Urinary Incontinence: What Every Woman Should Know

Urinary Incontinence is a condition affecting millions of adults of all ages in the United States. The majority suffers in silence, believing there’s no remedy for this medical condition and that there’s no remedy for this medical condition and that there’s nothing for them to do except put up with it and adapt their lifestyles around their limitations. Among women, there are many who resign themselves to the idea that incontinence is an untreatable consequence of having had children or as a result of aging. Those suffering from this condition not only have to bear the physical symptoms; they have to bear a great deal of emotional suffering as well. Often they isolate themselves, they feel ashamed and they stop participating in many social activities because they feel embarrassed, which results in a loss of self-esteem. 

If you or a loved one is affected by urinary incontinence, you should know that you are not alone. 

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15 Must-Know Facts About Incontinence Surgery

Studies have found that 85 percent to 90 percent of women are completely dry within a year after surgery.

Think about your goals, and whether you might be able to achieve them without an operation.
"Everyone needs to make their own decision," says Harvey Winkler, MD, co-chief of urogynecology and director of female pelvic medicine and reconstructive surgery at North Shore–Long Island Jewish Health System in Great Neck, N.Y. Surgery is the best approach, he says, "if you're looking for the one-shot deal that's going to give you the best dryness option."
It's no guarantee of a cure, but studies have found that 85 percent to 90 percent of women are completely dry within a year after surgery.

Try Kegels first

Exercises to strengthen the pelvic floor, known as Kegels, are the most basic and noninvasive approach to treating stress incontinence.
If you're willing to do these exercises several times a day, indefinitely, you can expect a 70 percent improvement in your symptoms, says Dr. Winkler.
Consider bulking agents
There are outpatient procedures in which bulking materials like collagen or silicone are injected around the urethra. Although these procedures can offer short-term relief, especially for people who don't respond to surgery, they have to be done repeatedly because your body will eventually eliminate the injected material.
There also are several medications that are sometimes prescribed, including drugs for treating muscle spasms and antidepressants, but they tend to be more effective for treating mild or moderate stress incontinence.

The sling's the thing

The most popular surgical treatment for stress incontinence is the mid-urethral sling or tension-free sling procedure.
The surgeon loops a thin strip of material—usually synthetic mesh, but occasionally some of your own tissue or tissue taken from a cadaver——to support the bladder and urethra.
This helps you shut off the flow of urine when you sneeze, cough, or do something else that could cause leakage, says Thinh Duong, MD, an associate at Southern California Permanente Medical Group, in Los Angeles.

Mesh can be a problem

You may have heard warnings about the use of mesh in gynecological surgery. The FDA says side effects of mesh are potentially serious and include urinary problems, infections, and pain during sex, although it is still reviewing the risk associated with slings for incontinence.
Dr. Duong says the risk of complications is low for sling procedures because they require a relatively small piece of mesh (other procedures use larger pieces of mesh). In addition, synthetic materials that have been associated with higher rates of infection have been taken off the market.
Here are some important questions to ask your doctor before a procedure, according to the FDA.

Find the right surgeon

You should seek a surgeon who has done a fellowship in urogynecology or female pelvic medicine and reconstructive surgery, Dr. Winkler says. Ask how many procedures he or she does a year. Some gynecologists go to weekend training sessions to learn how to place a particular type of sling, but this isn't enough, Dr. Duong says.
It's also key, he says, to ask about the complications associated with the procedure, as well as which complications your potential surgeon has seen and how he or she dealt with them.

It's often an outpatient procedure

Sling procedures are often done on an outpatient basis, meaning you don't have to spend the night in a hospital.
They can be done under local anesthesia, Dr. Winkler says, whereas a different type of procedure called retropubic suspension is usually done under general or spinal anesthesia and involves a hospital stay.
Post-surgical pain can usually be tamed with ibuprofen, he says.

You may need a catheter at first

You may go home with a catheter after surgery if you have difficulty urinating on your own, or can only urinate very slowly.
You may need to use a catheter at first to empty your bladder a few times a day. Difficulty in urinating rarely persists, and you may need to have the sling readjusted or removed.

You'll need to limit activity

After surgery, you'll want to avoid stressing the surgical area so your body can heal. Your surgeon will advise you to avoid heavy lifting, exercise, having intercourse, or using tampons, typically for at least a couple of weeks.
If, at this point, you aren't leaking or experiencing pain, your doctor may allow you to return to your normal activities.
"I tell people to plan for a week off," says Dr. Winkler, although he says some of his patients have had the procedure on a Thursday and gone back to work on a Monday.


Complications are possible
As is the case with any type of surgery, complications — including bleeding, infection, or damage to surrounding blood vessels and organs—can occur.
Major complications, such as significant bleeding and blood vessel injuries, occur about 1 percent of the time, says Dr. Duong.
The mesh may also find its way out of the vaginal incision, and while this can be distressing, it's an easy complication to fix.

You may need a repeat surgery

About 15 percent to 20 percent of the time, the sling surgery is unsuccessful, and may need to be repeated.
You can take steps to help make the second surgery more successful, such as making sure you get adequate rest after the procedure, losing weight if you are overweight, not smoking, and keeping your pelvic muscles strong with Kegels. But if you did all these things and the surgery still didn't work for you, your chances might not be as good the second time around.
In general, Dr. Duong tells patients to expect a 50% to 60% success rate with repeat surgery.

