A female family friend in her early 50s called me from the United States of America, last week. She went to see her urologist (a specialist doctor who treats diseases of the urinary organs). The urologist did a cystoscopy (examination of the bladder and urethra using a cystoscope); she was diagnosed with “over-active-bladder” for which the urologist recommended, “bladder physiotherapy” for her.
To be or not to be? To do or not to do? She was in a catch-22 dilemma. To add insult to injury, the urologist warned her that if she does not commence bladder physiotherapy immediately, to strengthen her bladder muscles, she would likely to develop urinary incontinence in future as she aged more.
Hell was let loose; she was panicky and disheveled. She said the words “urinary incontinence” gave her the jitters such that she developed “panic attacks” and started calling me non-stop until she got me on line.
Her question was straightforward, “Do I take up bladder physiotherapy?” I asked her to answer some questions for me. She countered that she needed a “yes” or “no” answer from me. The ding dong continued. I fired her a barrage of questions, which I needed answers to, before I could answer her “yes” or “no”.
These were my questions: Did your mother have urinary incontinence? Do you have an elder sister, is she still alive? Has she had she urinary incontinence? What of your aunts, grandmothers both maternal and paternal? Did any of them develop urinary incontinence?”
She fired back: “How would I know? Am I their doctor?” I told to make calls to any of them that is still alive, find out.
She responded with more questions: “Does it run in the family, is it inherited? How would they or I, know if we have urinary incontinence? I now urinate more frequently, and if I do not hurry to the rest room when pressed I could wee on my underwear. Is that what you doctors call incontinence?” Please find out the information I requested, I said to her with finality.
You see, in my long years of medical practice, I have always been reluctant to ask my patients that have over active bladder to go for bladder physiotherapy.
Okay, I did not explain the symptoms of over-active bladder. They include unusual urges to urinate, that may be hard to control. There might be a need to pass urine many times during the day and night. There also might be loss of urine that isn’t intended called “urgency incontinence.”
People with an overactive bladder, might feel self-conscious. That can cause them to keep away from others or limit their work and social life. The good news is that it can be treated. Simple behavior changes might manage symptoms of an overactive bladder. These include changes in diet, urinating on a certain schedule and using pelvic floor muscles to control the bladder. These are called Kegel exercises. Get regular, daily physical activity and exercise. Limit caffeine and alcohol intake. Maintain a healthy weight. Manage your ongoing chronic conditions such as diabetes, that might add to overactive bladder symptoms. Quit smoking.
Yes, there is evidence that overactive bladder and urinary incontinence can be hereditary. This means that a family history of these conditions can increase your risk of developing them due to genetic factors playing a role in their development.
We know that over-active bladder is most common in people 65 and above. Women may have overactive bladder at a younger age, usually around 45.
Of course we know that urinary incontinence in women is involuntary, spontaneous urine loss that occurs either with strenuous physical activity (stress incontinence) or urine loss associated with an uncontrollable sense of urgency (urgency incontinence), or both (mixed incontinence)
It may be caused by alteration in anatomic support and or neuromuscular functions of the pelvic floor, or may be idiopathic (unknown).
Urinary incontinence can have devastating effects on the woman, detrimentally affecting her level of activity and psycho-social state, leading to depression and withdrawal from social settings.
Characterisation of the type of incontinence can help to elucidate the underlying aetiology and help to guide management.
There are several types of urinary incontinence. Each type has different symptoms and causes viz: stress incontinence; urge or urgency incontinence; overflow incontinence; mixed incontinence; transient incontinence; bed-wetting.
There are many different reasons women could experience incontinence. Some causes are temporary health conditions, which usually go away once treated. Chronic causes of incontinence do not go away easily.
Temporary causes of urinary incontinence include, urinary tract infection, pregnancy, medications, beverages, constipation, pelvic floor disorders, stroke, diabetes and menopause.
Women experience stress incontinence twice as often as men. As women advance in age their bladder and urinary sphincter muscles (especially for those who have been delivered of babies, weaken, which may result in frequent and unexpected urges to urinate.
Even though incontinence is more common in older women, it is not considered a normal part of aging. Excessive body fat, other chronic diseases, like vascular disease, kidney disease, diabetes, Alzheimer’s disease and other conditions may increase the risk of urinary incontinence. A chronic smoker’s cough can trigger or aggravate stress incontinence by putting pressure on the urinary sphincter.
Treatment for urinary incontinence depends on the types of incontinence, the severity and the underlying cause.
Bladder training to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between trips to the toilet until you are urinating only every two-and-half hours to three-and-half hours
Double holding to help you learn to empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating then waiting for the need to go.
Fluid and diet management will help to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic food. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.
It is not always possible to prevent urinary incontinence. Being obese can increase your risk of urinary incontinence. You may be able to cover your risk by maintaining a healthy weight, through regular exercise and healthy eating.
Depending on your particular bladder problem, your doctor can advise you about the amount of fluids you should drink.
If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee and coke. These can cause kidneys to produce more urine and irritate your bladder.
The recommended weekly limit for alcohol consumption is 14 units. A unit of alcohol is roughly half a pint of normal strength lager or a single measure of 25 mls of spirits.
If you have to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However make sure you still drink enough fluid during the day up to 2.5 liters a day.
Always be medically guided.
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