The Top 12 Questions About Incontinence

However, many people are afraid to bring up the topic with their doctor. "Patients have a tremendous reluctance to speak about this problem," says Dr. Victor Nitti, urologist at NYU Medical Center and vice chairman of urology at the NYU School of Medicine. In fact, he says that less than half of patients with incontinence talk with their doctor about it.

This month we have teamed up with leading physicians to share some of the most commonly asked questions, as well as questions that patients should be asking their doctors but are not. They include:

1. Is incontinence a normal part of aging?

   
   "Incontinence is not a normal part of aging and should be brought to the attention of your doctor," says Donna Schempp, program director at the Family Caregiver Alliance in San Francisco, Calif. "There are all kinds of treatment options available now."

2. Can anything be done to treat my incontinence?

   
   "Yes, there are things that can be done," says Dr. Nitti. "It really depends upon the type of incontinence one has and what one is willing to do to have their incontinence improved or eliminated."

   Treatment options include behavioral modification, medications and/or surgery. Products such as absorbent pads, undergarments and external collection devices are also available to help manage the condition.

3. What type of incontinence do I have?

   
   As we have discussed in a previous article, Incontinence: Types and Safety, there are several types of incontinence that you can experience. According to Dr. Nitti, however, two of the most common types are urge and stress incontinence.

   Urge incontinence (also known as overactive bladder) occurs when a sudden urge is accompanied by a loss of urine. "Patients usually feel the urge but are unable to make it to the bathroom," he says.

   Stress incontinence is characterized by a loss of urine caused by an activity, such as coughing, sneezing, laughing, walking or standing up from a seated position. "Stress incontinence has more to do with a weak urethra or weak outlet," says Dr. Nitti.

4. What causes urinary incontinence?

   
   There are many different causes of urinary incontinence, as we have discussed in the previous article, Cause and Effect: The Causes of Urinary Incontinence and Ways to Manage It. You should work with your doctor to determine your type and cause of incontinence and prepare the best plan for treatment.

   Dr. Nitti lists a few of the common reasons for urinary incontinence:

   • Medications;
   • Urinary tract infections;
   • Dementia or confusion;
   • Constipation;
   • Surgeries, such as prostrate procedures or hysterectomies;
   • Prolonged sedentary state (such as being hospitalized).

5. How serious is incontinence?

   
   Though not life threatening, incontinence can cause disruption of daily activities or other conditions such as depression, skin irritation, and kidney failure from chronic infections, says Dr. Denise Elser, who specializes in the area of incontinence in women at Advocate Christ Medical Center in Chicago, Ill. It is important that patients with incontinence speak to their doctor and devise a treatment or management plan to avoid additional complications.

6. Is incontinence temporary?

   
   Urinary incontinence may be temporary when caused by conditions such as infection or constipation. "Most of the time the condition is chronic," says Dr. Elser, but adds that it is also a very treatable condition.

7. Do I need to treat my incontinence?

   
   Many people with incontinence have found absorbent products that work well with their busy lifestyles and do not want to treat the condition with medications or surgeries. "Many times, patients just want to be reassured that they do not have a more serious medical condition causing the incontinence," Dr. Elser says. A physician will be able to determine the cause of the bladder leakage, and together you can decide if treatment is necessary.

8. How can I modify my behavior to treat incontinence?

   
   Behavioral modification often can help manage incontinence. These include Kegels, which are exercises designed to strengthen the pelvic floor; bladder retraining, a behavioral technique that involves scheduling bathroom visits and gradually increasing the time between urination; and biofeedback techniques, which help you identify and control the correct muscles around the bladder opening. All are safe, non-invasive techniques which can help improve or eliminate incontinence.

   "It is important for patients to do Kegel exercises correctly," says Dr. Elser. "Many physical therapy centers can help patients who are having trouble performing these exercises." For more information on how to correctly perform Kegel exercises visit Depend.com.

9. What daily activities should I implement to manage incontinence?

   • Good Hygiene – Changing absorbent pads frequently and keeping the affected skin as dry as possible will help prevent rashes and infections. Topical creams can also form a barrier to prevent moisture from contacting the skin, and rash or anti-fungal creams can help with irritation.
   • Diet Modification – Certain foods and fluids can irritate the bladder. "Carbonated drinks, coffee and some citrus fruits and drinks can be hard on the bladder," says Dr. Elser. Your doctor can work with you to determine if certain foods or drinks need to eliminated from your diet.
   • Absorbent Products – A variety of absorbent pads and undergarments are available that you can wear unnoticed under clothing. Dr. Elser recommends using absorbent pads made specifically for urine leakage.
   • Exercise – General exercise can help keep a person healthy in a variety of ways, including maintaining continence. "A sedentary life leads to incontinence," Schempp says.
   • Bathroom Accessibility – Having easy access to the bathroom can make a big difference to someone experiencing problems with incontinence, says Schempp. For people who are having trouble getting to the bathroom without an accident, she suggests having a commode near a favorite chair, providing grab bars by the toilet and wearing clothing with elastic waistbands.

10. How long should I try a particular treatment option?

    
    The length of time needed for a treatment to manage or cure incontinence varies according to the method. For example, Dr. Elser has seen patients who have been taking incontinence medications for years. "But they are still struggling with incontinence," she says. Many times, patients keep asking for refills, hoping that the medication will eventually work.

    Instead of trying a technique indefinitely, Dr. Elser suggests trying a medication or treatment plan for two to three months. If it is not working after the trial period, consult your doctor about other options or a different dosage. She adds that if a treatment is working, patients should ask their physician if the therapy is required indefinitely or if there is a time when treatment will no longer be needed.

11. Should I be concerned about nighttime incontinence?

    "Some patients are fine during the day, but have trouble with incontinence during the night," says Dr. Nitti. "As we get older, our bodies begin to produce more urine during the nighttime hours when we are lying flat."

    Dr. Nitti recommends bringing nighttime incontinence to the attention of your doctor. "Treatment may be as simple as cutting back on fluids during the evening," he says.

12. Where can I go for support about incontinence?

    
    Your doctor is a great source of information about incontinence, as well as for offering ways to treat and manage the condition. There are also Web sites available that answer questions and give tips on managing incontinence. They include:
    • The National Association for Continence at www.nafc.org;
    • The National Kidney Foundation at www.kidney.org;
    • DEPEND® Absorbent Products at www.depend.com;
    • The National Kidney and Urologic Diseases Information Clearinghouse at www.kidney.niddk.nih.gov.