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Letting Your Doctor Know How You Feel continued...

Fourteen years later, however, she noticed symptoms of stress incontinence again. “I was just leaking a little,” she says. “But I knew about physical therapy and felt that if I worked on developing those muscles now, before it got really bad, I wouldn’t need to have surgery again.” She also wanted to avoid taking medications, if possible.

Her doctor referred her to a urogynecologist, a specialist in urinary and associated pelvic floor problems. “I told him I wanted to try physical therapy first, unless it was something I couldn’t do because of prior surgery or other issues," Kathleen says.

The urogynecologist’s exam turned up two issues adding to her stress incontinence -- a weak urethra and a prolapsed, or dropped, bladder. He advised trying intensive pelvic floor physical therapy, including Kegel exercises, and referred her for nine weeks of treatment.

“He said that at the end of that time, if they sign off and say I’m doing great, I can do my therapy at home,” Kathleen says. “But if not, he wants to see me and we’ll discuss surgical options.”

Lifestyle Changes That Can Make a Big Difference

When people are considering their treatment options, Kitegawa says, it’s important for doctors to make sure they have realistic expectations. “We know people want a ‘quick fix,’” he says. “That’s a possibility sometimes, but they need to know that physical therapy and lifestyle changes can have a much longer lasting impact.”

Your doctor may want you to start with these behavioral changes:

  • Cut caffeine, alcohol, and nicotine. Stepp and Kitagawa say this is critical. “If you cut your caffeine intake in half, you’ll notice a difference,” Stepp says. “If you eliminate it completely you’ll notice more of a difference.” Stepp calls alcohol the "double whammy": “Not only is it an irritant, it also makes you pee more. It increases the volume in the bladder.” And he is adamant about eliminating nicotine. “If you want to tackle bladder symptoms, you have to stop smoking,” Stepp says. “Nicotine stimulates urgency.” And coughing associated with smoking aggravates stress incontinence.
  • Bladder retraining. In addition to eliminating caffeine, Kitagawa suggests restricting fluids prior to going to bed, if possible. "Timed voiding" -- going to the bathroom at regularly timed intervals -- is one way of retraining your bladder.
  • Kegel exercises. These can help strengthen the muscles that hold urine in. 

“I would rather avoid medications if at all possible because they aren’t without their own side effects, including dry mouth and dry eye,” Kitagawa says. “That seems counterproductive.” When he does prescribe medications, he does so with the caveat that the person must quit caffeine, nicotine, and alcohol. “Those three will undo whatever the meds are trying to accomplish,” he says.

Whether solutions are achieved through lifestyle and behavioral changes, medication, surgery, or a combination of treatments, talking openly and honestly with your doctor can get you on the right road. “There is help available, and some of it is super easy," Stepp says. "Incontinence doesn’t have to control your life.”

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