Published: December 24, 2008 08:55 am      

Bladder problems may not be a natural aging process

DEAR DR. MONA: I’ve been told that leaking urine is a fact of life as I age. Since it is not going to kill me, it is OK, I guess, but I really am not accepting this gracefully. Can you help? — Marian

DEAR MARIAN: Thanks for the question. I agree with you; you should not accept this. Losing urine or leaking urine or the inability to control your stream of urine is known as bladder incontinence.

Incontinence is a very common problem affecting millions of men and women. Although it may not kill you, it may rob you of your social life and result in isolation. For some the urine loss can be really severe, to the point that heavy lifting, coughing or laughing results in loss of urine. Other individuals report predictable episodes of incontinence; still others may not be able to reach the bathroom in time once the urge arises, making it quite difficult at work or in social settings.

Urinary incontinence is not just a natural process of aging as many want you to believe. Moreover, this is not an unavoidable result of childbearing; it could be either a simple process or a major disease. Incontinence could be due to problems of the bladder or issues with the nerve supply to the organs in the pelvic area. A complete investigation is necessary to understand and begin to resolve this problem

Stress incontinence (leaking with coughing or pressure) is more common in women than men since women have had pregnancies, deliveries, menopause and so on. Men with large prostates may have increased feelings of urgency and possibly overflow incontinence. In general, as men and women age, the bladder and the valve that controls the urine (urethra) also ages and becomes less compliant.

Other predisposing factors to stress incontinence include obesity, smoking (because of constant coughing to clear the throat), vascular disease, and systemic disease such as diabetes and hypertension. In addition, some medications (such as blood pressure medicines) increase the urine production.

Oh, one more thing to consider: What if you do not treat incontinence? Well, individuals using Depends or other products may have skin problems from the urine touching the skin; these in turn can lead to infections and ulcers. Bladder infections are common in patients with continence problems. Lifestyle changes may be dramatic and could transform an active, involved person into a hermit with minimal social life or a life that involves knowing the location of all the bathrooms in the mall or any place they visit.

Some patients may complain of being unable to work or sit at their desks because they have such frequent trips to the restroom, and at night many patients do not sleep because they are up and down with many trips to the bathroom. While on trips or vacations, patients are not able to stop going to the bathroom constantly and must make frequent stops, frustrating members of the family unable to understand the problem, and this may lead to depression or anxiety.

Having said all this, Marian, there are things that can be done about this problem and even if it is not going to treat it 100 percent it can make a dramatic improvement.

What can you do about leakage? You can learn to do some kegel exercises in which you train the pelvic muscles to improve tone; you can also see a physical therapist trained in rehabilitation of pelvic floor muscles in order to help strengthen them. Scheduling toilet use and bladder training are other methods of dealing with incontinence.

Medications are available to help and there are many of them, whether they are generic or brand names (Detrol, ditropan, oxybutenone, Enablex, Vesicare, Sanctura) and more drugs are on the way. Inserts placed in the vaginal area to support the bladder (pessary) or urethral plugs are also available to help control leakage of urine

Surgical interventions are possibilities; these could include bladder suspension using stitches, or using slings that can be placed vaginally to help provide a back board to control urine loss. Both of these surgeries can be done locally and on an outpatient basis. Sacral nerve stimulation is another method used to control incontinence and improve the nerve stimulation to the bladder allowing it to rest and decreasing urinary urgency.

So you can see there are many options; you do not necessarily have to live with this problem. See your doctor and explore the options that might work for you. You may never have a bladder that acts like that of a 20 year old, but I suspect you can find an acceptable resolution to your problem!



Dr. Mona Alqulali is a board certified OB-GYN.