Don't Hold It!

By Michaela Gibson Morris/NEMS Daily Journal

When toddlers do the potty dance, it’s cute. For adults, bladder trouble is nothing to dance about. But incontinence isn’t an isolated problem.
“It’s the most common problem in post-menopausal women,” said Lauri McKell, a certified urology nurse practitioner, who works with the Continence Center set up by Urology P.A. of Tupelo.
But just because it’s common doesn’t mean that people have to accept it as the normal course of aging, like menopause or graying hair, McKell said.
“A certain generation may not realize it’s not normal,” McKell said.
Incontinence can set off a cascade of problems beyond the embarrassment and discomfort of wet pants. As it gets worse and less controllable, people suffering from the condition stop going out, leading to social isolation and depression, McKell said.
“It is truly debilitating,” McKell said.
It also can create a physical challenge when people wake up in the middle of the night and struggle to get to the bathroom quickly enough. In the worse case scenario, this can lead to falls and broken hips.
“Incontinence is one of the biggest reasons to be admitted to a nursing home,” McKell said.
There are solutions to the problem.
Depending on the source of the problem, medication, physical therapy, minimally invasive procedures and minor surgery can successfully address the problem. Using a pad to catch leaks isn’t a good, long-term fix.
“Quality of life is so much better,” when the problem is addressed, McKell said. “Don’t suffer in silence.”
In women, incontinence has two primary forms. Stress incontinence – leaking when you cough, sneeze or exercise vigorously – and urge incontinence – that gotta go, gotta go feeling. Some women have a mix of both, McKell said.
For men, incontinence issues are less common, but are usually connected to benign prostate issues.

Stressed out
For most women, stress incontinence goes back to the heavy load they carried in the name of continuing the species, McKell said.
The pelvic floor muscles support the bladder and other structures. They should tighten to hold in urine before a sneeze, cough, laugh or exercise, McKell said. These muscles can get really stretched out during pregnancy and delivery.
Likewise, there is a tiny sphincter muscle that controls the flow of urine out of the bladder that should tighten. It also can be affected by labor and delivery, but some women are born with an intrinsic weakness in this muscle.
Unfortunately, time is not a friend to either of these muscles.
“As we age, muscles get weaker,” McKell said. “If you’re now leaking, you tend to get worse over time. If you leak before you go through menopause, you’re going to have trouble.”
Kegel exercises can be helpful for strengthening the pelvic floor muscles, but they won’t help the sphincter muscle, McKell said.
Urodynamic studies are especially important in determining which set of muscles aren’t working well and what therapy is likely to work, McKell said. That way physicians can get women the right fix for the right problem.
For women with pelvic floor issues not resolved by a month of diligent Kegel exercises, women may need to consider other measures.
Collagen injections can help the sphincter, McKell said.
A minor surgery, called the transobturator sling, uses a strip of mesh to support the pelvic floor and the sphincter. The mesh is inserted through a small vaginal incision during an outpatient procedure. Women can go back to normal activity very quickly.
If women aren’t good candidates for surgery because of other health problems or they need to delay surgery, a pessary, which is a small, round flexible device, McKell said, is inserted in the vagina. It can help prop up the pelvic floor, bladder and internal organs. It can be taken in and out easily, and most people find it comfortable to use, McKell said.
“It puts pressure on the urethra, helping to clamp it off so they don’t leak,” McKell said. “It’s also good if the bladder has fallen, too.”

Gotta go
Urge incontinence or overactive bladder, happens when the bladder sends out the message that it’s full when it’s not. It’s not always clear what causes urge incontinence, which is sometimes associated with strokes or multiple sclerosis.
A class of medicines called anti-cholinergics, which include the one advertised with the catchy jingle, are very effective, McKell said.
For men, the continence issues are usually connected to the prostate. As men age, the walnut-shaped gland that produces semen can infringe on the urethra – the tube that takes urine out of the body from the bladder.
It’s usually not prostate cancer; however, doctors typically will rule out prostate cancer when evaluating urinary symptoms in men.
Alpha blockers, like Flo-Max, are usually effective in giving men more room to get the urinate out of their body.
“Some men still need treatment for overactive bladder,” McKell said.