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Urinary incontinence in women

Ways to deal with urinary incontinence, from our health columnist.
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Gotta pee? It's a common problem. Photo supplied.

Some women say, “You only know a place well if you know where the restrooms are located.” They’re likely suffering from urinary incontinence (UI). They know if they delay too long, there may be an accident. But there are ways to correct this nerve-racking problem.

A report from the University of California claims only one in four women with this trouble seeks help. This is due to embarrassment and the common but illogical notion that it is part of aging.

There are two main types of UI. Urge incontinence is an overwhelming desire to urinate immediately. As goes the old saying, “If you don’t go when you’ve got to go, by the time you go, you’ve already gone!” The other type, stress incontinence, occurs due to increased abdominal pressure from lifting a heavy object, coughing or exercising. The muscles of the urethra, the small tube that carries urine to the outside, are too weak to stop the flow of urine.

So how can women with UI prevent this embarrassment? One prime treatment has stood the test of time.

In 2019, a study reported in the Annals of Internal Medicine analyzed 84 clinical trials on both urge and stress incontinence. It found that changing lifestyle and behaviour was more effective for these disorders than medication.

An exercise known as the Kegel exercise builds up muscles surrounding the urethra. Patients are advised to squeeze their muscles as if they want to stop the flow of urine for 10 seconds, done ten times, three times a day. How long it takes to get results depends on the degree of damage to the muscles. If made part of the daily routine, results should be seen in two months.

But Kegel exercises must go along with timed voiding. This means that during the day, trips to the bathroom to void must be made every two or three hours. It’s also necessary to keep drinking water. Cutting back on alcohol and caffeinated drinks is helpful.

Losing excess weight is good advice as well. A report in the New England Journal of Medicine shows this pays dividend. Obese women who enrolled in a weight-loss program enjoyed a 47 percent improvement in UI compared to 27 percent in the control group.

And stop smoking. Good sense tells us that coughing can’t be helpful for fighting UI.

If all fails, your doctor will suggest drugs that can help to reduce bladder spasms. But some of these drugs cause constipation. The use of a vaginal pessary that repositions the urethra may also be an option.

Many women with UI suffer from thinning of the vaginal lining due to a lack of estrogen. So, ask your doctor if he or she would consider adding a vaginal estrogen gel for a few months.

Surgery is the last resort. Bulking agents can be injected around the urethra to thicken the area and help to control the leakage.

Several different operations can be done. Some require an abdominal incision. Or a small incision in the vagina to insert synthetic material underneath the urethra to change its angle.

Remember Rome was not built in a day. Nor will weak bladder muscles be rebuilt without consistent daily efforts.

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