by JoAnn Lister, FNPC

You may know the feeling: you have to empty your bladder and are afraid you can’t wait til you find a bathroom. That’s called urinary urgency. How about when you cough or sneeze or laugh and urine leaks out onto your underwear? That’s stress incontinence.

Incontinence is loss of voluntary control of the bladder. Incontinence symptoms are reported by 19% of all women by age 75 and by 9% of all men. Feeling like you have to go all the time or can’t wait long enough to make it to the bathroom is experienced by 13% of all 75 year old men and 8% of women the same age. It is suspected many do not ever report the problem.

Despite the fact that this problem is more common the older men and woman become, it is not a normal consequence of aging.

Overactive bladder (OAB) is a cluster of symptoms that includes urinary urgency (most common symptom) with or without urge incontinence, urinary frequency and nocturia (frequent night time urinating). Stress incontinence is not associated with urgency but occurs during physical exertion involving increased abdominal muscle strain, such as coughing, sneezing, laughing, exercise, lifting or sitting.

While loss of estrogen through age or surgery can cause symptoms in women, it has not been proven that giving estrogen cures the problem.

As you can imagine OAB causes lots of other problems in the person’s life including:

      1. Sleep disturbances with the nighttime bathroom trips and then, daytime fatigue

      2. Increased risk of falls and fractures trying to get to the bathroom at night in a hurry.

      3. Increased risk of skin infections from leakage

      4. Increased risk of urinary tract infections; chronic wetness can lead to fungal infections

      5. Depression: 1 out of 3 women with depression also have urinary incontinence.

You would think the problem of incontinence might be depressing enough. But actually serotonin and norepinephrine can affect the bladder or urinary sphincter, and coincidently, depletion of these normal body hormones causes persons to experience depression more often. So treating your depression, may improve your bladder problems.

There are many medications that can cause bladder problems and you should ask your health care professional if your new bladder symptoms could be a side effect of one or more of the ones you are taking. Diuretics increase urinary output and put more pressure on the bladder, but they may be needed. So you may need to try different ways to take your medication which should also be discussed with your health care professional. Sedatives, sleeping pills and certain anti-depressants can cause accidents from drowsiness or plain loss of bladder control.

One of my young patients was taking a medication for her panic attacks that worked great until she began to lose control of her bladder. We had to quickly find an alternative for her to prevent a new cause of panic!

Some medications relax muscles so much, they relax the bladder too, and the urine is not able to be expelled, resulting in bladder pain, stretching, overflow, and infection. Many drugs for treating Parkinson’s Disease do this and the patient needs to be attentive to bladder emptying on a regular basis.

There are some triggers that cause OAB such as caffeine, chocolate, and alcohol. Keeping a bladder diary (measure the volume and time of each void and incontinence episode for at least 24 hours and note amount of fluids consumed and any symptoms at the times of voiding; also snacks or activities during the day) can help identify possible triggers of urgency or incontinence.

Physical changes in women can cause OAB, such as thining of tissues around the urinary meatus in later years, which can reduce the ability to close the sphincter at the urinary opening.

Pelvic organs can prolapse and prevent appropriate emptying; then urine may distend the bladder and overflow may occur. Also pelvic muscle tone can be weak in women, especially if they have had multiple pregnancies or difficult labors.

Physical changes in men which increase the likelihood of OAB include enlarged prostate, prostate cancer and urethral obstructions.

There are multiple types of strategies for addressing the OAB. These are best used in combination. They include life style changes, bladder training, and medications.

Lifestyle changes include reducing fluid intake, especially in the evening. Avoid drinks that irritate the bladder such as those containing caffeine, alcohol, acidic and spicy foods, citrus juices and artificial sweeteners. You have to be sure not to dehydrate as that can cause urine to be concentrated and result in further irritation.

Also, avoid constipation which increases pressure on the bladder. Eat adequate fiber, exercise regularly, and again, don’t get dehydrated.

Get weight under control. In 1 study, women who lost just 5% of their weight decreased their incontinence episodes by 50%.

Stop smoking: this has been found to coexist with OAB, although the reason for this correlation is unknown. Some researchers say the smoker’s cough is a possible cause of urge incontinence.

In bladder training you must first understand the cause of incontinence and what normal patterns are. One method is called “scheduled voiding.” Start with a schedule of voiding every 2 hours and gradually increase the amount of time between visits to the bathroom. Studies show this has resulted in 57% improvement with OAB.

There are “Urge Control” strategies: Concentrate on relaxing the bladder through deep breathing. Tell yourself you can wait another 15 minutes or that you will be able to make it to the bathroom in time. Tighten your pelvic floor muscles when feeling the urge to void.

Learn Kegel exercises, where you identify and tighten the muscles around the vagina, urinary opening, and the muscles around the anal opening. Think about how you can gradually increase the intensity of this tightening as you visualize yourself going up in a slow elevator. When you get to the top of the building, the muscles are very tight, then slowly and deliberately relax each muscle in the pelvic floor as you come back down.

This exercise is recommended 50 to 100 times a day. You might pick an activity you do regularly and include it at that time-during a favorite TV show in the morning and in the evening; when standing at the sink washing dishes or cleaning vegetables, when typing at your computer certain hours of the day, etc.

Medications are available to improve bladder control and relax the spasm or irritability of the bladder. These include Oxybutynin, Ditropan, Detrol, Vesicare, Sanctura. They are available in pills and/or patches. They are very good at controlling symptoms of urgency, urge incontinence, frequency, and nighttime voidings, and in increasing the volume voided. Side effects include dry mouth, blurred vision, constipation. Some side effects are intolerable, such as blurred vision, and others can be overcome with various measures. Some people do not have any side effects. Some side effects can be controlled by lowering the dose or trying a different medication.

These medications are usually effective by the end of the first week of use and increase in effectiveness over the first month. But they really work best when combined with the previously noted exercises and life style changes.

Finally, there are surgical techniques that could be helpful. Prolapses can be repaired. There is a pacemaker type nerve stimulation implant that is reserved for those who cannot find anything else to work. Botulinum toxin injections can be administered around the urethra to build up tissue and help it close better.

And if surgery cannot be tolerated, vaginal pessaries can be used to support the vaginal walls and keep the bladder from falling back into it resulting in poor bladder emptying.

I hope if you relate to any of these symptoms, you don’t delay in discussing them with your healthcare professional.

JoAnn Lister is a Family Nurse Practitioner Certified, at both the Marathon Health Center and Alpine Family Health Care Services. The Marathon Health Center is open Mondays & Thursdays, 8:30 a.m. - noon, 1:00 - 5:30 p.m. Located at South First at Post Road in Marathon. Phone: 432/386.4316. The clinic accepts appointments and walk-ins. Alpine Family Healthcare Services is located at 910 East Lockhart Street in Alpine. Phone: 432/837.1541.