Oops, I Leaked: Tales of Incontinence

Gotta go all the time? Worried you'll wet your pants if you laugh too hard? You may be suffering from mild incontinence, and you're not alone.

From the WebMD Archives

"I'm more sensitive now to women when they say they've 'gotta go,'" says 51-year-old professional speaker, author, and prostate cancer survivor Chuck Gallagher. The Greenville, S.C., resident experienced mild incontinence for six weeks following his laparoscopic surgery. "Guys don't want to talk about it; it's embarrassing. They think they have to suck it up and deal with it."

And men aren't the only ones who don't want to talk about their little leaks or mild incontinence.

According to the National Association for Continence (NAFC), 25 million Americans suffer from transient or chronic urinary incontinence. Statistically, it's a condition that skews toward women; 75%-80% of sufferers are female. Even more staggering, women wait nearly seven years before talking to their doctor or seeking treatment. But regardless of gender, one-third of the population thinks incontinence is a natural part of aging, something they have to contend with rather than conquer.

"It's time for incontinence to come out of the 'water closet,'" says Jill Rabin, MD, chief of ambulatory care and urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She is the co-author of Mind Over Bladder: I Never Met a Bathroom I Didn't Like. "This is a quality-of-life issue. You don't have to tolerate it. It's treatable in almost every situation."

Talking about a leaky bladder or the frequency of your bathroom breaks may not be fodder for Facebook updates. But more and more people are taking Rabin's advice and doing something about their incontinence. WebMD talked to real women and men who experienced incontinence at various points in their lives. Read on for their stories.

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The Personal Side of Incontinence

Meet Tasha Mulligan of Des Moines, Iowa. The physical therapist, athletic trainer, triathlete, and mother of three refused to let mild incontinence slow her down.

"The topic of incontinence isn't one that I have always been focused on, but my own journey through pregnancy and delivery pushed me into the women's health field of physical therapy five years ago. After my delivery, my pelvic floor just didn't bounce back," she tells WebMD. "Then I began to realize that a lot of my female patients would laugh and joke about wetting their pants as I asked them to perform specific exercises. My grandmother talked about her uterine prolapse, and my pregnant friends were asking a lot of questions about why they couldn't hold their bladder. I began to realize the widespread effect of weak pelvic floor muscles."

This revelation -- that women are disproportionately affected by incontinence -- spurred her to action.

"Just like after knee surgery when we have to do exercises to ensure that our quadricep muscle will fire again and resume normal strength, we should also exercise our pelvic floors after the trauma of pregnancy and delivery to keep us continent and 'supported,'" says Mulligan.

Pregnancy, Childbirth, and Mild Incontinence

"Women absolutely have more incontinence because we are mothers," says Elizabeth Mueller, MD, assistant professor in the department of urology and the department of obstetrics and gynecology at Chicago's Loyola University. "The increased prevalence is simply due to our different anatomies. During pregnancy and labor, nerves are compromised. Sometimes, they can't recover fully."

According to a 2008 study published in TheJournal of the American Medical Association, 25% of women over the age of 20 have a pelvic floor disorder, with urinary incontinence the most common symptom.

Natalie Herback, a physical therapist with Scripps Memorial Hospital in La Jolla, Calif., says that other symptoms of pelvic floor disorders include difficulty sitting, pain with sexual intercourse, lower back and abdominal pain, and rectal or vaginal pain.

"The most effective weapon in the fight against pelvic floor disorders are Kegel contractions -- exercises that involve the contracting, holding, and releasing the pelvic floor muscles," she says.

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The Power of Kegels for Urine Control

The pelvic floor is a combination of muscles, ligaments, and connective tissues that support the pelvic organs, including the bladder, vagina, uterus, prostate, and rectum. Muscles in the pelvic floor help support the bladder and hold urine in check. Weak muscles -- from pregnancy, childbirth, surgery, heavy lifting, aging, obesity, or chronic medical conditions -- are more likely to contribute to leaks.

While conducting interviews for a book he is writing about prostate cancer, Gallagher found out that just six men out of 132 had been told by their doctors to do Kegel exercises. Yet both men and women with stress incontinence can greatly benefit from Kegels. And the exercises are noninvasive, totally free, and without side effects.

"A specially trained physical therapist who teaches you how to do the proper Kegel exercises has been the biggest help with [incontinence]," says Susan Mead. The 50-year-old first experienced mild incontinence nine years ago after delivering a 9 1/2 baby. She first tried herbal remedies, but when those failed, she turned to physical therapy. "I always know my routine is slipping if I have that bit of leakage when I sneeze, cough, or laugh," she says.

Treatment Options for Mild to Moderate Incontinence

Rabin encourages those who suffer from incontinence to seek help from a qualified health care practitioner.

"[This condition] fundamentally affects how we see ourselves. Untreated, it can affect our ability to be intimate [and] contribute to isolation, depression, and obesity. But your life doesn't have to be ruled by your bladder."

Depending on the severity of incontinence, doctors may prescribe a variety of treatments to patients.

Treatment options for urinary incontinence include medications, nerve stimulation, biofeedback, and insertion devices.

And though it is the most invasive and expensive treatment method, some doctors may recommend surgery for some patients.

After having three large babies -- all weighing more than 9 pounds -- in less than four years, 37-year-old Laura Jackson of Stevensville, Mich., experienced stress incontinence.

"I struggled with the condition until I spoke to my doctor, who recommended a surgical procedure called the Monarc Subfascial Hammock by AMS. I've had great success with it. I am an amateur triathlete and was really bothered by my incontinence prior to surgery. Since the surgery, I have competed in seven triathlons. The [surgery] restored my self-confidence and commitment to exercise. It was truly life-altering."

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Experts and those managing their incontinence offer some additional tips:

  • Avoid common bladder irritants such as spicy food and caffeine.
  • Monitor your medications. Many pills can contribute to incontinence and some prescribed medications can lose their efficacy. Talk to your doctor about changes.
  • Use tampons during heightened physical activity. Up to 25% of elite female athletes experience incontinence. Tampons are cheap, effective insurance against an "accident."
  • Wear dark clothing. If you are struggling with leakage, darker clothing can camouflage an episode. Keeping a change of underwear and/or pants can provide peace of mind.
  • Use shields or pads. They aren't a cure, but they are useful in providing a measure of protection and confidence.

WebMD Feature Reviewed by Louise Chang, MD on June 02, 2009

Sources

SOURCES:

Chuck Gallagher, speaker; author.

Nancy Muller, executive director, National Association for Continence.

Jill Rabin, MD, chief of ambulatory care and urogynecology, department of obstetrics and gynecology, Long Island Jewish Medical Center, Hew Hyde Park, N.Y.

Natalie Herback, physical therapist, Scripps Memorial Hospital, La Jolla, Calif.

Tasha Mulligan, physical therapist, Des Moines, Iowa.

Susan Mead.

Elizabeth Mueller, MD, assistant professor, departments of urology and obstetrics and gynecology,  Loyola University, Chicago.

Laura Jackson.

National Association for Continence web site

Rabin, J.  Stein, G. Mind Over Bladder: I Never Met a Bathroom I Didn't Like, iUniverse, December 2008.

Nygaard, I. The Journal of the American Medical Association, Sept. 17, 2008; vol 300: pp 1311-1316.

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