It may change your life

Debbie S., 42, had been living with stress incontinence for years.
"I have four kids and I just was at the point where I couldn't sneeze or laugh without leaking," she recalls. After talking with friends, she opted for the sling. "It's just a quick, easy, in-and-out procedure," she says.
"It was actually, literally, a life-changer," says Debbie, about a year after having the surgery. She says she can now enjoy a good laugh with no fear of leaking. "I would really recommend it to anybody."

Surgery is less common for urge incontinence

Behavioral therapy, physical therapy, and medication are still the first-line therapies for urge incontinence, which is most common in the elderly and involves frequent urination with little warning.
Medications for urge incontinence, which can be caused by overactive bladder, usually work by relaxing the overly twitchy organ.
Bladder training, which involves teaching yourself to urinate less frequently, can also be effective.

Tibial nerve stimulation

Insurers recently started covering a technique called tibial nerve stimulation, in which a needle containing an electrode is placed near your ankle, stimulating one of the nerves responsible for bladder control.
A 2010 study found that about half of people reported a significant improvement in their urge incontinence symptoms after 12 weeks of once-weekly half-hour sessions, compared with 20 percent of people in the placebo group.

Anne Harding (from MSN/Health)

Copyright © 2009 Health Media Ventures, Inc. All rights reserved.

 

Urinary incontinence: Women have options to treat urinary incontinence

While not often talked about, urinary incontinence is more common than you think, and there are treatments that can help.

For the 25 million U.S. adults with urinary incontinence, a little leakage can carry a lot of shame. But many people don't do anything about it.

"Urinary incontinence is a very insidious process," said Dr. David Glazier, co-director of the pelvic floor center at Virginia Urology in Richmond, Va. "It occurs very slowly; (people) think it's a normal part of aging."

Women — 75 to 80 percent of sufferers, thanks largely to the wonders of childbirth — endure leakage for an average of eight years before seeking help, Glazier said, even though it's highly treatable.

Increasingly, women are taking action. They are "more physically active, fit, and they're not going to tolerate wearing pads all the time," said Dr. Vivian Aguilar, a urogynecologist at Cleveland Clinic Florida who sees many incontinence patients in their 30s, 40s and 50s.

The most common types of incontinence among women are stress and urge incontinence. Pelvic organ prolapse can be a cause. Most women see improvement or cure through behavioral modification (losing weight, limiting caffeine, alcohol and artificial sweeteners) and Kegel exercises to strengthen the pelvic floor muscles, considered the frontline treatment for both types, said Dr. Margaret Roberts, attending physiatrist with the Rehabilitation Institute of Chicago. But a third of women don't do Kegels correctly, she said, and those frontline treatments don't work for everyone.

Here are other solutions, which depend on what type of incontinence a woman has, drawing from the expertise of Glazier, Aguilar and Roberts:

Stress incontinence

What it is: Leaking urine as a result of abdominal pressure, such as laughing, coughing, sneezing, running, jumping or having sex. It happens as the valve muscle around the urethra weakens and wears down with time, and commonly starts after childbirth, which stretches out the tissues that support the urethra and bladder. It is the most prevalent type of incontinence among women, affecting one-fourth of women over 17, and it becomes increasingly common with age.

Medication: There are no FDA-approved medications for stress incontinence. Duloxetine (Cymbalta), an antidepressant, is approved in the European Union for stress incontinence and is sometimes used off-label in the U.S., but it carries an FDA-issued black-box warning of suicide risks.

Bulking agents: Injecting collagen or carbon spheres into the tissue around the bladder neck and urethra helps close the bladder opening to reduce leakage. Over time, the body might eliminate the agents so you have to repeat injections.

Slings: A small ribbon of mesh, usually inserted through the vagina, is placed around the urethra to support it. This common outpatient surgical procedure, usually done under general anesthesia, has a 90 percent success rate, but it carries risks. The FDA in 2008 warned of serious complications with mesh used for stress incontinence and prolapse procedures, including infection and migration or erosion of the mesh into the vagina, potentially causing pain during intercourse. The procedure also can be performed using tissue from your own body.

Burch procedure: Through an incision in the abdomen, a surgeon pulls up the bladder and sutures it to ligaments behind the pubic bone, giving support to the urethra. It has a slightly lower success rate than a sling, but it has fewer side effects, according to a study published in the New England Journal of Medicine.

Urge incontinence

What it is: Having the sudden urge to urinate and not always making it to the toilet. While the causes aren't well understood, it happens when abnormal nerve signals cause bladder contractions when you're not ready and can be brought on by infection or nerve injuries, such as multiple sclerosis or stroke. It is associated with overactive bladder, which also includes urinary frequency (needing to urinate more than seven to 10 times per day), and nocturia (waking up at least twice a night to pee). Urge incontinence and overactive bladder affect one-fifth of adults older than 40 and are twice as frequent in women as in men.

Medication: Medications such as VESIcare, Ditropan and Toviaz help with overactive bladder symptoms by relaxing the bladder muscles.

Neuromodulation: Interstim is the brand name for a pacemaker-like device that is implanted under your skin, just above the buttocks, to deliver electric pulses that calm the bladder. You do a two-week trial before implantation to confirm it works before committing. Possible complications include discomfort and infection. Because it's metal, you can't have an MRI.

