Transient incontinence. Infections of the urinary tract, medication side effects, severe constipation with stool pushing against the urinary tract, and other conditions may cause a temporary incontinence.
Women, take note: it is not uncommon to suffer from stress and urge incontinence simultaneously, in which case your doctor will tell you that you have mixed incontinence.
Two other problems often are associated with incontinence, and indeed may be part and parcel of the problem. They are urinary frequency, or the constant need to urinate, and urinary urgency, which is a powerful feeling that you must go, and stronger than the normal signal one receives when the bladder is full.
What Doctors Do for Incontinence
A physician begins diagnosing the problem by asking you about your symptoms: when do you leak, how often, what are you doing at the time, and so on. He or she will ask about recent surgery, medication use, and other factors that may trigger transient incontinence. Then comes a physical examination and appropriate tests to check for tumors, impacted stool, or other items that might be to blame, as well as tests of your bladder capacity and function. Your doctor may call for a blood test to check for infections, an ultrasound examination of your bladder and surrounding structures, or cystoscopy, in which a tiny camera embedded in a skinny tube is inserted into your urethra to look for clues.
Once a diagnosis is made, your physician can proceed with treatment. Depending on the type of incontinence, this may include:
Tracking your urination patterns, then timing your trips to the bathroom so as to empty your bladder before it usually empties itself.
Kegel exercises to strengthen the muscles of the pelvic floor. These exercises are recommended for women who have given birth, to firm up their “stretched” muscles and prevent or reduce incontinence. Doctors and nurses teach their patients how to do Kegel exercises, which can be done at home without special equipment. The only difficult part is learning to identify the muscle to be squeezed: you can do this by sitting on a toilet and trying to stop the flow of urine, or by inserting a finger into your vagina and squeezing down on it. If you can do either of these two things, you have found the right muscle to exercise. Your doctor or nurse will tell you how often and how long to practice Kegel exercises. A typical schedule may be to tighten the muscles for a count of ten, ten times a day. You can find more information about Kegel exercise at websites such as Medline Plus Health Information and the University of Iowa Health Care.
Brief electrical stimulation of the pelvic muscles. The goal is to strengthen the muscles of the lower pelvis while relaxing overactive muscles and encouraging urethral muscles to contract.
Biofeedback to help increase your awareness of and control over the appropriate muscles. Biofeed-back can be combined with Kegel exercises.
A stiff ring called a pessary, inserted into the vagina such that it presses out against the vaginal walls and urethra so as to reduce stress incontinence.
Medicines that either reduce the activity of an overactive bladder or relax or strengthen certain muscles, or estrogen to aid in overall urinary tract function. Some of the drugs used for various types of female and male incontinence are Ditropan® (generic name oxybutynin), Detrol® (tolterodine), Urispas® (flavoxate), and Levbid® (hyoscyamine).
Implants, such as collagen or your own transplanted fat, to “bulk up” the urethra and help it to function properly. Injections of collagen or fat are not permanent, and may have to be repeated as the body absorbs the material.
Surgery to reposition a “drooping” bladder or implant an artificial sphincter. Stress incontinence often is triggered when the bladder droops down toward the vagina. Surgeons may use string-like material to hold the bladder in a higher, more-normal position. For more-severe cases, a wider sling may be used to hold the bladder in place and, at the same time, squeeze down on the urethra to prevent urine from leaking through. Surgeons also can implant an artificial sphincter, controlled by fluid pumped in and out when manipulated by a valve implanted under the skin.
A New Approach Based On Traditional Chinese Medicine
Where Western medicine tends to favor strong drugs and surgery that target the site of the ailment or injury, traditional Chinese medicine seeks to help the body heal itself. Instead of focusing solely on the bladder, Chinese medicine attacks urinary incontinence by improving circulation, regulating neuromuscular function, and modulating hormones. All this, in turn, helps strengthen and tone the various muscles that keep urine in the bladder until it is time to void.
Improving circulation is key, for as women age the blood supply to bladder muscles and connective tissues becomes less efficient. This can be seen clearly in tissue samples taken from women of various ages. Those belonging to young women are healthy and smooth, while those from older women have numerous “holes” or empty spaces indicating undernourished tissue. Improving the blood flow in the bladder area provides essential nutrition to the muscle and connective tissues, thus improving the overall health and function of the bladder.
Regulating neuromuscular function—the interplay of nerves and muscles—is also important, for nerves running to and through the bladder influence the muscles that control the flow of urine. A sensation of urgency—that feeling that you have to go right now—may be triggered by spasms of these nerves. These spasms may be alleviated by introducing neurotransmitters that help calm the nerves, or by reducing the sensitivity of the corresponding muscles. This may be how certain Chinese herbs help reduce the feeling of urgency.
Balancing hormones completes the three-part approach. The typical woman with bladder control problems usually begins to notice leakage or other symptoms after hormonal changes that begin with peri-menopause, suggesting that female hormones play an important role in bladder function. Specifically, changes in hormone levels may decrease the mass and tone of the muscle systems that help regulate bladder function. Naturally tilting hormone levels to a more-youthful profile can help strengthen bladder muscles and reduce leakage.