Losing your water: you may not have to "just live with it"

Urinary incontinence is a common problem, especially in older people. But it's not a normal part of aging, and may be more treatable than you think.

Many people with incontinence don't let anyone know that they have a problem. As a result, they may miss out on possible treatments.

Do you need help?

Answer these 3 questions:

1. Am I having trouble passing my urine?
2. Do I ever wet myself when I don't want to?
3. Do I wear pads or diapers to protect against losing urine?

If you answer 'yes' to any of these questions, your doctor may be able to help you. The good news is that effective treatments are available for many patients.

What causes incontinence?

There are a number of causes of incontinence, and many of them are treatable. Sometimes the muscles that help keep urine from leaking can become weakened. Certain medications can cause urinary problems. So can conditions like diabetes, an enlarged prostate, urinary tract infections, or even constipation. Some patients have difficulty reaching a toilet in time due to confusion or trouble getting around.

Assessment

Tell your doctors when and how much urine you leak, and what seems to bring on the problem. bring a complete list of all the drugs you are taking, including prescription, over-the-counter, and "alternative" medicines.

Bladder diaries

A bladder diary is an easy way for you to record how often you pass urine, and how often and how much urine you leak. This can help determine the correct diagnosis. Such a diary is also useful for measuring how well you respond to treatment. Your doctor can give you a bladder diary form to fill out.

Types of incontinence

There are five major kinds of incontinence, as explained below.

Quality of life survey

Your doctor might ask you to fill out a simple questionnaire to help figure out how much your urinary symptoms affect your quality of life.

Getting relief

Lifestyle changes

• losing weight: weight loss of 5-10% in overweight women can decrease wetness episodes by more than half:
• increasing physical activity;
• reducing caffeine and alcohol;
• stopping smoking; and
• treating constipation.

Behavioral treatments

These non-drug approaches are safe and can help with many types of incontinence. Which treatment is right for you will depend on the type of problem you have.

• pelvic muscle exercises: for stress incontinence: increases the strength of pelvic muscles by repeatedly contracting them as if you're trying to hold in urine. Repeated several times daily.
• bladder training for urge incontinence: gradually increases the times between urinating by 15-30 minutes each week, until you can go 2-3 hours between trips to the bathroom.
• prompted voiding: caregiver regularly remind you about the need to go to the toilet.

Containment products

Diapers, pads, and sanitary napkins can be useful in managing incontinence, but are no substitute for careful diagnosis and treatment. If you are using these products already, be sure to let your doctor know that you are having problems with incontinence.

Prescription drugs

Several medications are available to treat severe problems, especially urge incontinence ("overactive bladder"). However:

• They are not always needed because non-drug measures can be very effective.
• The may cause side effects.
• Their use must be reviewed regularly and discontinued if they are not helping.

If you think a medicine is not helping or is causing an unwanted side effect, talk to your doctor or other primary care practitioner.

More information

A good brochure for patients on incontinence is at:

• http://www.acog.org/publications/patient_education/bp081.cfm