A less invasive option is peripheral nerve stimulation, wherein a doctor places a small needle in one of the nerves in the foot, next to the ankle bone, and sends an electric signal to the bladder nerves to calm down. You must do half-hour sessions once a week for 12 weeks, and then once a month after that. Unlike Interstim, it's not covered by most insurance.

Botox: The FDA in August approved Botox bladder injections to treat urinary incontinence in people with neurologic conditions such as spinal cord injury or multiple scerlosis. The effect lasts for up to 10 months, so you'll need repeat visits. Some people have trouble emptying their bladder afterward and must use a catheter.

Augmentation cystoplasty: The end-of-the-road treatment for overactive bladder, this involves cutting into the bladder to increase the capacity and decrease contractility. Afterward patients may have to catheterize themselves.

PELVIC ORGAN PROLAPSE

When childbirth, hysterectomy or other surgery weaken the muscles and tissues supporting the pelvic organs, a woman's bladder, uterus, bowel or rectum can shift from their normal positions and drop into the vagina. Stress incontinence can result, or the drooping organs can kink the urethra, causing urinary retention. POP affects as many as half of women who have given birth, but only 10 to 20 percent experience symptoms.

Pessary: A diaphragm-like device that you insert into the vagina to help keep the organs in place. You must remove and reinsert the pessary regularly for cleaning.

Surgical repair: Surgeons can fix prolapse as they would a hernia, pulling up and securing collapsed organs. When prolapse is accompanied by incontinence, they would install a sling during the same procedure. For women who have had several unsuccessful repairs, some doctors insert mesh through the vagina to hold up the sagging organs, but mesh has risks. In July, the FDA updated its warning on using mesh to correct prolapse, citing serious complications including mesh protruding through the vaginal wall and organ perforation during insertion. The greater risk does not come with greater clinical benefit, the FDA said, and removing the mesh may not be possible and may not resolve complications.

Learn more: National Association for Continence, nafc.org.
By Alexia Elejalde-Ruiz

Copyright © 2011, Chicago Tribune

 

Urinary Incontinence a Clearer Picture: Fact & Fiction

Urinary incontinence is the involuntary discharge of urine. The ability to control urination requires: a normal anatomy, a normally functioning nervous system and the ability to determine and respond to the warning signs of impending urination. Urinary incontinence occurs when one is unable to control the flow, causing leakage or in severe cases an inability to retain urine. This can be precipitated by everyday actions: coughing, standing up, laughing, running, sneezing etc.

Due to the nature of this affliction it is not a topic which is openly discussed, thus many falsehoods abound. Here’s an attempt to separate some of the facts from fiction.

Fiction: Incontinence is a disease.

Fact: Incontinence is merely a symptom of a pre-existing condition and can occur due to a number of extenuating circumstances: prostate surgery, menopause or child birth, a nervous system disorder, side effects of some medication, a birth defect, and loss of estrogen in women and enlargement of the prostate in men.

Fiction: Incontinence is a rare ailment.

Fact: The nature of the ailment and the reluctance of sufferers to openly discuss it lead to most people suffering in silence and by extension to the misconception that it’s an uncommon problem. The ‘National Association for Continence’ estimates that 200 million people worldwide (25 million American adults) have experienced some degree of incontinence.

Fiction: I’m in perfect health and therefore I’m not at risk

Fact: In and of itself there are no particular risk factors involved for either of the sexes. As previously indicated one can become incontinent by unforeseen circumstances, making us all likely candidates.

Fiction: Only “old people” get incontinence.

Fact: Although it may be perceived as an affliction of senior citizens it can affect people of all ages and sexes. The risk does increase with age due to weakening of the pelvic muscles and enlargement of the prostate gland. However it cannot be considered an age related ailment, surveys have found that 1 in 4 women over may experience episodes of involuntary leakage and both sexes age 30 - 70 have experienced incontinence occasional or chronic symptoms at some point as adults. Incontinence affects the following groups of people:

• 10% of six-year-olds
• One in four women middle-aged or older
• 15% of all men aged 60 years and over
• Many individuals with neurological disorders and spinal cord

Fiction: There are no solutions if you’re incontinent. Just live with it,

Fact: There are many types of incontinence (e.g. stress, urge, mixed) and they can all be treated, cured or managed successfully. Regardless of age or gender there are many available treatment options. Your doctor will determine which is right for you based on the nature, cause and severity of your ailment.

Fiction: The only available options are medication and/or surgery

Fact: It is widely accepted that Kegel exercises can play a huge role in treating and in some cases even reversing the effects of incontinence. Kegel exercises consist of contracting and relaxing the pelvic floor muscles thereby strengthening them and allow one greater control of  the pelvic floor muscles which controls the bladder. There are exercises for both men and women. Magnesium, vitamin D, a healthy body weight, and abstaining from smoking, alcohol and caffeine are also known to play a role in the improvement of this affliction.

Fiction: Incontinence can be fatal.

Fact: Incontinence is neither fatal nor life threatening. However its impact is such that one’s quality of life can be greatly affected. Due to the fear of “accidents” persons with this affliction tend to place severe restrictions on their social activities, leading to self imposed isolation and depression.

Incontinence should neither be ignored nor kept to oneself. Though not fatal it can lead to negative lifestyle changes which can be devastating. It is an indication of an impending or pre-existing condition which necessitates a visit to your medical practitioner without delay. Like any major ailment an early diagnosis can make a world of difference.

