. This will make both stress and
urge incontinence worse, and can cause frequent urination as
well.
• Avoid drinking excessive
amounts of alcoholic beverages such as beer and wine. Alcohol is a diuretic as
well, so it will also make stress and urge incontinence worse. Alcohol can also
cause increased urinary frequency.
•
Avoid drinking excessive amounts of liquid during the day; most individuals do
not need more than 64 ounces (eight 8-ounce glasses) of liquid each day. Also,
avoid drinking a lot of fluid at one time. It is better to space out fluid
intake evenly during the day.
• If
you get up more than twice during the night to urinate, avoid drinking liquids
after 7–8
PM.
When
to Call Your Doctor
• If your
symptoms are not improving.
• If you
cannot tolerate the side effects of any prescribed
medication.