health & wellness

Gotta Go! Gotta Go!

The health problem women don't like to talk about.

Ruthan Brodsky
Special to the Jewish News

M

ost women are so self-conscious
about their urinary inconti-
nence that they won't discuss
it with their physician:' says Jennifer
Sobol, D.O., of Royal Oak-based Michigan
Institute of Urology. "They believe they're
the only ones who suffer with leakage
problems. They think it must be part of
aging because their mother had similar
problems. As a result, they go undiag-
nosed and untreated for years:'
According to the National Association
for Continence, two-thirds of women ages
30-70 have never discussed bladder health
with their doctor. Rebecca (not her real
name) was such a person. She waited close
to 30 years before she talked to a urologist.
When she was in her mid-40s, Rebecca
stopped doing anything aerobic because
of small leakages. She realized she had a
more serious bladder problem when she
soiled her mother-of-the-bride gown 20
years ago. Even so, she continued to ignore
all her bladder issues and told her physi-
cian that "everything was great."
Twelve years ago, Rebecca started hav-
ing small leakage accidents walking from
the garage to her front door. Ten years ago,
she had a major accident on a cruise and
emptied her bladder before reaching the
toilet.
"I still didn't do anything for three more
years:' said Rebecca. "I lived in constant
fear I'd have an accident anywhere I went
until I finally made an appointment with a
urologist"
The good news, Rebecca learned, is that
although urinary incontinence affects 30
percent of women over age 60, it is not a
normal part of the aging process. It is a
treatable condition, and women suffering
from it should consult their physician to
determine which treatment option is best
for them.
"There are many options to treat uri-
nary incontinence that are well tolerated,
at low risk and non-surgical or minimally

You Can Help

T

ips to making lifestyle changes
to help prevent urinary inconti-
nence:
• Cut the amount of caffeine you drink
at least by half. Caffeine is an irritant and
it increases the volume in your bladder.
• Stop smoking because nicotine stimu-
lates urgency. Also coughing associated

invasive," says Sobol, speaker at a Lunch
and Learn program sponsored by the
Greater Detroit Chapter of Hadassah.

Two Types

The two primary kinds of urinary incon-
tinence are stress incontinence and urge
incontinence.
"Stress incontinence
happens when you
sneeze, cough, laugh, do
aerobic exercise or other
things that put pressure
on your bladder; says
Sobol, who specializes in
female
urology, neurol-
,
ogy and male inconti-
Dr. Jennifer
nence.
Sobol
"It can be caused by
pregnancy and childbirth, weight gain or
other conditions that stretch the pelvic
floor muscles. When these muscles can't
support the bladder properly, the bladder
drops down and pushes against the vagina.
You can't tighten the muscles that close off
the urethra so urine may leak because of
the extra pressure on your bladder."
Urge incontinence happens when you
have a strong need to urinate but can't
reach the toilet in time. This may happen
even when your bladder is holding only a
small amount of urine. It may be caused
by bladder irritation, emotional stressors,
neurological diseases such as Parkinson's
disease or stroke. Some women, especially
as they age, have both types of inconti-
nence.
"Sometimes patients complain of a need
to urinate that is so sudden, they can't
make it to the bathroom in time to prevent
leakage says Sobol. "This condition is due
to spontaneous bladder spasms that can
result from bladder stimulants such as caf-
feine, medications such as sedatives or a
urinary tract infection:'
Rebecca was diagnosed with a prolapsed
or dropped bladder.
"The doctor explained to me where my
bladder was located and where it should
be said Rebecca. Her solution was a sling

with smoking can aggravate stress incon-
tinence.
• Engage in bladder retraining such as
urinating on a schedule and restricting
fluids before going to bed.
• Perform Kegel exercises regularly to
help strengthen the pelvic floor muscles.
• Manage medications. Some medica-
tions contribute to bladder control prob-
lems. These include high blood pressure

procedure, a common surgery to treat
stress incontinence that provides support
for the bladder and urethra. Sling proce-
dures are mildly invasive and sometimes
can be done under local anesthesia on an
outpatient basis.
Rebecca started 10 weeks of bladder
therapy, learning how to do Kegel exer-
cises correctly. All was well for the next
six years. Last year, when Rebecca turned
71, leakage started again. This time,
Rebecca saw her urologist immediately. A
second sling to support the bladder was
the treatment.
"The procedure is painless, and after-
ward I attended my second physical
therapy program," she says. "They told
me I needed to strengthen my core and to
walk on a regular basis. I also understood
that my problem could be chronic.
"Incontinence impacted my entire life
Rebecca says. "I arranged my social life
around not being embarrassed. I lived in
anguish. Today, I'm still leaking and wear
a thin Poise pad, but most of the time I
don't think about my incontinence. My
advice is if you have any of my symp-
toms, don't wait and isolate yourself. Talk
to your physician; it will be worth it?'

Making Lifestyle Changes

Sobol explained that the first treatment
doctors usually recommend for urinary
incontinence is making lifestyle or behav-
ior changes to reduce the problem. This
is not a quick-fix approach and takes
time to have a lasting impact.
Physical therapy for pelvic floor muscle
dysfunction is one of the specialties of
the Women's Urology Center at Beaumont
Hospital. The center also offers special-
ized treatment and research for women's
incontinence, pelvic pain, sexual dysfunc-
tion and other urologic conditions.
According to the National Pain
Foundation, pelvic pain affects one out of
every six women. However, 61 percent of
women with pelvic pain remain undiag-
nosed.
Andrea Sanfield, a physical therapist

drugs, heart medications, diuretics, mus-
cle relaxants, antihistamines, sedatives
and antidepressants.
• Maintain a healthy weight. Being
overweight may contribute to bladder
control problems, particularly stress
incontinence because excessive body
weight puts pressure on the abdomen and
bladder.
• Exercise regularly. Some studies indi-

specializing in pelvic
floor muscle dysfunction
at the center, explains
that half of the center's
patients are treated for
incontinence and the
other half for pelvic
pain.
Andrea
"It's important that
Sanfield
women discuss these
pain issues with their physician because
it can impact their entire life and family
planning, especially if there is pain with
intercourse Sanfield says.
"Urinary incontinence affects men and
women in any age group, but is more com-
mon in women and the elderly:' Sobol
says. As the population ages, the number
of people suffering bladder control prob-
lems increases. The costs of this problem
are personal, physical and financial, and
many with incontinence suffer social
embarrassment, isolation, ill health and
even depression. What is important to
understand is that incontinence shouldn't
prevent anyone from engaging in fulfilling
activities because treatment is available:'

/..m

Medications

Medications to calm an overactive bladder
are often used together with training for
making behavioral changes. However, they
can also cause side effects, including dry
mouth, blurred vision, constipation and
urinary retention.
The FDA recently approved over-the-
counter Oxytrol for women, a medicine
to treat overactive bladder. It is available
as a patch that is applied to the skin every
four days. The patch delivers oxybutynin,
a medicine that helps relax the bladder
muscle.
Newer on the list is the Botulinum toxin
or Botox injections, now approved to treat
urinary incontinence in people with spinal
cord injuries and other nervous system
problems. The injections may also provide
some relief for people with overactive
bladders.

❑

cate that 30 minutes of moderate activity,
such as walking briskly, reduces bladder
control issues.
• Minimize constipation. Straining
excessively during bowel movements
can damage the pelvic floor. Some
medications for treating bladder control
problems can make constipation worse.
Exercise, drinking water and eating high
fiber food can improve constipation.

❑

February 28 • 2013

49