MEDICAL SURFARI: BLADDER CONTROL

Your body stores urine, water and waste removed by the kidneys in the urinary bladder. The bladder is a muscular bag that connects to the urethra, the tube through which urine leaves the body, and during normal urination the muscles in the wall of the bladder contract forcing the urine out through the urethra.

Urinary incontinence (UI) is the unintentional loss of urine and although it can happen to anyone it is more common in women, especially senior women. In fact, there are 13 million Americans in the United States who experience UI and 85 percent of them are women. So, if you are experiencing UI, you are not alone.

This condition can range from mild leakage to uncontrollable, embarrassing wetting and it is, in fact, a major health problem because it leads to personal disability and dependency. Unfortunately, UI dramatically changes many women's lives as they stop exercising, become less social and in some cases deliberately refrain from laughing because they are afraid of "having an accident". The important thing to know is that there is no need to feel guilty, as UI is a medical problem which most of the time can be improved and often can be completely resolved.

Although UI can be improved in eight out of ten cases, fewer than half of those with bladder problems will ever discuss the condition with their physician as they have mistakenly assumed or heard that UI is a normal part of aging and something that "you have to live with". It is not!

As you have learned in recent weeks, with the onset of menopause your body stops making the female hormone estrogen, which has some effects on the lining of the bladder and the urethra as well as the mass and strength of your pelvic muscles. This is yet another issue to consider when you discuss the pros and cons of hormone replacement therapy with your physician.

Weakened pelvic muscles may not be able to resist the flow of urine, especially when there is pressure on the bladder from coughing, sneezing or lifting. This type of UI is one of the most common, although there are many other types of medical conditions that may have a similar effect. Another very common type of bladder control problem for senior women is urge incontinence, meaning that the bladder muscles squeeze at the wrong time, or almost all the time, causing leaks.

Just as there are many different types of incontinence, there are many different causes. Other problems causing UI include bladder infections, medications, nerve damage from diabetes or stroke, heart problems, depression, prior hysterectomy, multiple sclerosis and being overweight.

Since there are many types of incontinence, each with different causes, it is best to discuss your condition with your physician since your treatment will depend upon the type of bladder control problem you have. The simplest treatment for women includes pelvic muscle exercises that are to strengthen the pelvic muscles that function in bladder control. These exercises are simple and often very effective. Some types of UI are more complicated requiring treatment with medication and some require surgery. In addition, there are a variety of devices that control UI in patients who cannot regain control by these simpler means.

The first step toward relief is to see your physician and to discuss this condition. Your family physician, internist, gynecologist or urologist can help you with this problem. Remember, nearly everyone with a bladder control problem can be helped, so call your clinic and find out how.

WORLD WIDE WEB RESOURCES

National Kidney and Urologic Diseases Information Clearinghouse

www.niddk.nih.gov/health/kidney/nkudic.htm

This clearinghouse is designed to increase knowledge and understanding about kidney and urologic diseases and health and provides very comprehensive information about urinary incontinence.

National Association for Incontinence

www.nafc.org

Through this web site you can access information on urinary incontinence for both consumers and healthcare professionals.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701.