Fixing Leaks

The most common causes of urinary incontinence, and their solutions.

By Melinda Dodd
Photograph: Photo by: iStockphoto

If coughing, sneezing, laughing or exercising make you release urine…
You’ve probably got stress urinary incontinence (SUI), which occurs when you bear down on impaired pelvic floor muscles or a weak urethra.

What to try first Shedding just eight percent of your excess pounds relieves enough pressure to cut accidents nearly in half. Doing Kegels may also strengthen muscles. To shore up a sagging urethra, consider biannual collagen injections, which reduce leaks by 70 percent.

Surgical solutions Urethral slings are 85 percent effective in treating SUI. The surgically attached graft material provides enough resistance at the neck of the bladder or mid-urethra to keep urine from leaking out during activities. But, notes American Urological Society spokesperson Tomas L. Griebling, MD, “Any type of artificial material used in sling surgery can be associated with risks. If you’re concerned, ask your doctor about using slings made from natural tissue.”
If you have a sudden accident or feel a constant, urgent need to urinate…
You may suffer from an overactive bladder or urge incontinence, which may be due to pelvic irritation, weak pelvic floor muscles or a spastic bladder muscle.

What to try first Avoid foods that can aggravate the bladder (carbs, caffeine). Vaginal estrogen (in creams, rings and suppositories) boosts mucus production, soothing dried-out bladder and vaginal tissues. “Women who experience increased urgency or frequency during menopause can find great relief,” says Sandra Culbertson, MD, of the University of Chicago.

Medications  “Anticholinergic drugs interrupt unnecessary contractions of bladder muscles,” says Michael H. Safir, MD, coauthor of Overcoming Urinary Incontinence. Antispasmodics also stop spasms in the bladder.

Get wired  If meds fail, consider sacral nerve stimulation, in which a small implantable pulse generator placed under the skin of your buttocks is connected to a lead wire near the tailbone. “This modifies the signal transmitted from your central nervous system to your bladder, allowing you to hold urine and experience less urgency,” says Craig Comiter, MD, of Stanford Medical School. Five years after the procedure, 70 percent of users maintain significant improvement.

First Published Thu, 2009-07-30 11:26

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