You are not alone; tens of millions of Americans experience leakage of urine from the bladder or the bowels. It’s a condition that causes frustration and embarrassment, and it can be both unhygienic and even dangerous.
While it’s true that it often begins with mild episodes – most noticeably with a sneeze, cough, or exercise – and worsens over time, incontinence isn’t normal at any age. Why, then, do so many people believe leakage is an inevitable part of growing older?
Common Causes of Incontinence
For the vast majority of people, the problem of leakage stems from loss of one or both of the two integral parts of the system that must work together to empty the bladder and the rectum normally – the muscles and the nerves.
Both the bladder and the rectum depend on a complex system of muscles that include sphincters and broad support muscles – what we call the “pelvic floor.” These muscles and nerves, in both women and men, can be damaged or otherwise lose their integrity in several ways.
Specific conditions of the rectum or bladder can lead to incontinence, and so can anything that causes irritation or inflammation to these organs.
Conditions like bladder infections, cancer, and diabetes can lead to urinary incontinence, so a urinalysis is often a first step to check for bacteria, blood, or excess sugar in the urine, none of which should be there.
Childbirth and pregnancy are the next reason these muscles and nerves may be injured. Babies passing through the birth canal often tear the muscles in ways that don’t show up as problematic until decades later. And during pregnancy and delivery, the important nerve transmission lines can get stretched and injured.
Finally, a number of other conditions can contribute to the loss of proper bowel and bladder function and control – things like medications, radiation, surgery, and a broad range of health conditions that affect the nerves and muscles, including myopathies, Parkinson’s, and many more.
To blame age alone is to overlook any of these likely culprits. And understanding the real issue is the first step toward finding a resolution, something that is almost always possible.
I wrote recently about the general lack of understanding in the medical profession regarding incontinence. After mustering up the courage to speak with a doctor about the issue, many people often receive no real direction and no solutions.
Standard recommendations include diet modifications, limited fluid intake, pelvic floor exercises, and changes to one’s voiding schedule. Indeed, here at The Continence Center in Nevada, these are often the first steps we advise as well.
We usually ask patients to keep a diary of diet and fluid intake with special care to note caffeine and alcohol intake. Sometimes just cutting back on alcohol, caffeine, or nighttime fluids will cause a big improvement in bladder control.
Scheduling a visit to the bathroom every two hours is another strategy that will sometimes allow a person to avoid leakage and accidents, though it might require setting an alarm for reminders. Some people can also improve upon the emptying of the bladder by voiding twice – so-called double voiding. After going to the bathroom, take just a few minutes and then try to empty the bladder a second time.
Exercises and pelvic floor therapy can also help improve the pelvic floor muscles and reduce leakage. Contracting the sphincter muscles – i.e., Kegel exercises – are the mainstay of any exercise therapy.
Additional pelvic floor exercises have been shown to improve bladder leakage. Some of these involve squats, kneeling leg lifts, and other specific exercises on the mat. These can be done at home alone with the help of a training video, or with a biofeedback therapist. We like to prescribe an exercise therapy program for every patient.
All of these strategies comprise the standard recommendations for treating incontinence. But almost without exception, by the time someone comes to see us at The Continence Center, they’ve tried all of these, usually for years, without durable success.
Sacral Nerve Modulation
The most effective solution for bladder leakage or overactive bladder remains sacral nerve modulation. Approved by the FDA nearly 20 years ago, it is covered by Medicare and virtually all insurance plans.
The procedure takes about 25 minutes, during which a tiny device – similar to a pacemaker, which was actually the inspiration – is placed beneath the skin around the “back pocket” area of the body. No general anesthetic is required.
Bioengineers wondered whether they could replicate tremendous efficacy of cardiac pacemakers by similarly restoring the transmission lines to the pelvic floor muscles and sphincters of the bladder and bowels. Their efforts paid off with a highly effective treatment that now is routinely performed as a minor procedure with local anesthetic.
The recent device has a battery life of more than 15 years and is 90% successful at resolving bladder incontinence or overactive bladder. The only problem? There are relatively few doctors with specialized training in neuromodulation, so you have to do some searching to find one.
However, for our patients, dealing with the struggles of incontinence is motivation enough to do some digging. For them, and for anyone reading this who understands all too well the challenges posed by incontinence, please know that bladder leakage is definitely not something you have to put up with; nor is it a sign of normal aging.
Is bladder leakage something you’ve been living with? Have you been told that ‘it’s normal’? What have you gone through in your incontinence journey? Please share your experiences and advice with the community.