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HMC urology unit helps patients to fight incontinence

By Noimot Olayiwola/Staff Reporter
 
People who experience a sudden need to urinate followed by instant bladder contraction or involuntary loss of urine while coughing, sneezing, laughing or exercising have been advised to seek immediate medical attention as they could be having problems associated with urinary incontinence.

“We have found that many people are still finding it difficult to openly discuss that they have urinary incontinence . They need not suffer in silence. It is high time they started discussing the problems with a physician as there are a number of ways they can be assisted and protected from the psychological, physiological and sociological effects of leaking urine,” Urology consultants Dr Adralan Ghafouri and Dr Omar Isam Mohamed Ali told Gulf Times yesterday.

Both consultants working at the Dysfunction Unit of the Hamad Medical Corporation’s Urology Department, disclosed that many patients also thought it was part of normal life changes while growing older and thus did not deem it necessary to seek medical intervention.

“Statistics show that the prevalence of incontinence worldwide ranges between 4-36% with varying degrees in each country and the problem could have a really negative impact on life,” they maintained.
The department, which has recently installed a second Urodynamic machine procured for QR200,000 from a Canadian company, receives yearly between 400-450 patients, comprising both males and females.

According to Dr Ghafouri, there are different types of incontinence with the most common being stress, urge and mixed incontinence.

“Stress incontinence occurs during certain activities like coughing, sneezing, laughing, or exercising while urge incontinence involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. In this case, you don’t have enough time between when you recognise the need to urinate and when you actually do urinate and mixed incontinence involves more than one type of urinary incontinence,” he explained.

According to him, though both women and men suffer from urinary incontinence, with women mostly suffering stress incontinence due to a number of risk factors including: being female, multiple childbirth, chronic coughing (such as chronic bronchitis and asthma), ageing, obesity and smoking.

They said factors that could lead to incontinence in men are injury to the urethral area during surgical interventions, some medications and surgery of the prostate or pelvic area.

 “The ability to hold urine and control urination depends on the normal function of the lower urinary tract, the kidneys and the nervous system. A patient must also have the ability to recognise and respond to the urge to urinate. The average adult bladder can hold over two cups (350ml-550 ml) of urine,” Dr Ghafouri explained adding that two muscles were involved in the control of urine flow: the sphincter, which is a circular muscle surrounding the urethra and the detrusor, which is the muscle of the bladder wall. 

“A person must be able to squeeze the sphincter muscle to prevent urine from leaking out and the detrusor muscle must stay relaxed so that the bladder can expand. In stress incontinence, the sphincter muscle and the pelvic muscles, which support the bladder and urethra, are weakened. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen such as when you cough, laugh, or lift something heavy,” he explained.

Dr Ali mentioned that diagnosis of the condition can be done through a number of means including physical examination of the genital, rectal and pelvic floor, pad test, urinalysis and a procedure called flowmetry.

“Treatment depends on how severe the symptoms are and how much they interfere with the patients’ everyday life.There are four major categories of treatment for stress incontinence, which are behavioural changes, medication, pelvic floor muscle training (Kegel exercise) and surgery- when every other treatment method has failed,” he explained.

“Some women may use a device called a vaginal cone along with pelvic exercises, while biofeedback and electrical stimulation may also be helpful for those who have trouble doing pelvic muscle training exercises,” he mentioned.

However, Dr Ali maintained that there were still no effective approved oral medication to treat stress incontinence and that the only available medication was to treat depression, the use of which is being discouraged due to its side effects.

He added that the Urodynamic department has recorded up to 95% success rate with the use of a simple 20 minutes procedure called “day procedure” to help patients correct stress incontinence.

14 Tips For Dealing With Male Incontinence

About 25 million Americans have urinary incontinence. It's estimated that three-fourths are women, but that leaves more than five million men with bladder problems. Men can have incontinence due to an enlarged prostate or prostate surgery, but other causes may play a role too. Still, men are often uninformed about the issues, and they may face challenges -- physically, socially and emotionally -- when dealing with the diagnosis. Here's what you should know about male incontinence.

It's more than post-void drips.

Most men have mild post-void drips, hence the oft-quoted, "No matter how much you shake and dance, the last two drops get on your pants." But frequent, excess leakage after urination is not normal, says William Steers, M.D., chair of the urology department and Paul Mellon professor at the University of Virginia School of Medicine, in Charlottesville. If it makes you uncomfortable, shows through your clothes or causes skin irritation, it's a form of incontinence -- and it could be a symptom of a more serious problem.

It's not uncommon.

Between 2 percent and 15 percent of men ages 15 to 64, and 5 percent to 15 percent of men over 60 who live at home (as opposed to a nursing home), have incontinence, according to the National Association for Continence (NAFC). Prostate removal for cancer treatment is one of the most common causes. "Most patients who come to see me about stress urinary incontinence are men who've had surgery for prostate cancer, nine out of 10," says Dr. Steers. (In stress incontinence, coughing and sneezing can trigger leakage).

If patients have stress incontinence and have not had prostate surgery, another condition -- such as a neurological disorder, spinal injury or diabetes -- may be to blame, says Dr. Steers.

Extra weight can be a cause.

