Losing It
No, this month\’s column is not about your memory. Nor is it about weight. Rather, it\’s about an all-too-common problem that many of us face at this age – urinary incontinence. And why discuss it now, during the last days of summer? Because of the unusually hot weather this summer, hopefully you\’ve been drinking lots of fluids to keep from getting dehydrated. Increasing fluid intake is just one of many things which can increase urinary incontinence. But more on that in a minute.
Exactly what is urinary incontinence (UI)? First of all it\’s a symptom, not a disease, and is defined as any involuntary loss, or leakage, of urine. There are two main types – temporary and chronic. Temporary UI is just that – it occurs only once or a few times, or on a limited basis, and is always associated with another condition, such as a urinary tract infection. Once the other condition is treated, the UI goes away as well. Some of the other conditions associated with temporary UI are urinary tract infections, constipation (the straining to have a bowel movement causes leakage of urine) and excess fluid intake.
Chronic UI is divided into 3 types based on the circumstances under which it occurs. Stress incontinence is that leakage of urine which occurs only with certain activities, and stops when those activities cease. These activities, such as coughing, sneezing and high impact exercise, lead to pressure, or stress, being placed on the bladder, and urine escapes due to a weakening of the muscles which control voiding. Urge incontinence is the involuntary leaking of urine which occurs with, or right after, the urge to void, and can occur anytime. Known also as overactive bladder, this type of UI can have the common symptom of urinary frequency, and is due to the inappropriate, and or excessive, contraction of the muscles surrounding the bladder. The third type of chronic UI is known as mixed incontinence and shows up with symptoms of both of the other types.
What causes UI? Aging itself can cause a weakening of the muscles of the urinary tract which control voiding which can lead to stress incontinence. Aging can also cause the muscles surrounding the bladder to contract too often and erratically, which then leads to urge incontinence. However, in most cases, aging alone does not lead to UI in all women. Though it used to be thought that menopause itself, i.e., the lack of estrogen, led directly to UI, this has never been proven in any study. So again, being menopausal and your current age do not inevitably mean you will develop UI. But there are other causes which are quite common and together with the changes of aging, can lead to UI. These include your having had vaginal deliveries, pelvic surgery, a chronic respiratory disease (or a longtime habit of cigarette smoking) which cause you to have a chronic cough, obesity or a large weight gain, frequent heavy lifting, neurologic diseases such as multiple sclerosis or spinal cord injuries/diseases, and genetic factors. The bad news is that many of us have one or more of the risk factors listed above. The good news is that almost all cases of UI can be treated, or improved, and not necessarily with surgery.
The first thing you need to do is see your primary health care provider about your UI, and find out which type you have. This may seem obvious, but many studies have shown that patients will not admit to having this symptom, even when asked by their provider. Finding out which type of UI you have is important as each type has its own recommended treatments. The diagnostic tests are fairly simple. Once the diagnosis is made, you have many options for treatment. Surgery is recommended as the first line treatment in only one circumstance – for those women with severe stress incontinence. Otherwise, surgery can be tabled while less invasive methods of treatment, such as behavioral therapies, medications, and several unique and new devices (besides pads).
Surgery is recommended mainly for stress incontinence to repair or aid the muscles which control urination, and which have been damaged or stretched out by vaginal deliveries, pelvic surgery, chronic coughing, or weight gain. The two types of surgery used, the “suspension” type and the “sling” type, have both been shown to be highly successful.
Now, back to where we started – all those fluids you should be drinking this summer. Though you shouldn\’t drink excessive fluids, you should definitely NOT cut back on the fluids you routinely drink to try to lessen your UI symptoms; this will only lead to dehydration and eventually to kidney disease. Hopefully after reading this, you will discuss with your clinician any symptoms of UI that you have and make plans to have diagnostic tests. This is so important because you don\’t have to suffer with these symptoms as there are many treatments, and most are effective in at least improving UI, if not curing it.
