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What to Do About ... a 'Going' Problem?

September 28, 2006 By:
Todd Goldberg, M.D., JE Feature
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 "Gotta go, gotta go ... " We've all seen the commercials and laughed. But to the millions of women (and some men) who suffer from overactive bladder or urinary incontinence, it's no laughing matter. This is a real medical problem with a number of effective treatments, and should not be ignored or attributed to normal aging. While not life-threatening, it can be extremely uncomfortable, embarrassing and disabling.

Many older people limit their normal activities, and have to wear protective undergarments in order to avoid "emergencies" and embarrassing wetness. Some people even end up in a nursing home because they and their families cannot cope with incontinence.

But have hope and read on.

The term overactive bladder refers to excessive/frequent urges to urinate, sometimes with incontinence or leakage of urine. Other causes of urinary frequency and incontinence include certain medicines, weakened vaginal and pelvic tissues in women, enlarged prostate gland or prostate surgery in men, urinary infection and other medical problems, such as diabetes.

Stress incontinence -- common in women whose pelvic muscles are weakened by childbirth or surgery -- refers to sudden leakages of urine due to pressure on the lower stomach muscles, such as when you cough or laugh. Urge incontinence occurs when the need to urinate comes on before you can get to a toilet -- this is due to excessive contractions of the bladder muscle, also called overactive bladder, the most common type of problem in older women and sometimes men. This condition is most responsive to medication.

Although certainly more common in seniors -- about 20 million Americans suffer from OAB and urinary incontinence -- this should not be considered a "normal" part of growing older, but a legitimate medical problem deserving of medical evaluation and treatment.

Exercises Available
Treatment of OAB and urinary incontinence can include medications, nonmedical measures and surgery. Nonmedical measures that can be helpful, include wearing protective pads or undergarments, and limiting alcohol and caffeine intake, as these substances stimulate excess urination.

Kegel exercises -- a repetitive tightening of the urinary and rectal sphincter muscles (imagine trying to stop going to the bathroom) -- can also work, especially for stress incontinence. This should be done in sets of 10 at least five times per day. Bladder training -- urinating at set intervals, even if you don't feel like you have to go -- can also be helpful. And talk to your doctor about certain medications geared to relax the bladder and reduce excessive urination.

Other advanced techniques, such as collagen or botox injections, artificial implanted sphincters or electrical devices, are sometimes used by urology specialists. In rare cases, surgery or a catheter may be required. But there is almost always something that can be done, so never feel helpless or hopeless.

It is important to mention that OAB and urinary incontinence should never be painful. Pain or blood when urinating are indicative of a more serious medical problem, such as infection or cancer, and require immediate medical attention.

There are many resources and reference sites on urinary health for older women and men. Some useful Web sites include:

· http://familydoctor.org/189.xml

· www.nafc.org (National Association for Continence)

· www.fda.gov/opacom/lowlit/bladprb. html

· www.nlm.nih.gov/medlineplus/ urinaryincontinence.html

· www.medicinenet.com/overactive_ bladder/article.htm

· www.urologychannel.com/bladdercontrol/index.shtml

· www.detrolla.com

· www.enablex.com.

Dr. Todd Goldberg is director of the Geriatrics Fellowship Program at Albert Einstein Medical Center; medical director of Pauls Run Retirement Community and the Golden Slipper Health & Rehab Center; and assistant professor of medicine at Thomas Jefferson University.


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