Workouts and romance may both trigger ‘accidents,’ but stress incontinence treatments can bring relief.

By Kathleen Doheny
WebMD Feature

Reviewed by Brunilda Nazario, MD

Stress incontinence has an annoying way of showing up at the most inopportune times.

You’re jogging along, feeling great — and then you realize your running shorts are damp with urine. Later that night, during a romantic rendezvous with your partner, a trickle of urine appears again, definitely spoiling the moment.

Lest you think stress urinary incontinence is a problem only of middle-aged or elderly women, think again. Surprisingly, young women actually have more stress incontinence during sex than older women, according to Amy Rosenman, MD, a gynecologist at Santa Monica — UCLA Medical Center, Santa Monica, Calif., and co-author of The Incontinence Solution.

When incontinence occurs during intimate moments, women feel anxious, Rosenman says, even if they are in stable marriages. This could even lead to sexual dysfunction.

The same anxiety can occur during a workout, where you may end up with an embarrassing wet spot on your pants for the world to see.

Stress Incontinence Due to Weak Pelvic Floor Muscles

The problem, whether the stress incontinence occurs during exercise or sex, has a common denominator, says Beverly Whipple, PhD, RN, professor emerita at Rutgers, The State University of New Jersey, and a sexuality researcher.

“Stress incontinence is related to the strength of the pelvic floor muscles,” Whipple says. The weaker those muscles are, the more likely you are to have symptoms of stress incontinence — leaking urine during physical activity, such as exercise, sex, sneezing, laughing or jumping–in the absence of bladder contraction.

While many women experience minor leakage from time to time, at any age, if it becomes more frequent or interferes with your normal routine, you should tell your doctor. There is an array of very effective treatments for stress incontinence. Stress urinary incontinence is the most common cause of urinary incontinence in younger women and the second most common cause in older women.

If you have had several pregnancies and childbirths, your pelvic muscles and tissues may have gotten stretched and damaged. With age, the muscles can weaken, too, although stress incontinence is not an inevitable part of aging. Excess weight can also weaken pelvic floor muscles and cause stress incontinence.

Kegels Can Help Stress Incontinence

Strengthening the muscles of the pelvic floor is crucial, experts agree.

One recommended way to do that is through Kegel exercises, according to the American Academy of Family Physicians (AAFP).

First, some anatomy: at the bottom of the pelvis, many muscle layers stretch between your legs, attaching to the pelvic bones at the front, back and sides. If you think of the muscles you would use to stop the flow of urine, those are the ones you will be targeting when doing your Kegels.

The how-to’s: Pull in or squeeze the muscles, pretending you are trying to stop urine flow. You should hold that squeeze for about 10 seconds. Follow that by a 10-second rest. How many? Try three to four sets of 10 squeezes a day, recommends the AAFP.

The beauty of Kegels, most experts find, is that they can be done anytime and just about anywhere — sitting in your car or at your desk or watching television or while talking on the phone. No one will know what you are doing unless you tell them. But to ensure proper form, ask your doctor or nurse to describe to you exactly how to do them correctly.

If you do Kegels correctly and often, you can expect to leak less, Rosenman says.

Typically, bladder control improves after 6 to 12 weeks of daily Kegels, according to the AAFP. But you may notice improvement in stress incontinence after just a few weeks.

Kegels and Vaginal Weights for Stress Incontinence

Another way to prevent stress incontinence is to use vaginal weights. Vaginal weights can help you to isolate the pelvic floor muscles while doing your Kegel exercises. They come in various sizes and are inserted into the vagina using a cone. As you progress, you insert heavier weights.

Vaginal weight kits are sold online and over the counter.

Biofeedback for Stress Incontinence

Biofeedback, as the name implies, uses monitors and “feeds back” information to patients about body processes, including control of the pelvic floor muscles.

In one study of 14 women with stress incontinence, a 12-week program of pelvic floor training with biofeedback gave favorable results, according to a report published in the International Brazilian Journal of Urology. The number of leakage episodes decreased from about eight a day to 2.5 among study participants, the researchers report.

Self-Help Products for Stress Incontinence

If your stress incontinence is not severe, you may get by with urinary incontinence products such as pads and panty liners. You might want to consider rubberized bed sheets.

Another stress incontinence treatment option is a device called a pessary, which is inserted into the vagina to help elevate the bladder neck and keep urine from leaking.

