Health: Fixing the leak of untold incontinence

Dr. W. Gifford-Jones

Urinary incontinence is one of the most common problems of aging. It instills, needlessly, the prospect of embarrassment and a fear of leaving the house. Comedians quip, “If you don’t know when you need to go, by the time you find out, you’ve already gone!” But in fact, it’s no laughing matter when a sneeze, cough, or even just standing up causes urine suddenly to leak through your clothes.

Stress incontinence occurs when pressure in the urinary bladder is greater than the ability of the muscles to hold back the flow of urine. In men, it may be associated with aging, or the result of a radical prostatectomy for cancer of the prostate gland. For women, it’s often due to repeated pregnancies and the strain on pelvic muscles during labour.

Urge incontinence is the issue when you feel a sense of panic. “I’ve got to go quickly to urinate or I’m in trouble.” The sudden, intense urge to urinate is followed by an involuntary loss of urine.

The risk factors include obesity, which increases pressure on the bladder and surrounding muscles, and smoking, where continually coughing exerts stress on pelvic muscles.

Constipation is another factor. Grunting and pushing with bowel movements of hard, compacted stools further injures pelvic muscles and causes nerves to become overactive, which increases the urge to urinate frequently. Taking 2,000 milligrams (mg) of vitamin C at bedtime triggers results. If it does not, increase to 4,000 the next night. Then eat a high fiber cereal and a hot drink in the morning. A bowel movement will follow. As a cardinal rule, don’t ruin your colon with laxatives.

Making changes in lifestyle can help to ease this problem. Decrease caffeine, alcohol and other diuretics. Stop smoking. Avoid acidic foods.

Remember dams that leak must be strengthened. So do exercises. Imagine trying to pick up a marble and hold it using the muscles in your pelvic floor. Do this eight times several times a day and continue daily for three months. Remember Rome wasn’t built in a day. This simple procedure usually improves incontinence as it bulks up pelvic muscles surrounding the urethra (the tube that carries urine to the outside) and helps to stop dribbling of urine. If the muscles have become so weak that they fail to respond to this exercise your doctor may suggest electrical stimulation to trigger muscle response.

Artificial bulking agents made of biocompatible material are available to help improve urethral function. A cystoscope is inserted into the penis or vagina and the bulking agent is injected around the urethra. This may take two or three sessions to get the required result. But results are not as good in males who have had a radical prostatectomy.

If all this fails, surgery will be suggested. For women this usually means a vaginal operation, but some surgeons prefer an abdominal one. A sling operation is currently the most effective. The rationale behind this surgery is quite simple. By placing a sling under the urinary bladder, it will not only be lifted, but the procedure will also change the angle, decreasing the loss of urine.

For males with significance urinary incontinence who have had a radical prostatectomy, an artificial urinary valve can be inserted which closes the valve on a continual basis. But it can be opened by a small pump implanted under the scrotum skin.

Urinary incontinence is called a “closet problem.” After all, who wants to admit they wet their pants. But too many North Americans suffer from this disorder in silence, when they should be getting help.

Dr. W. Gifford-Jones can be reached at contact-us@docgiff.com.