$Unique_ID{BRK01997} $Pretitle{} $Title{Treatments for Uncontrollable Bladders} $Subject{treat treating treatment Treatments Uncontrollable control controllable bladder Bladders old older incontinence age aging urine urinate urinating urination Urge stress physical laugh laughing cough coughing lift lifting pregnancy pregnant examine examination examinations behavior behavioral therapy therapies drug drugs medicine medicines medication medications electric electrical stimulate stimulation stimulations surgery surgeries operation operate operations muscle muscles Kegel exercise exercises retrain retraining spasm spasms nerve nerves test tests testing} $Volume{} $Log{} Copyright (c) 1993 Tribune Media Services, Inc. Treatments for Uncontrollable Bladders ------------------------------------------------------------------------------ QUESTION; I find that I have a very distressing and embarrassing problem which I can not bring myself to discuss with my doctor. There are times when I just lose my water, and I can't do anything about it. I head for the bathroom, but never quite make it. Does this mean back to diapers for me, or have they come up with any treatments to help older folks like me? Please consider writing something about this problem in your column. ------------------------------------------------------------------------------ ANSWER: While incontinence is more frequent in older people, it is found in all age groups. At least one estimate puts the number of Americans who suffer from incontinence above 10 million adults, so you do have a bit of company. Incontinence refers to the situation where there is a loss of ability to control urination and it may be divided into two classifications. "Urge incontinence" mean that the person cannot hold urine long enough to make it to the bathroom, and sounds like it might be your problem. About 25 percent of people with the problem have this type. In another 25 percent, it is associated with "stress" incontinence, where urine leaks out during physical events, such as laughing, coughing or lifting heavy things. Stress incontinence often occurs during the last months of pregnancy as well, when the enlarged uterus pushes down upon the bladder. In many cases the exact cause of the incontinence can not be found even after diligent examination. However, if you are to get the treatment you need, and there are several that can help, you will have to confide your problem to your doctor, for only after proper examination can a successful treatment strategy be developed. There are essentially four ways to treat incontinence; behavioral therapy, drug therapy, electric stimulation and surgery. Behavioral therapy takes time and patience to learn, and helps you become more aware of the muscles used in controlling urination. Exercises (called Kegel exercises) are used to strengthen the voluntary muscles that affect urination. You might also be placed on a strict schedule for urination, in the beginning as often as every hour, to retrain the muscles of your bladder. Gradually this time can be increased as you are able to go for these increasing periods of time without losing your water. After 6 weeks of such training, almost 85 percent of the patients achieve good results with 10 to 15 percent gaining complete control. Drugs can be used to help increase the bladder's capacity and to reduce involuntary muscle spasms that can cause you embarrassment. Spasms cause your muscles to contract at the worst moment, pushing urine out of the bladder when you are not prepared. In some cases, using electrical stimulation of the bladder muscles can help you regain control. When all these methods do not produce the results you may desire, surgery can be used to either increase bladder capacity or to disrupt the nerve impulses that lead to spasms by blocking certain nerves. It is hard to know which one or which combination of several of these methods would work best in your case. That can only be worked out after you have had the benefit of some testing, by your own physician. And you must be willing to try out new therapies if the first attempts are less than satisfactory. It is the rare family physician indeed that hasn't seen and dealt with this problem, so you need not feel embarrassed. I know that revealing this problem may not be the easiest thing you have ever done, but it is certainly the best path towards solving your dilemma. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.