As you age, the muscles that control bladder function start to lose strength, and weight gain can put extra pressure on the bladder. Although obesity seems to affect women more than men when it comes to bladder control, Dr. Steers says he's increasingly seeing the connection in his male patients. Cigarette smoking, heavy drinking and diabetes also increase a man's risk of bladder problems.

Prostate trouble is often to blame.

Most men experience prostate enlargement with age. It can block the urethra and cause overflow incontinence, which is the leakage of a small amount of urine, or difficulty urinating. Prostate removal due to cancer can also damage or weaken the pelvic floor muscles and nerves around the bladder, and it may cause significant leakage issues for about half of men just after surgery. One in five still has problems a year or more later. This is one reason doctors often suggest "watchful waiting" for slow-growing prostate cancers, says Dr. Steers. Delaying the surgery can also help you avoid erectile dysfunction.

Parkinson's disease and stroke can play a role.

In some men, incontinence problems can be caused by nerve damage from diabetes, a stroke, Parkinson's disease (which mostly affects men), or multiple sclerosis (which mostly affects women). In addition, men are more likely to be involved in car or motorcycle accidents, workplace injuries or active-duty combat, which puts them at higher risk for spinal cord injuries that can trigger incontinence, says Nancy Muller, Ph.D., executive director of the NAFC.

Male-geared products may help.

"Fortunately, the manufactures of adult absorbent products have recognized, finally, that the male anatomy is different from female," says Muller. "Only recently have major incontinence brands come out with gender-specific adult products." Men can find absorbent or disposable underwear, ranging from briefs to boxers, as well as compression pouches that support the urethra, in most pharmacies. For severe incontinence episodes, consider an external collection unit, which fits like a sheath over the penis and contains a collection bag (that fits inside a pair of briefs).

Surgical options exist

Men with severe stress incontinence can consider surgery if other therapies fail. Doctors can implant an artificial rubber sphincter around the urethra. The sphincter is inflated and deflated to control urine flow. Another procedure, called the bulbourethral sling (or male sling), supports the urethra with a mesh hammock.

Urge incontinence can be treated with sacral nerve stimulation, a pacemaker-like electrical stimulator that is implanted under the skin and sends signals to the sacral nerve to control bladder activity. Doctors may also recommend prostate surgery for cases of overflow incontinence caused by an enlarged prostate.

There are medications for men.

Medications for male incontinence often target the underlying cause. For example, drugs can be used to shrink an enlarged prostate or reduce symptoms of neurological disorders. If you experience urge incontinence, also known as overactive bladder, your doctor may prescribe anticholinergic or antispasmodic medications to calm the muscles in your bladder. Certain types of antidepressants are also sometimes effective for bladder problems.

Fluid intake matters.

Watching your fluid intake could help you improve incontinence symptoms, even without medication or surgery. "Sometimes we find that men are drinking full six-packs of beer, and if your resistance is already low, then that's going to cause a problem," says Dr. Steers. "If you make more urine, you stress the system."

Limiting alcohol in general, as well as caffeine and carbonated beverages, can help. Staying hydrated and drinking water when you're thirsty is always healthy, says Dr. Steers, but there's no need to aim for a certain number of glasses a day.

Some medications make it worse.

Some common medicines, such as diuretics, antihistamines and antidepressants, can cause urinary leakage, so your doctor may also look at drugs you're already taking.

Skin problems shouldn't be ignored.

Chronic leakage and post-void "after-dribble" tends to cause more skin irritation in men than in women, says Muller. "They have more problems with rashes and skin fungus, and often don't give enough attention to the perineal area around the scrotum." Moisturizers and barrier creams can keep skin from becoming too dry and inflamed. Men who use absorbent pads or products should change them every few hours to prevent infection.

Men can do Kegels too.

Kegel or pelvic floor exercises, in which you squeeze and hold the muscles you'd use to stop urination, aren't just for women. A small 2010 Italian study suggests that men who do them for one month before prostate removal surgery have less incontinence after. The NAFC recommends a set of 10 slow and 10 fast contractions, two or three times a day, gradually working up to about 80 repetitions a day. "It's just like bench presses at the gym," she says. "Doing too much too soon can actually damage the muscles, so you can't rush into it."

Men have issues some women don't.

Men can face unique physical and emotional challenges with incontinence. "For starters, women are used to wearing pads several days of the month," says Dr. Steers, "whereas a man is not socially attuned to wearing anything down there. Just the idea can be really embarrassing to them." It may also be hard to avoid situations where leakage is common, he adds. More men than women might have jobs that entail heavy lifting, for example, or friends might expect participation in sports like golf and tennis, which can put pressure on the bladder.

There are online resources for men

Only 18 percent of men versus 33 percent of women talk to their doctor about their symptoms, according to an NAFC survey of people with bladder problems. Plus, more online resources are aimed at women. (Men can, however, refer to the What Every Man Should Know section of the NAFC's site). Men who've had prostate surgery may benefit from a prostate cancer support group, which can help address a range of emotional and physical and issues. Local support groups can be found at ustoo.org.

Article from Huffington Post

My doctor told me I have incontinence... now what?

"You have urinary incontinence."

Hearing these words from your doctor can bring out all kinds of feelings and questions. You may be feeling embarrassed, angry, afraid, and alone. You may also have questions about incontinence, how it will affect your work and social life, and where to go for help.

