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Managing Urinary Incontinence

Thursday, December 26th, 2013

Urinary incontinence refers to the loss of bladder control and is a very common problem. Unfortunately, it is also a very embarrassing problem for many women, and so they often just live with it rather than discussing it with their doctors – which is too bad, because there are effective treatments available, and some of them are very simple.

Urinary incontinence can be mild or severe, ranging from the occasional leak upon sneezing or coughing to having such strong, sudden urges to urinate that you can’t make it to the toilet in time. If incontinence is affecting your day to day activities, please don’t hesitate to talk to your doctor about it. He or she has heard it before, and some simple medical treatment or even just lifestyle changes in some cases can make a huge difference. There are several different types of urinary incontinence, for example:

Stress Incontinence: Leaking urine when pressure is exerted on the bladder, such as through laughing, sneezing, coughing, or heavy lifting. Childbirth and menopause often result in stress incontinence. Obesity is a very common culprit.

Urge Incontinence: An intense and sudden need to urinate. Women with this type of incontinence often experience involuntary loss of urine and “not making it” to the toilet in time. The bladder contracts and in some cases the woman has only a matter of seconds to reach a restroom. This type of incontinence can be caused by a variety of health problems such as UTIs (urinary tract infections), stroke, Parkinson’s or Alzheimer’s disease, and multiple sclerosis. 

Overflow Incontinence: Women who have trouble emptying their bladders completely may experience overflow incontinence, or the frequent or constant leaking of urine. A women with this type of incontinence may not be able to empty her bladder and may be able to produce only a weak stream of urine; typically, this is caused by some type of damage to the bladder – for example, nerve damage caused by multiple sclerosis or diabetes.

There are also cases where women experience more than one type of incontinence. To be sure, it can feel embarrassing to tell your doctor you are having a problem with incontinence. But this is a much better option than suffering in silence. For starters, incontinence may be a symptom of a more serious problem. It can also seriously affect your quality of life, especially if you are restricting your activities and limiting social interactions.

What Causes Urinary Incontinence?

Incontinence can be temporary or permanent, mild or severe. It can be caused by a number of different things. Sometimes, temporary incontinence or isolated incidents can be caused by alcohol, caffeine, or over-hydration; it can also be caused by a UTI and in this case, it goes away as soon as the infection is treated.

When incontinence is persistent, it may be caused by an underlying physical condition or problem, such as an undiagnosed urinary tract infection , pregnancy, hysterectomy, neurological disorders, or obstruction of the urinary tract by a stone or tumor.  The most common reason is just aging and not pregnancy or the mode of delivery.   As stated here back in May, nuns have the same prevalence of urinary incontinence as mothers.


See Your Doctor for a Solution

Often, women with urinary incontinence are most comfortable talking to their gynecologists first. In most cases, your gynecologist can help you with this problem; in certain cases, he or she may need to refer you to a urogynecologist or other specialist. When you go to your appointment to discuss your problem, be prepared with some information that your doctor is sure to ask you for. For example, your symptoms in detail and a list of all medications you take (including vitamins). Also write down questions you have so you don’t forget them once you are in the doctor’s office.

The type of treatment recommended will depend on your individual symptoms and the type of incontinence you are experiencing. Your doctor will most likely suggest the least invasive treatments first, and often, these are quite effective. He or she may suggest that you try certain techniques such as bladder training, double voiding, diet and fluid management, or Kegel exercises.

If these are not effective, there are medications available that can help. There are also medical devices such as urethral inserts and pessaries that can be helpful. Sometimes, urinary continence may require surgical treatment.

To reduce your risk of developing urinary incontinence or to prevent yours from worsening, maintain a healthy weight, do regular Kegel exercises, don’t smoke, and avoid foods known to irritate the bladder such as caffeine and alcohol. You will almost certainly be glad that you talked to your doctor about your incontinence. Go make your appointment now and you’ll be one step closer to relief.

– Yvonne S. Thornton, M. D., M. P. H.

