Written by Melissa Bean Sterzick
Incontinence might seem like an inconvenient and inevitable side effect
of aging, but it is treatable for both men and women. With more than 40%
of women over age 65 affected by urinary incontinence, according to the
Centers for Disease Control and Prevention, it is a more common condition
than many may realize. It also increasingly affects men as they age and
is estimated up to 34% of older men have some form of urinary incontinence.
Physicians are comfortable discussing all aspects of their patients’
health, so those experiencing incontinence should talk to their doctor
about their symptoms. Here
Sunetris Fluellen, MD, and
Joseph Roofeh, MD, both Torrance Memorial Physician Network OB-GYNs, answer important questions
What are the symptoms and types of incontinence?
Dr. Roofeh: The main symptom of incontinence is involuntary leakage of urine. However,
it also depends on the type of incontinence. There are many causes and
types of urinary incontinence. The most common type is stress incontinence,
which is leakage of urine in situations of increased abdominal pressure
(for example: sneezing, laughing, coughing, lifting heavy objects). This
is due to the weakening of the pelvic floor musculature. Urge incontinence,
or overactive bladder with incontinence, is another common type. It arises
from overactivity of the muscles in the bladder, giving the urge to void
immediately, with involuntary leakage prior to getting to the restroom.
What causes incontinence?
Dr. Fluellen: Several factors are associated with urinary incontinence. These include
increasing age, obesity, smoking, chronic coughing or constipation, and
specifically for women, the number of pregnancies.
Dr. Joseph Roofeh: Less commonly, causes of incontinence are certain medications, urinary
tract infections and other medical conditions such as diabetes, high blood
pressure, stroke or a neurological disorder.
How is incontinence treated?
Dr. Roofeh: For stress incontinence, we start with lifestyle modifications, pelvic
floor physical therapy and pelvic floor muscle strengthening exercises
(such as Kegels). If that does not work, we advance to a continence pessary
(a prosthetic device) or surgical intervention.
Dr. Fluellen: Stress incontinence is typically treated with a minor surgery involving
a sling. Studies have shown moderate improvement with pelvic floor physical
therapy, but the definitive treatment is the sling. This procedure can
only be done once the patient is done with childbearing. For patients
who cannot have surgery or decline surgery, they can also try a pessary
to help with symptoms. Urge incontinence is typically initially treated
with oral medication. If symptoms do not improve after trying two different
types of medication, there is also a procedure called InterStim that some
patients are candidates for.
What lifestyle changes can help reduce the symptoms of incontinence?
Dr. Fluellen: Patients can decrease smoking, focus on weight loss and do Kegel exercises
to help strengthen the pelvic floor. Keeping a food and bladder-voiding
diary may also help. This will allow you to track certain triggers that
may worsen incontinence. For instance, foods with high acidity, carbonated
drinks, alcohol and caffeine have been shown to worsen urgency symptoms.
Dr. Roofeh: Urinary continence sometimes arises from increases in abdominal pressure
such as chronic cough and obesity. Weight loss will decrease abdominal
weight and pressure, helping relieve symptoms of incontinence. Rapid urine
production can worsen symptoms of incontinence. Alcohol and smoking both
cause diuresis and increased urine production.
What is important for individuals to know about incontinence?
Dr. Roofeh: Incontinence is very common, and while it is usually seen in older women,
it can affect all ages. In men over 65, it is often related to prostate
issues. The first step in treating incontinence is to see a doctor.
Dr. Fluellen: Pregnancy, childbirth and menopause all affect the urinary tract and pelvic
floor muscles. Those muscles can become weak or damaged, and this makes
it difficult for the bladder to hold urine. I want women to know there
is no need to be embarrassed to talk to your physician about incontinence.
If your symptoms are affecting your quality of life, please seek treatment
with your OB-GYN or urologist.
Factors That Contribute to Incontinence
- Being overweight
- Previous pelvic surgery or radiation treatments
- Having other medical conditions, such as diabetes, high blood pressure,
stroke or a neurological disorder
- Genes that cause weakened pelvic floor muscles
- Experiencing chronic constipation, which exerts pressure on the pelvic
structures and strains pelvic floor muscles
- Consuming too much caffeine or alcohol
Ways to Prevent or Control Incontinence
- Eat a balanced diet
- Be more physcially active. It can help you lose weight, prevent constipation
and reduce pressure on your bladder
- Cut back on alcohol and caffeine, which can stimulate the bladder
- Stop smoking
- Strengthen pelvic floor muscles by performing Kegel exercises
Kegel Exercises to Keep Your Pelvic Floor Muscles Strong
- Empty your bladder and lie on your back. Tighten your pelvic floor muscles,
hold the contraction and then relax.
- Increase pelvic strength by trying to lift pelvic floor into abdomen like
an elevator rising. Work up to 10-second hold.
- Practice 8 reps, 3 times a day. Consistency is key! With consistent daily
exercise, you should see results in six to eight weeks if your primary
problem is small leakages with exertion.
Sunetris Fluellen, MD, is an OB-GYN specialist at Torrance Memorial Physician
Network Women’s Center in Torrance at 2841 Lomita Blvd., Ste. 200.
She can be reached at 310-784-6822. Joseph Roofeh, MD, is an OB-GYN at
Torrance Memorial Physician Network Women’s Center Carson Obstetrics
at 824 E. Carson St., Ste. 203. He can be reached at 310-543-5488. Both
doctors practice at Torrance Memorial Physician Network Women’s
Center in San Pedro at 24909 S. Western Ave. in Rancho Palos Verdes.