It may help to know that you're not alone: over 3 million Canadians of all ages have incontinence. But you may feel alone because most people are too embarrassed to talk about it - only 26% of people with incontinence ask their doctor for help. So congratulate yourself on having the courage to speak up! By talking to your doctor and getting a diagnosis, you're on the road to taking control of your incontinence.

Here are a few "next steps" to help you cope with your diagnosis and get your life back.
Educate yourself. Learn all you can about urinary incontinence and the management options available to you.
Here are the answers to frequently asked questions for people newly diagnosed with urinary incontinence:

• Can it be treated? Yes. There are many treatments available to help manage your incontinence so that you can get on with your life.
• Will everybody know? No. With the new discreet treatment and management options available, no one will know about your incontinence unless you decide to tell them.
• Is this the end of my social life? Definitely not! You can still enjoy an active social life. Just be prepared: follow your treatment plan, consider using absorbent products for leakage protection, and have an emergency kit (containing extra clothes and absorbent products) to deal with leaks.
• How will this affect my relationship with my partner? Your relationship could become stronger than ever as you work together to cope with incontinence. The first step is to share your feelings and concerns with your partner.
• Will it be an issue at work? With a proper management plan, it shouldn't be. As with social occasions, it's all a matter of being prepared.
• Where can I get help? Talk to your doctor about available support groups and consider confiding in trusted friends and family so they can offer their support.

Talk to your doctor about your treatment plan. Discuss your treatment and management options with your doctor and work with your doctor to choose a treatment plan that will work for your lifestyle.
Get back to your usual activities. When you first found out you had urinary incontinence, you may have scaled back on your social life and physical activities. But incontinence shouldn't get in the way of the things you enjoy. Once you have a treatment plan in place, you can go back to your usual activities.
Find support. Talk to your partner or a trusted friend about what you're going through. You can also join an incontinence support group or online community.

"Copyright 1996 - 2007, MediResource Inc. All rights reserved"

Silent struggle with Incontinence

One of Hollywood’s most celebrated actresses with a career spanning over 50 years, Debbie Reynolds led a very active life till she began to experience the symptoms of an overactive bladder. However, the actress thought that these more frequent trips to the bathroom were just a natural part of the aging process. She had no idea that her symptoms signalled a medical condition or that there were treatments available. Besides, she was too embarrassed to talk to anyone about the situation.

Impacting the quality of life
Not just Reynolds, there are millions of women who suffer from the involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine during coughing, sneezing or running and so on. Normally, the urinary bladder stores urine and empties it when desired. The brain controls this urinating mechanism. An Overactive Bladder (OAB) is a condition that results from a sudden and involuntary contraction of the urinary bladder. This causes a sudden compelling desire to urinate, a sensation that is difficult to defer.

Often, urine leaks before one can reach the toilet. Abnormal nerve signals might be the cause of these bladder spasms. Certain medications such as diuretics, uncontrolled diabetes or emotional states such as anxiety can worsen OAB. An Overactive Bladder is a “silent struggle” for many women. It causes embarrassment and social inactivity, but it is treatable. While women have many urological issues, the most overlooked and common medical condition is OAB. This condition can be associated with other medical problems such as urinary tract infection (UTI), skin infection and, in elderly persons, an increased risk of falls and fractures. Patients should not hesitate to discuss the symptoms of OAB.


Treatment for OAB
Persons with OAB may have poor sleep quality due to frequent urination during the night. This causes chronic fatigue and difficulty in performing daily activities. Increased incidences of hip fractures due to falls in elderly persons have been attributed to OAB. In some people the problem is severe and it interferes with normal daily activities. The sufferer may gradually stop engaging in outdoor activities and may become a social recluse. OAB may affect one’s work and ability to travel. Urine loss can occur during sexual activity and cause a lot of emotional distress.

While there are many causes of OAB, often no distinct etiology is found. An involuntary contraction of the bladder muscles can occur because of the damage to the nerves of the bladder, to the spinal cord and brain, or to the bladder muscles themselves. A clinical diagnosis of OAB can be made on the basis of the history and a physical examination, in conjunction with a few simple tests. Behavioural therapies: Patients are educated about how urine is formed, stored and then expelled out of body when desired. Some patients benefit by making it a point to urinate at regular intervals of time, a habit called timed voiding. As one gains urinary control, the time between scheduled urination is extended. Behavioural treatment also includes pelvic floor muscle exercises to strengthen the muscles that help hold in urine.

Medications for OAB: There are medications available now which reduce the contractility of the bladder muscle. However, their use is limited by side-effects, like a dry mouth, drowsiness and constipation. The newer ones have fewer side-effects. Behavioural therapy combined with medicines offers good results in OAB patients, with up to 80 per cent of cases improved. Severe OAB refractory to the oral medications can be treated by injecting Botox into the bladder muscle. But in a few patients, it can paralyse the bladder muscle completely so that they are unable to pass urine.

if medications don’t work
Biofeedback: Biofeedback can help one to become aware of the body’s functioning. By using electronic devices or diaries to track when the bladder and urethral muscles contract, one can gradually control these muscles. Biofeedback is a useful adjunct in treating urinary incontinence.

Neuromodulation: For OAB not responding to behavioural treatments or medicines, stimulation of the spinal nerves to the bladder can be effective in some patients. Neuromodulation is a new technique approved for the management of OAB. It requires the surgical implantation of a small device for sacral nerve stimulation. Although it can be effective, it requires careful patient selection.

