Saturday, December 5, 2009

Guide to Bladder Control - Ever laugh so hard that you peed? And the joke wasn’t that funny? You’re not alone, and it may be a sign of incontinence. Find out how to prevent or cope with embarrassing little leaks.

Losing control of your bladder is embarrassing, uncomfortable and, well, wet... not to mention relatively common. Incontinence affects 10% to 30% of women 64 and younger, says the National Women’s Health Resource Center.

Even if your bladder is behaving now, it may betray you later. About 25% of women will experience involuntary urinary leakage at some point in their lives.

Luckily, those little leaks when you cough, sneeze, laugh or exercise – called stress urinary incontinence (SUI) – are problems you can solve and even prevent.

It’s an Anatomy Thing
Urine leaks occur when bladder pressure exceeds what the urethral sphincter can hold back, says Colleen Kennedy, M.D., assistant professor of obstetrics/gynecology at the University of Iowa.

Declining estrogen levels during menopause increase your SUI risk because the urethral tissue becomes thinner and less elastic, leading to reduced sphincter control, she says.

Women who have had multiple vaginal deliveries or difficult labors are particularly prone to leakage because pressure on the internal organs can permanently weaken the urethral sphincter.

Gail Stein can relate. After a breach delivery with her first-born, the stress incontinence - and frequent urge to go that started in her teens - worsened.

“I would be in the bathroom 20 or 30 times a night,” says Stein, co-author of Mind Over Bladder… I Never Met a Bathroom I Didn’t Like. “My pants were down more than they were up.”

A public school teacher, Stein learned to “pee at the bell,” avoid fluids after 7 p.m. and always scope out the nearest bathroom.

"As women lose control over their body, daily activities and even sex life, depression can set in,” says Jill Maura Rabin, M.D., co-author of Mind Over Bladder and head of urogynecology at Long Island Jewish Medical Center. “Getting a diagnosis and treatment is so key.”

Preventing an Accident
Anything that puts pressure on the pelvic organs can open the floodgates. Here’s how to prevent incontinence or minimize accidents:

1. Monitor your fluids.
Too much water overloads the kidneys, making you have to pee all the time, Rabin says. Take your ideal body weight and cut it in half. This number represents the total ounces of fluids you should drink throughout a day.

2. Take a leak – beforehand.
If you’re leaking during exercise or sex, empty your bladder before you begin either activity. You may even want to insert a tampon to support the urethra before strenuous exercise.

3. Plan your bathroom breaks.
“Timed voiding” can help women who have a constant urge to pee, Rabin says. If you normally hit the restroom every 15 minutes, aim instead for 20-minute intervals.

Stretch the time by five minutes each week. In 6-8 months, you’ll be able to wait 2-3 hours between bathroom breaks.

4. Lose weight.
A study in The New England Journal of Medicine found that women who lost just three pounds reduced accidents by 28%; those who lost 17 pounds cut accidents by half.

5. Avoid constipation.
Eat a fresh pear and spinach with extra virgin olive oil each day to keep things moving, says Janet A. Hulme, a physical therapist at Phoenix Core Solutions and author of Beyond Kegels: Fabulous Four Exercises & More to Prevent & Treat Incontinence.

6. Keep a food diary.
Recording what you eat will help you find patterns that trigger an urge to pee. Rabin recommends limiting these bladder-irritating foods:

* Artificial sweeteners
* Apples, citrus fruits, peaches, cantaloupe, grapes, guavas, pineapples, plums and strawberries
* Alcohol
* Caffeine
* Carbonated beverages
* Corn syrup
* Honey
* Milk and milk products
* Spicy foods
* Sugar
* Tomatoes and tomato-based products
* Vinegar
* Vitamin B complex and vitamin C

7. Wear pads.
Pads aren't a solution, but they can help manage leaks while you’re working with a doctor for diagnosis and treatment.

Skip menstrual pads and go for incontinence pads, which are designed to absorb urine and prevent skin irritation, Kennedy says. With options ranging from light protection pads to heavy absorption disposable underwear, wear what's comfortable and meets your needs.

Kegels to the Rescue
Often used as a way to boost sexual satisfaction, Kegels can also prevent and treat incontinence.

Judy Florendo, a Chicago physical therapist specializing in pelvic floor dysfunction, helps women isolate the muscles properly.

“A woman has to prepare and go slowly; otherwise she can do damage,” she says.

Try these at-home tips to find the right muscles:

1. Insert a finger into the vagina and squeeze around it. You should feel tightness and a lift around finger. The buttocks, abdomen and thighs should all be relaxed. You shouldn’t be able to tell you’re doing a thing from the outside.
Or try it with a tampon. Insert, pull the string taut and do the same squeezing motion.

2. You also can locate the right muscles by stopping the flow of urine. Don’t do this repeatedly because it can damage the urethra and break down the complex communication between the bladder and the brain during urination.

Florendo recommends two strengthening exercises:

* If cough- or sneeze-induced leaks are your problem: Squeeze and release in one-second intervals, gradually working your way up to three sets of 10.

* If you feel fine in the morning, but can’t hold your urine as much later in the day: Squeeze for 10 seconds and release for 10 seconds, gradually building to three sets of 10.

Beyond Kegels
Hulme’s simple “Roll for Control” exercise rebalances the pelvic rotator cuff to help prevent leakage:

1. Lie on your back on a high-density foam wedge that raises your hips 6 to 8 inches above your shoulders. Place feet up against a wall with legs straight. (Wedges are available online or ask an upholstery store to cut one to size.)

2. Take 4 or 5 breaths (using your diaphram) allowing your stomach to soften and move in and out.

3. Pivoting on your heels, roll knees and toes out hip-width while inhaling.

4. Pivoting on your heels, rolls knees and toes back to neutral while exhaling.

Long-Term Options
If you’re still having accidents, other treatments are available.

Surgery is one option that yields great results, Kennedy says. The procedures restore support to the urethra, giving women control of their bladders again.

For women who don’t want to have surgery, other treatments include:

* Herbal remedies: Corn silk, saw palmetto, pumpkin seed and magnesium supplements have shown promise in reducing bladder leakage.

* Duloxetine (brand name: Cymbalta): Several studies have found that this anti-depressant can help treat incontinence.

* Vaginal pessaries: A pessary is a device designed to be inserted into the vagina to support it. Women need to be properly fitted for a pessary.

* Collagen injections near the urethra: The injections help narrow the urethra and improve bladder control. Results typically last 2-4 months.