Medications, Surgery for Stress Incontinence

If your stress incontinence becomes more severe or if it interferes with your lifestyle and kegel exercises and other self-help measures fail, your doctor may suggest medications or surgery.

Medications can help tighten muscles at the bladder neck and urethra, preventing urine from leaking and relieving stress incontinence.

In one operation for stress incontinence, surgical threads are used to help support the bladder neck. In another procedure, called a “sling” operation, the surgeon uses strips of material, either natural or synthetic tissue, to support the bladder neck. Bulking material such as collagen is sometimes used around the bladder opening for women with stress incontinence

Talking to Your Doctor About Stress Incontinence

Your doctor should routinely ask you about your bladder function to determine if you are having stress incontinence or urge incontinence (also called overactive bladder), Rosenman says.

If your doctor does not ask, Rosenman advocates the straightforward approach. Try something like: “I’m having some problems with my bladder.” At that point, if your doctor does not pepper you with questions about how often you experience symptoms, and how long it has been going on, Rosenman suggests asking for a referral to another doctor or to a specialist, such as a urogynecologist. A urogynecologist is a gynecologist who has extra training in urology.

Talking to your partner about stress incontinence is not simple, either, Rosenman acknowledges. But she tells women it may be the most important thing they can do to help their relationship. Communicating well about the problem, she writes in her book, will lead to greater affection and trust. And getting the problem out in the open is often a relief, she says.

In addition to good communication and effective treatments, Rosenman says some simple measures can help women with stress incontinence enjoy a better sex life. Among other tips, she tells them to always empty the bladder before intercourse and to cut back a bit on fluids before intercourse. Don’t dehydrate yourself, but don’t overdo the fluids, she says. And she encourages experimentation to find positions that are more comfortable, reducing overall anxiety.

In getting more comfortable with talking about stress incontinence, you might also take a cue from two famous Olympic athletes from the U.S. — speed skater Bonnie Blair and gymnast Mary Lou Retton. In recent years, both have spoken publicly about their experiences with incontinence, raising awareness that the problem exists and, more importantly, that treatments can improve or eliminate the problem.

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The Souris Valley Care Center in Velva and the Good Samaritan Nursing Home in Mohall have begun a new physical therapy program to treat urinary incontinence and other related problems.

The program focuses on simple exercises individuals can do to help with urinary incontinence without the use of surgery or drugs. Physical therapists from Souris Valley Care Center, Krista Becker and Teressa Brock, have completed several courses of specialized training for the program.

“We have established the main exercises (to help with urinary incontinence) into our exercise program. There’s also a tremendous amount of information we can give someone, so they can make educated choices,” Brock said.

Incontinence, Becker said, is the second most prevalent reason individuals enter a nursing home, next to dementia. Preventing and easing the incontinence problem can help individuals stay at home longer.

The program isn’t focused solely on the elderly, either, but on men, women, and children of all ages who suffer with the problem.

“It can happen to anyone. It can happen in children, athletes, and women who are pregnant, postpartum, premenopausal, or menopausal,” Becker said.

“It happens in people who exercise a lot. There are even aerobics instructors, people who do a lot of jumping, who have to wear a pad when they teach. You always picture an older person, and it’s not,” Brock said.

The program can also help those who have pelvic pain, prolapses, or pelvic surgeries as well as those who have Parkinson’s, Multiple Sclerosis, or other peripheral neuropathies, cancer patients, children over age 6 with bowel and bladder problems, and chronic constipation sufferers.

Individuals will learn the exercises through a series of one to four physical therapy sessions, and will continue to practice the exercises at home. The exercises work to strengthen the pelvic floor muscles, called the pelvic rotator cuff. Brock said individuals are usually eager to continue practicing the exercises.

“People are usually very motivated. They’re willing to stand on their head if they think it would help. After they come in, they’re so glad they did,” Brock said.

In addition to the exercises, Brock and Becker offer information on lifestyle changes such as dietary changes that will help with preventing incontinence.

“We educate them about bladder irritants, such as caffeine, carbonated beverages, citric foods, acidic foods like spaghetti sauce, spicy foods, and chocolate,” Becker said.

“Sometimes, people will find there are one or two things they are sensitive to, so they might want to eat those foods more sparingly,” Brock said.

Along with the program, Becker and Brock will offer community presentations on preventing urinary incontinence. They have already presented at several assisted living facilities in Minot, and hope to continue presenting in other areas in northwest North Dakota. They are in the process of securing grant money for community presentations.