Surgery: Augmentation cystoplasty is rarely necessary in idiopathic OAB. In this reconstructive procedure, a patch of the bowel is joined to the bladder. This increases the bladder capacity and disrupts the coordinated contraction of the bladder muscles.

The writer is Director-Urology and Renal Transplantation Fortis Escorts Heart Institute
New Delhi

10 things that can make incontinence worse

(Health.com) -- Incontinence can happen to anyone, although it's more common in women than in men.

"Mild urinary leakage affects most women at some time in our lives," says Mary Rosser, M.D., Ph.D., an assistant professor in obstetrics and gynecology at Montefiore Medical Center, in New York City. "Although it is more common in older women, younger women may experience leakage as well."

You may have stress incontinence, urge incontinence, or some other type. The good news is that there are treatments -- and lifestyle changes -- that can help.

Health.com: What type of incontinence do you have?

 

Fluid intake

It's no surprise that too many drinks -- whether water, milk, or other beverages -- can be a problem for people with incontinence.

However, you can't solve incontinence by severely cutting back on fluids. This can lead to dehydration, constipation, and kidney stones, which can actually irritate your bladder and make symptoms worse.

It's important to get the right balance, says Rosser, who recommends about two liters of fluid a day, which is eight 8-ounce glasses. (The right amount depends on your lean body mass.)

If you're prone to nighttime incontinence, cut back your fluid intake in the evening.

InHealth: Simple solutions for an overactive bladder

Alcohol

If you have incontinence, happy hour can be anything but happy. Alcohol is a diuretic. It causes you to produce more urine, which can contribute to urge incontinence. And it can irritate the bladder, which is a problem for those with overactive bladder.

"Limiting the amount of alcohol you consume to one drink a day can help," says John L. Phillips, M.D., program director of urology at New York Medical College, in Valhalla, New York.

Health.com: 3 ways to manage overactive bladder

Coffee and tea

Coffee and tea, once your best friends, may now be your worst enemies.

They contain caffeine, which like alcohol, is both a diuretic and a bladder irritant.

"Caffeine is implicated in directly causing irritation of the bladder lining. People who do have bladder problems, on average, do better if they reduce their caffeine consumption, so it's the first thing we look at," says Phillips.

Decaf coffee and tea, which contain small amounts of caffeine, may be no better. If you love your caffeine, cut back slowly to avoid headaches and other withdrawal symptoms.

Chocolate

Sorry chocolate lovers, but thanks in part to the caffeine content, this sugary treat may spell trouble for an overactive bladder.

It doesn't matter if it's dark or milk chocolate, hot chocolate, or chocolate milk (which contains about the same amount of caffeine as decaf coffee).

When it comes to incontinence, all might pose a problem.

Sugar

Before you replace your chocolate fix with Twizzlers, consider this: Controlling your sweet tooth may also help you control your bladder.

Although not as well-studied as caffeine and alcohol, sugary foods, including those that contain honey, corn syrup, and fructose, can also aggravate your bladder, some evidence suggests.

Artificial sweeteners may be no better; some research indicates they contribute to urge incontinence.

But that doesn't mean you have to cut out sweets completely. "Sugar is enjoyable -- just make it part of a balanced diet," says Phillips.

Health.com: 12 natural remedies for incontinence

Fizzy drinks

A can of Coke may be a double whammy for your bladder thanks to the caffeine and carbonation.

Carbonated drinks have been shown to worsen some incontinence symptoms.

"When someone is suffering from incontinence, we suggest cutting artificial foods and colorings, chemicals, and caffeine, and trying to stick to a more natural diet, filled with natural antioxidants and vitamins, including fruits and vegetables, and water," says Phillips.

Try eliminating bubbly beverages -- even those without caffeine -- to see if it helps.

Spicy foods

If it's hot, you may have to go.

Studies suggest that people who avoid spicy foods, like curry, chili pepper, and cayenne pepper, may reduce their urinary incontinence symptoms.

"There are certain foods that are triggers for people with incontinence or overactive bladders, including spicy foods, which doctors have identified as common irritants for women," says Kristen Burns, an adult urology nurse practitioner at Johns Hopkins Hospital, in Baltimore.

"The best thing is to avoid foods and drinks if you notice they are a problem for you."

Citrus fruits

They may provide vitamin C, but citrus fruits and drinks can be a problem for people with urge incontinence.

Acidic foods and beverages, such as grapefruits, oranges, limes, lemons, and even tomatoes, can irritate your bladder, and may worsen incontinence symptoms.

"The bladder muscle has all kinds of nerves that can be affected by irritants, like acidic foods, which can exacerbate urgency symptoms," says Burns.

Health.com: Gotta go? 13 reasons for urine trouble

Cranberry juice

Because it's often used to help control urinary tract infections (UTIs) and bladder infections, many people wrongly assume that cranberry juice can also help with an overactive bladder.

Unfortunately, when it comes to certain types of urinary problems, like incontinence, cranberry juice can actually make symptoms worse, due to its acidic pH.

"Cranberry juice (unless you have frequent UTIs and want to prevent infections) is not a good choice for someone who already has an irritable bladder, because of its acidic content," says Burns.

Medication

Certain heart medications, blood pressure-lowering drugs, muscle relaxants, sedatives, and other drugs can make incontinence worse.

"Diuretics remove excess fluid from the body so the heart and other organs can function more efficiently," says Rosser. "This leads to an increased fluid load to the bladder."

