USA Today founder Allen H. Neuharth made headlines when he publicly announced a few years ago that he wears adult diapers. This disclosure was news because few people are willing to admit—even to their doctors—that they suffer from urinary incontinence.
With age, bladder size typically decreases and pelvic floor muscles, which help control urination, weaken. But urinary incontinence (UI)—the involuntary or unwanted loss of urine—is not normal. Even so, about 38% of women age 60 or older and 17% of men in that age group suffer from the condition.
DO YOU HAVE UI?
To determine whether you may have one of the four common varieties of UI, ask yourself if any of the following applies to you…
Stress incontinence refers to urine leakage during any physical exertion, such as when exercising or sneezing, coughing or laughing. Stress incontinence also can occur in men after prostate treatments and in women after pregnancy.
Urge incontinence (also called over-active bladder) is an increase in urgency and frequency, typically accompanied by urine leakage on the way to the bathroom. Men and women will have frequent trips to the bathroom. Awakening to urinate at night is called “nocturia.”
Mixed incontinence is stress and urge incontinence combined.
Overflow incontinence occurs when the bladder does not empty completely because of a blockage in the urethra or diseases of the brain or spinal cord.
UNDERSTANDING THE BLADDER
When full, an adult’s bladder expands to about the size of a football and holds 12 to 16 ounces of urine. If you’re under age 65, it’s normal to urinate every four to five waking hours…and every three to four waking hours if you’re age 65 or older.
As you age, it can be normal to get up once or twice a night to empty your bladder. This is partly due to a shift in the circadian rhythm of water excretion, causing the greatest proportion of urine production to occur when the body is at rest.
In addition, certain medical conditions, such as diabetes, can predispose a person to UI. For example, excess blood sugar (glucose) causes people with diabetes to urinate more often and suffer frequent urinary tract infections (UTIs)—both of which raise the risk for UI.
Certain medications also can cause UI. For example, diuretics (often used to treat blood pressure) lead to urinary frequency and urgency for up to six hours after the drug is taken…and calcium channel blockers (typically used for heart conditions) can result in urinary retention—when the bladder is unable to empty completely.
SIMPLE STEPS THAT WORK
For about eight out of 10 people, lifestyle interventions reduce or eliminate most types of UI.
Do not cut back on fluids. If you suffer from UI, you may be tempted to reduce your fluid intake to help minimize trips to the bathroom and urine leakage. This is a mistake. If you don’t drink enough fluids, your urine may become highly concentrated (dark yellow and strong-smelling). This puts you at risk for bladder infections, which can worsen UI. Aim for about 64 ounces of fluids daily. Good beverage choices: Water as well as apple, cherry and grape juices.
Do not drink too much fluid. Drinking large quantities of fluid can overload the bladder, causing increased frequency of urination. Therefore, it is best to moderate daily fluid intake. While some guidelines recommend daily fluid intake of 75 ounces to 100 ounces, I advise people with bladder symptoms to consumer about 50 ounces to 70 ounces of liquid daily, This means that each day you should drink or eat what equals six to eight eight-ounce glasses of liquids (any beverages and soups), much of which can be in the form of solid foods (like fruit).
Surprising fact: Citrus juices—along with alcohol and carbonated beverages—may cause bladder overactivity, for unknown reasons, in many people. Even cranberry juice, which contains an enzyme that can help prevent UTIs, can irritate the bladder. For this reason, two 500-mg cranberry supplements daily may be a better choice.
Limit caffeine—in all forms. Caffeine acts as a diuretic, causing the bladder to fill more quickly, so you have to urinate more urgently and frequently. If you have urinary problems, limit your caffeine intake to 200 mg daily. An eight-ounce cup of brewed coffee contains 95 mg, while the same amount of decaf contains 2 mg to 4 mg. Five ounces of black or green tea contains about 40 mg of caffeine.
“Hidden” sources of caffeine: Hot chocolate (2 mg to 15 mg per five ounces)…chocolate ice cream (5 mg per two-thirds cup)…and some over-the-counter medications, such as Excedrin (65 mg per tablet).
Watch out for little-known bladder irritants. Highly acidic foods, such as tomato-based products, and spicy foods, such as Mexican food, can irritate the bladder.
Surprising fact: For unknown reasons, foods that contain milk and/or artificial sweeteners also can reduce bladder control.
Perform pelvic floor muscle exercises correctly. Tightening and relaxing the pelvic floor—the hammock-like muscle that supports all the pelvic organs, including the bladder—can improve symptoms of UI in women and men.
Don’t make this mistake: When attempting to locate the muscles to tighten, many people tense the muscles of the legs, buttocks or abdomen. Proper form: Imagine that you are trying to control the urge to pass gas. The rectal muscles you use to hold in the gas are the pelvic floor muscles. This technique is preferable to the widely used method of stopping the flow of urine to isolate the muscles. It is not a good practice to interrupt the voiding process.
Once you find these muscles, tighten them for three seconds, then release them for three seconds. This constitutes one set. Practice while sitting, standing and lying down so that you strengthen these muscles while in the positions that you will be in over the course of a day. Aim for 20 sets of squeezing and relaxing the muscles a day in each position, and gradually increase the hold to 10 seconds. When performed diligently, pelvic floor muscle exercises should reduce urine leakage within eight weeks.
“Retrain” your bladder. If you have strong, frequent urges to urinate (more than eight times in a 24-hour period), ask your health-care provider about bladder retraining. This technique involves emptying your bladder on a predetermined schedule (roughly every two hours).*
Little-known strategy: You can use deep breathing and meditation while you are waiting out the urge to urinate. Bladder retraining minimizes strong, frequent urges to urinate. It may take four to six weeks before you see improvement.
Prevent constipation. Being constipated (having fewer than three bowel movements per week) can worsen UI because the hard stool can press against the bladder. Eating more fiber-rich foods usually improves constipation. Examples: Prunes and figs…and whole grains (such as All-Bran and Bran Flakes cereals).
Natural constipation fighter: Blend: One-half cup of prune juice…one cup of applesauce…and one cup of unprocessed wheat bran flakes. Eat two tablespoons of this mixture with breakfast daily when you experience constipation.
WHEN NOTHING ELSE WORKS
If the strategies described earlier don’t improve urgency incontinence, you may need a medication—such as darifenacin (Enablex), fesoterodine (Toviaz), oxybutynin gel (Gelnique), tolterodine (Detrol), trospium (Sanctura) or solifenacin (Vesicare). Side effects may include dry mouth and constipation. There is also mirabegron (Myrbetriq), which includes headache as a side effect. For those who experience bothersome nighttime frequency or nocturia, a new formulation of desmopressin acetate (Novtiva) is now available. Side effects include a possible drop in blood sodium.
For stress UI that is not improved with pelvic floor muscle exercises, a procedure known as sling surgery, which involves the insertion of synthetic tape to support the urethra, may be needed. Overflow UI can be improved through removal of an obstruction or through catheterization to empty the bladder.
HOW TO STAY DRY
Many products can help protect people who suffer from urinary incontinence avoid “accidents.” Women who have light-to-moderate urine leakage can wear absorbent panty liners and pads. Men can use products, such as socklike, drip-collecting pouches and guards that are worn inside briefs.
Options for moderate-to-heavy urine loss include disposable protective underwear…and pads-and-pants systems that combine cloth underpants and disposable pads. All are available at drugstores.
*To find a nurse incontinence specialist to help with pelvic floor muscle exercises or bladder retraining, contact the Society of Urologic Nurses & Associates or the Wound, Ostomy and Continence Nurses Society.