A Cesarean Delivery Will Not Lower Your Chances for Incontinence

Thursday, April 4th, 2013

Obviously, childbirth can really do a number on a woman’s lower body. While we have all dreamed of the day we become mothers since we were little girls, we have also all feared it. Both women and men alike understand the pain and discomfort of childbirth. Some of that discomfort can even last beyond the pregnancy itself. Many women report incontinence after they’ve delivered a baby. Whether it’s a long bathroom line or a hearty laugh, you might find yourself darting to the nearest empty stall in horror as you realize you don’t have the bladder control you used to. It’s a common misconception that women who opt for Cesarean delivery are impervious to incontinence postpartum. Believe it or not, studies show that the mode of delivery actually has no influence on whether or not a woman will experience incontinence after she gives birth.

You’re probably wondering what causes incontinence postpartum then since the mode of delivery has no effect. If you are having bladder control problems after you give birth, it’s more likely a result of your age. Older women are more susceptible to incontinence to begin with, so childbirth will only bring it on sooner. Also, genes play a role. If your own mother was incontinent postpartum, there’s a better chance you will be also. Finally, your lifestyle might also play a role. Women who maintain a healthy weight and exercise regularly become incontinent less often. By avoiding those fatty pregnancy temptations and resisting the urge to become a couch potato during your gestation, you will be preventing incontinence.

If you’re thinking about having a Cesarean for health reasons, don’t let the potential for incontinence sway you. You have just as great a chance of becoming incontinent from a Cesarean delivery as you would from giving birth vaginally. Make other adjustments in your pregnancy if you are hoping to avoid incontinence. Stay healthy, plan the age at which you conceive wisely, and talk to your family members about their own incontinence postpartum to determine whether or not genes might play a role. While incontinence is embarrassing, it is temporary for many new moms who struggle with it for the first time.


– Yvonne S. Thornton, M. D., M. P. H.

How Kegel Exercises Can Help You Long after Birth

Thursday, November 22nd, 2012

Of course you’ve heard about Kegel exercises before. In fact, you probably did some of your own when you were pregnant. When you perform Kegel exercises, you strengthen the floor of your pelvis, which is an excellent way to prepare your body for birth and push more effectively in the delivery room when the big day finally arrives. Believe it or not though, Kegel exercises can be helpful even if you’re not planning on giving birth any time soon. Actually, they’re extremely helpful for women going into menopause. Studies show that Kegel exercises are a great way to prevent incontinence.

As we get older, our ability to hold in urine when we really have to go lessens. It’s simply a part of aging, and it usually comes on during menopause. Whether you’re having a laughing fit with the girls over brunch or rushing to the bathroom at a crowded sports game, you just won’t be able to hold it in like you used to. It’s common and nothing to be ashamed of, but regular Kegel exercises will improve your ability to hold it until you find a bathroom.

Your physician can help you learn how to do Kegel exercises if you’ve never done them before, but once you get the hang of it you’ll be able to do them anywhere.  Your daily Kegel routine will involve contracting and relaxing the muscles for a short period of time every day.  As stated in my women’s health book, Inside Information for Women, it takes about one to two hundred repetitions a day in divided segments of twenty at a time.  It’s important that you don’t do your Kegel exercises while urinating though, as this could lead to a urinary tract infection. Never interrupt the flow of urine once it begins. These exercises are especially helpful in obese women who have reached menopause and are experiencing incontinence.

It makes sense that Kegel exercises can help you better control the flow of your bladder. Just like any other muscular exercise, you will become stronger over time and have more control in general. The best part about the exercises is that you don’t need a gym or even privacy to do them. They are extremely discrete, so you could even do your routine at your desk or anywhere else you can sit comfortably. Of course, speak with your physician if your incontinence is seriously affecting your daily routine, but if it’s only a minor inconvenience, Kegel exercises might be the only treatment you need.

 – Yvonne S. Thornton, M. D., M. P. H.