Talk to your doctor about whether your prescription medications might be contributing to incontinence -- don't cut back or stop taking them on your own.

Also try to avoid caffeine-containing medication in general, such as Excedrin.

Copyright Health Magazine 2010

For a wide choice of incontinent products including: adult diapers and other protective underwear visit http://www.goldeneramart.com/incontinence_product/.

Living With Urinary Incontinence? Don’t Let It Be Your Secret

Incontinence is the involuntary discharge of urine or faeces due to a lack of control by the bladder (Urinary Incontinence) or bowel (Faecal Incontinence). The excretory system of urine is called the  urinary tract and comprises: the kidneys, the ureters, the bladder and the urethra. Urine is filtered by the kidneys and transported via two tubes (ureters) into the bladder. Several layers of muscle form the wall of the bladder; the thickest is called the detrusor muscle. At the junction of the bladder and the uretha is the sphincter muscle whose function is to control the flow of urine through the urethra. A healthy bladder is capable of expanding to accommodate 300-500 ml of fluid. At 200ml. we get the first urge to urinate. When this occurs, the detrusor muscle contracts, the sphincter muscle relaxes and urine is forced out through the urethra. Once finished, the process is reversed: the bladder relaxes and the sphincter contracts, stopping the flow of urine.

Your ability to control urination requires: a normal anatomy, a normally functioning nervous system and being able to determine and respond to the warning signs of impending urination. Urinary incontinence occurs when you are unable to control the flow, causing leakage or in severe cases an inability to retain urine.

Types, Causes and Treatment

There are five recognized types of urinary incontinence: Urge, Stress, Overflow, Functional and Mixed Incontinence:

• Urge Incontinence – Described as a sudden and uncontrollable urge to urinate and unable to get to the toilet in time to avoid loss of a substantial amount of urine. It can also manifest itself by an intense urge to urinate when there is only a small amount of urine in the bladder, resulting in the person straining to urinate. The leading causes of urge incontinence have been identified as: neurological disorders, urinary tract infections and changes in the bladder leading to its inability to contract effectively.
• Effective treatment includes: pelvic muscle exercises, bladder retraining, biofeedback and drugs in persistent cases.
• Stress Incontinence -- The most common type of this affliction. This is an involuntary loss of urine when you sneeze, cough, laugh, jog or perform any other activity which may increase pressure on the bladder. This occurs due to weakened support for the pelvic muscles and/or weakness in the sphincter muscle. The treatment for urge incontinence is the same as that of stress, however, surgery may also be recommended.
• Mixed Incontinence – This is the diagnosis for persons presenting the symptoms of both urge and stress incontinence. A widely held belief is that people with stress incontinence frequently empty their bladders prematurely, conditioning the bladder to function at a low capacity. Treatment is focused on the primary cause, employing the previously mentioned methods. 
• Overflow Incontinence  – In this situation there is frequent leakage without the person having any prior urge to urinate. The urine stream is usually weak This can be due to an obstruction in the bladder, causing it to become too full and eventually leaking. Other probable causes are: neurological disorders, medication, constipation, another medical condition (enlarged prostrate) and post-surgery side effects. This is usually treated through a change in diet, drugs or surgery.
•  Functional Incontinence -- This is not associated with any problem in the person’s urinary tract but due to a pre-existing condition such as: a physical or cognitive impediment, restricted mobility, nervous system disorders, or an inability to communicate. This affliction is very prevalent among people needing long-term care. There are no treatments in this situation but there’s an assortment of incontinent undergarments such as: incontinent panties, incontinent briefs, underpads along with incontinent bedding other  to be used in this situation.

The Silent Affliction

Let there be no misconceptions, incontinence is not an affliction of the aged. In fact adults of any age can develop this ailment with women being more at risk than men. This being due to anatomical differences and the changes brought on by pregnancy and childbirth. The risks increase with age however, because as the body ages, muscles weaken making urine retention more difficult. Many people with incontinence suffer in silence. Excretion (Incontinence) has always been an embarrassing topic, instead of seeking help most people try to manage the situation by themselves even keeping it from their doctor. This can often lead to the development of additional problems including: low self-esteem, social withdrawal, isolation, and depression.  This need not be so; in most cases incontinence can be treated. If you are suffering in silence or think you may have a problem, do not hesitate to consult your doctor

 © 2010 Goldeneramart.com - All Rights Reserved

For a wide choice of incontinent products including: incontinence panties, briefs, pads  and other protective underwear visit http://www.goldeneramart.com/incontinence_product/. 

Incontinence: 12 Natural Remedies

There are drugs and surgeries that may help incontinence, depending on the cause of the problem, but there are other options. Exercises, lifestyle changes, and possibly even some supplements may help.Find it here: http://www.huffingtonpost.com/2011/01/30/incontinence-12-natural-remedies-_n_813793.html#s229597&title=Kegel_Exercises

10 Ways to Live Normally With a Leaky Bladder

Nervous about going out because your bladder sometimes leaks? Or constantly worried about getting to a bathroom on time? About one in five adults over age 40 has problems with urinary urgency and frequency, according to the National Association for Continence. But an overactive bladder (OAB), also called urge incontinence or irritable bladder, doesn't have to cramp your lifestyle. Complete details: http://www.caring.com/articles/leaky-bladder