Incontinence

Incontinence, or leaking urine, is a common problem related to aging. There are two types of incontinence, stress incontinence and urge incontinence, and both are more common after menopause.

There are two types of incontinence, stress incontinence and urge incontinence

Stress incontinence, the more common of the two, is the leakage of urine during exercise, coughing, sneezing, laughing, or bearing down on the abdominal muscles. It is caused by a weakened pubococcygeus, a muscle in the pelvic floor that contracts around the urethra to hold urine in. It may be stretched or torn during childbirth and further weakened by age. Urge incontinence is the inability to hold back urine long enough to get to a bathroom. There are an increasing number of options for treating both types of incontinence. Kegel exercises can be very effective in preventing stress and urge incontinence. Biofeedback has also been shown to be effective in retraining the bladder. There are also a number of devices that can be used to plug the urethra. Pessaries are vaginal inserts that change the angle of the urethra and prevent incontinence. (A tampon inserted before exercise can also help reduce leakage.) Surgery is sometimes helpful, but less often than one would hope. And finally there are several new drugs for hyperactive bladder that may help. Treatment of urinary incontinence depends on the problem you are having. If the problem is urgency (always feeling as if you have to go but then producing only a little urine), there are behavioral modifications you can make, such as slowly training yourself to wait longer before emptying your bladder—one hour, then two hours, and then three. If the problem is stress incontinence (losing urine when you laugh or sneeze), you should first try Kegel exercises to strengthen your bladder. This involves exercising the pubococcygeal (PC) muscle. To find the muscle, simply stop your flow while urinating; it’s the PC muscle that contracts to do this. What’s great is that these exercises can be done at any time, such as sitting on the bus, stuck in traffic, or at your computer.

Incontinence can be prevented with Kegel exercises and Biofeedback

There are several different Kegel exercises. One is to contract your PC muscle for three seconds and then release it for three seconds. Repeat this six times, three times a day; then go to twelve times a day. Second, you can contract your PC muscle strongly for one second and then release it for one second. Repeat this twenty times, three times a day. Speed up the contractions until you have a fluttery feeling. A third is to contract the PC muscle for ten full seconds, working at holding the contraction. Repeat this five times, three times a day. Once you have your PC toned and can do all of these exercises well, you can do them just once a day. Another option is a pessary—a ring you insert just inside your vagina, above the bone, to help keep the organs in proper alignment and decrease leakage. It’s especially helpful if the problem is weak pelvic muscles, which can result after many pregnancies. Another option is a tampon. One study found that women who used a normal menstrual tampon while doing aerobic exercise had less incontinence than women who used a pessary. There is no evidence that hormone replacement therapy (HRT) or estrogen alone helps with incontinence. In fact, one study found an increase in incontinence in the women on HRT.

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