Dr. Marie's Help for Incontinence

By Marie Savard MD

A 2008 article in the “New England Journal of Medicine” revealed that 25 percent of perimenopausal women and 40 percent of postmenopausal women report leakage of urine. ThirdAge medical expert Marie Savard, M.D., author of “Ask Dr. Marie,” says that the main causes of this annoying condition are decreased estrogen levels and aging pelvic muscles that are losing strength. She adds that obesity can exacerbate the condition, as can asthma, diabetes, a chronic cough, and medications such as diuretics, antihistamines, and antidepressants.

“There are two types of incontinence, ‘stress’ and ‘urge,'” Dr. Marie says. “The word ‘stress’ doesn’t refer to emotional stress. It means pressure on your bladder. If you have weak muscles, that pressure causes urine to leak. This can happen when you laugh, cough, or just wait too long to go to the bathroom.”

She went on to explain that urge incontinence — also called irritable bladder syndrome, overactive bladder, or spastic bladder – is a condition in which your bladder empties even if it’s not full in spite of your attempts to hold it. This disorder is sometimes caused by diabetic neuropathy but is most often simply related to aging.

Dr. Marie says she can’t promise you a 100 percent cure, but that she can certainly help you gain more control. She deals with the problem herself and advises that your first line of defense should be to make sure you always have access to a toilet. “Just do as I do and check out the location of the bathroom everywhere you are,” she says. “Also, go often even before you feel the need!” Beyond that, she has tips for keeping the leaks at a minimum.

Often referred to as Kegels after Dr. Arnold Kegel, the gynecologist who created them in 1948, these exercises are the single most effective treatment for stress incontinence. Just as with any other muscles, you either “use it or lose it.”

Finding the muscles is easy. When you’re urinating, imagine that somebody accidentally comes into the bathroom and startles you. Your instinct will be to squeeze your muscles to stop the flow.

Dr. Marie recommends doing your Kegels three to five times a week by squeezing and holding for five seconds, then releasing and repeating for a total of ten repetitions. She says you will notice improvement in six to eight weeks and that after three to six months you may be cured, or nearly cured.

She speaks from experience. “Once I got past an initial aversion to doing Kegels, they became a routine part of my life,” she says. “I’m proud that I had the power to strengthen the muscles and alleviate my problem to a great extent.”

You can buy weights in the shape of cones that are the size of a tampon. They come in sets ranging from twenty to seventy grams. Begin by inserting the lightest one and holding it for fifteen minutes twice a day for four to six weeks. Then move up to the next heaviest weight and finally the heaviest one. However, Dr. Marie says that no research has shown that the weights are any more effective than Kegels. “In fact Kegels are often shown to be more effective than using weights,” she points out.

You knew this was coming. In the same way that you experienced extra pressure on your bladder if you were ever pregnant, carrying excess weight after menopause can make incontinence worse. Consider getting support from groups such as Weight Watchers or Overeaters Anonymous if dieting is difficult for you.

“Prescription medications can help some women with urge incontinence,” Dr. Marie says. She cautions, though, that the drugs are expensive and may have side effects such as a dry mouth, headaches, fatigue or sleepiness, constipation, and tummy aches.

They work by relaxing the smooth muscle of the bladder and blocking certain nerve receptors to the urethra to help keep it closed. Paradoxically, although this is a positive result for urge incontinence, it’s a negative for stress incontinence. Some of the commonly prescribed medications for urge incontinence include Ditropan, Detrol, Urispas, Tofranil, Bentyl, Levsin, Sanctura, Vesicare, and Enablex.

“Twenty years ago I wouldn’t have recommended surgery for stress incontinence,” Dr. Marie says. “That’s because your only option would have been a urologist whose greatest knowledge and practice was almost without exception limited to men. Today, however, I would encourage you to have a consultation with a gynecologic urologist.” She goes on to say that surgical cases have doubled recently as baby-boomer women with the proactive attitude typical of that generation have aged and demanded better treatments. There are now over 250 techniques ranging from collagen injections to minimally invasive surgery to tacking up of the bladder, vagina, and urethra to the pubic bone. Yet Dr. Marie warns that not all of these procedures have been well evaluated. “Do your research and seek a second if not a third opinion if you are considering surgery,” she advises.