“We have specific programs, and a general program for going into group meetings called “Bones, Bottoms, and Balance.” It’s a little less stressful than saying, ‘We’re going to talk about incontinence prevention.’ They’re interested, and it’s a way to talk to them about it without scaring them and making them too embarrassed,” Brock said.

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By Laura Gater

CHICAGO — September 5, 2008 – Initiation of weight loss should be considered a first-line approach to the treatment of overweight and/or obese women with urinary incontinence (UI), researchers reported at the American Urogynecologic Society 19th Annual Scientific Meeting (AUGS).

Overweight is a strong risk factor for UI, and weight loss results in improved continence, said study presenter Rena Wing, MD, The Miriam Hospital, Providence, Rhode Island, in a presentation on September 4.

The Program to Reduce Incontinence by Diet and Exercise (PRIDE) is a multicentre, randomised clinical trial including 338 overweight and obese women (BMI 25-30 kg/m²) experiencing up to 10 episodes of UI per week. The cohort had a mean age of 53 years and mean weight of 97 kg.

According to patients’ reports on 7-day voiding diaries, 22% of the women experienced stress incontinence, 43% had urge incontinence, and 35% experienced mixed UI.

Although the main objective was to determine the effect of weight loss on UI among obese and overweight women at 18 months, the study’s secondary objective was to evaluate the association between the magnitude of weight loss and frequency of incontinence episodes.

The women were randomised to either an intensive 6-month weight loss program that included diet, exercise, and behavioural modification followed by a 12-month weight maintenance program or to a structured education program.

Overall, 86% of the women completed the 18-month trial. The mean weight loss at 18 months in the intervention and control groups was 6.5 kg and 1.7 kg, respectively.

Although there were large within-group differences in weight loss and UI improvement, differences at 18 months between the intervention and control groups were not significant in decreased total incontinence (61% vs 55%), stress incontinence (70% vs 64%), or urge incontinence (55% vs 50%).

However, when the researchers combined the 2 treatment groups, there was a strong dose-response relationship between magnitude of weight loss and UI improvement. The decreases in UI frequency by type were significant at 6 months (P = .02), at 12 months (P < .01), and at 18 months (P = .40).

The cohort analysis concluded that greater weight loss was associated with a greater decrease in UI frequency. There was no difference between the groups in the use of the UI behavioural techniques in the UI behavioural training booklet.

A modest weight loss of just 5% can have a marked impact on UI, and participation in a behavioural weight loss program was an effective short- and long-term treatment for UI in overweight and obese women, concluded Dr. Wing.

[Presentation title: Weight Loss Improves Urinary Incontinence in Overweight & Obese Women Through 18 Months. Paper 16]

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NEW YORK (Reuters Health) - In pregnant women, pelvic floor muscle training for bladder-control problems, though beneficial initially, is ineffective over the long term, research shows.

Stress-related urinary incontinence “is a risk factor for long-term leaage but not necessarily enough to require surgery,” Dr. Robert M. Freeman from Derriford Hospital, Plymouth, UK told Reuters Health. Performing exercises before delivery designed to strengthen the pelvic floor muscles “does not seem to give good long-term results, and this is probably due to poor compliance,” Freeman noted.

The findings are based on 230 women who participated in two studies of the effectiveness of pelvic floor muscle training for preventing stress urinary incontinence after pregnancy.

At 3 months after pregnancy, significantly fewer women who perform

ed pelvic floor muscle exercises reported post-delivery urinary incontinence, compared with women who did not perform these exercises (19 percent versus 33 percent).

Eight years later, however, urinary incontinence was reported by a similar percentage of women in the pelvic floor muscle training group and the control group (35 percent and 39 percent, respectively).

More than two-thirds of the women in the training group reported that they still performed pelvic floor muscle training at 8 years, and more than a third said they were performing the exercises at least twice a week.

Despite these reports, the investigators say, incontinence rates did not differ between those performing pelvic floor exercises at least twice weekly and those performing the exercises less frequently.

“We are concerned that a lot of the evidence for both (before delivery

and after delivery) pelvic floor muscle training suggests poor long-term effect,” Freeman said. “We believe that compliance is the major issue, and this can only be improved by education.”

SOURCE: BJOG: An International Journal of Obstetrics and Gynaecology, July 2008.

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Sometimes we women put up with a lot of unnecessary discomfort because we are too embarrassed to talk about it or we think nothing can be done about it. One of the most common things that women tend to put up with is incontinence. A little incontinence for a short time after the birth of your baby is normal and common but if the problem does not go away then you need to speak to your doctor.

A study of 4,000 women by Kaiser Permanent which was funded by the National Institute of Health revealed that 1 in 3 women have problems with incontinence. Other research shows that 11% of women end up having surgery for a pelvic floor disorder. It is important to consult your doctor as the problem may be able to be rectified without surgery.

There may be medication that you can take and I am sure your doctor will advise you about the correct way to do pelvic floor exercises and hopefully the need for surgery will never arise. If you are one of the 11% who needs surgery there have been advances in this procedure which makes it much less invasive and can be done with laporoscopic surgery.

Incontinence is an embarrassing discomfort and is not something you should just ‘put up with’, so visit your doctor and start getting advice and treatment now. Remember, like everything else, early treatment is always the wisest option.

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When Pee Ruins Your Socks and Your Shoes

It’s not just rumor, it’s really true. Pregnancy and incontinence go hand in hand.

“I can remember during my first pregnancy I went for a walk, something made me sneeze — and I felt this gush of urine. I tried to get home as quickly as I could, but another sneeze brought a second gush and, well, it wasn’t long before I felt the warm trickle of pee down my leg, heading straight into my socks and shoes. I felt like I was 7 years old again,” says Quarty.

The problem, says Macaulay, is your growing uterus pressing on your bladder, making it hard to hold even a small amount of fluid.  While drinking less during the day can help if you’re out and about, Macaulay says that also means having to drink more fluids in the evening — which not only means up-all-night trips to the bathroom, but also the possibility of wetting the bed.

A better solution: Get going on those Kegel exercises — muscle-toning movements that help increase urinary control. “Don’t wait until after pregnancy — do them now,” says Macaulay. In the meantime, try wearing a sanitary napkin or incontinence pad for the times when sneezing takes you by surprise.

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Urinary incontinence affects millions of Americans. Unfortunately, many people do not seek help or treatment and live with this often embarrassing condition.

Because of differences in the pelvic region and childbirth, women are more likely than men to have issues with urinary incontinence. However, men can suffer from urinary incontinence. Three types of urinary incontinence are stress, urge and overflow incontinence.

Stress incontinence is urine leakage that happens during activity that causes pressure on the bladder such as laughing, lifting, coughing or sneezing. Stress incontinence is often seen in women who have had multiple pregnancies and vaginal childbirths, or who have pelvic organ prolapse. Urge incontinence or overactive bladder, is urine leakage that is an involuntary loss of urine following an urge to urinate that cannot be halted. Overflow incontinence occurs when the bladder does not empty properly and is characterized by the constant dribbling of urine and small frequent voids.

To help you determine if you have a bladder control problem ask yourself the following questions:

• Do you frequently have a strong, sudden urge to urinate?

• Do you sometimes not make it to the bathroom in time?

• Do you go to the bathroom more than eight times in 24 hours?

• Do you get up two or more times through the night to urinate?

• Do you experience a loss of urine during physical exertion?

• Do you experience a loss of urine when you sneeze or laugh?

If you answered “yes” to any of the above questions, you may have a treatable condition.

Treatment of urinary incontinence includes both non-surgical and surgical options. Most bladder control problems can be successfully treated without surgery. Some things that people can do to include:

Keep a bladder diary — Bladder diaries help show the causes of bladder control trouble by tracking when and what triggers your bladder weakness.

Modify your diet — Identify fluid and food issues that can alter your bladder function. For example, reducing caffeine or quitting smoking can help reduce how often you have incontinence problems.

Try pelvic floor exercises — Strengthening muscles that help hold the organs in place may help reduce stress and urge incontinence.

Biofeedback — Massage, exercise, water therapy and ultrasound help identify and correct musculoskeletal problems that contribute to pelvic pain or incontinence.

There are numerous medications, non-surgical and minimally invasive techniques available to help reduce incontinence. To help diagnose and treat your incontinence issue, consult a physician for a complete evaluation.

Dr. Brett J. Vassallo is a urogynecologist with Rush-Copley Comprehensive Pelvic Medicine and Continence Center in Aurora.

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Found at independent.ie

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The selection of the most appropriate one for every single patient might be quite a complex task. The choice of the first drug to be used, the selection of the most appropriate dosage, formulations and route of administration, the criteria for selection of a second anticholinergic drug in case of insufficient efficacy or intolerable adverse events, and, finally, costs are some of the most important issues that should be evaluated.

A systematic review of the literature was performed in August 2007 using Medline, Embase, and Web of Science. Efficacy (micturitions/24 Hrs, volume voided per micturition, urgency urinary incontinence episodes/24 hrs, incontinence episodes/24 Hrs.) and safety (mainly, adverse event, and withdrawal rates) end-points were evaluated in the RCTs assessing the role of anticholinergic drugs in non-neurogenic OAB.

The data of our systematic review and meta-analysis showed that tolterodine IR had a more favorable profile of adverse events than oxybutynin IR, while the controlled-release formulations of the 2 drugs had similar efficacy and safety. In all the comparisons among IR and ER formulations, ER formulations showed some kind of advantages, either in terms of efficacy or safety. With regards to solifenacin, a single RCT demonstrated the non-inferiority of solifenacin compared to tolterodine ER, while our meta-analysis showed similar rates of adverse events, with the exception of constipation that was more common in the solifenacin arm. A single trial is currently available on fesoterodine, suggesting that the new drug might be more efficacious than tolterodine ER. With regards to the routes of administration, a transdermal route did not seem to provide any significant advantage compared to oral intake, considering higher rate of localized application side effects and withdrawal due to adverse events.

The overall quality of the randomized controlled trials available in the field of overactive bladder was good. However, almost all the trials evaluated short-term therapy (mostly 12 weeks). Moreover, almost all the studies provided efficacy data derived from bladder diaries. A more suitable evaluation should also include subjective outcomes - such as the so-called patient-reported outcomes - lacking in most of the studies. Besides, virtually all the evidence derived from pharmaceutical company-sponsored trials reflected the needs of the companies for registrational studies - rather than addressing the questions more relevant to the clinical practice.

Considering these limitations, providing clear recommendations for the every-day clinical practice was not easy. With regard to the selection of the first drug to use in naïve patients, the physician might prescribe oxybutynin ER, tolterodine ER 4 mg or solifenacin 5/10 mg. Similarly, darifenacin 15 mg and fesoterodine 4 mg might be considered as valuable options, although further evaluation is needed and RCTs are ongoing. In case of insufficient clinical efficacy, the choice of the second-line drug therapy really cannot be based on solid pieces of evidence due to the lack of randomized trials. Making assumptions from the available data, in case of lack of efficacy of the first-line ER drug, fesoterodine 8 mg and solifenacin 10 mg might be a possible option, although an increased rate of adverse events has to be expected. In case of failure of the first line ER drug due to adverse events such as dry mouth, the transdermal formulation might provide some advantages compared to the oral one. Should the patient experience constipation, shifting from solifenacin to tolterodine ER might be useful. Alternatively, those patients taking IR formulations of anticholinergic drugs, without successful results, might be offered dose titration - providing the patients have not experienced significantly adverse events. Ultimately, ER formulations might be the preferred choice.

Written by:
Giacomo Novara, MD, FEBU, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc… of their research by referencing the published abstract.

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One of the largest-ever studies into urinary incontinence in women has found a very high prevalence - even in young women, and even in those who’ve never had a baby - and that adolescent bedwetting might be an important and neglected factor.

The University of Newcastle in New South Wales has been following the health of 42,000 women, and one of the things they asked about was whether they had any problems holding their water.

The two main problems are stress incontinence, which affects younger women more. This is trouble with leakage when laughing, coughing or taking exercise.

The other problem, especially in older women, is urge incontinence - which is an intense desire to pass water and trouble holding on.

Line up 100 adult women and around 35 of them will have a problem.

The risk factors are: increased weight - every kilo adds more pressure to the bladder; child bearing - the first and fourth children are the ones which cause the problem; and adolescent bedwetting. One of the reasons for high rates among young women is the under-recognised issue of unresolved bedwetting which goes on into adolescence and even early adulthood. It’s hidden and neglected.

The cost of incontinence is considerable to these women - hundreds of dollars a year, excluding the expense of treatments.

Teaching better bladder control and pelvic floor exercises to young women is thought to be part of the answer, and the Newcastle researchers have had some success with a more time-convenient regimen than is normally used.

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