May 21, 1998
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Kate Deely
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INCONTINENCE IS NOT A FACT OF LIFE UCSD
Urogynecologist says exercise is the key to control
The use of adult disposable paper undergarments dramatically exceeds the use of infant disposable diapers in the United States. Why? Incontinence -- the involuntary loss of urine -- one of the most prevalent, yet least discussed problems among women today.
"Incontinence is an area of concern, but it is a problem area that remains in the closet," said Charles Nager, M.D., associate professor in the UCSD Department of Reproductive Medicine and an obstetrician/gynecologist who specializes in the field of urogynecology. Incontinence, a treatable disorder which affects 10 million American women, occurs when the urethra loses support from the vaginal walls. Aside from being a physical health issue, incontinence, in a sense, can be an emotional and mental health issue as well. Because urine leakage can be an embarrassing problem, many women who suffer from incontinence become socially closed off, Nager said.
But, he added, no woman should have to suffer, physically or emotionally, from incontinence.
"A problem that can be solved should not have such power," Nager said. "Incontinence does not mean incompetent."
Childbirth is a major cause of incontinence, with age and menopause contributing.
Vaginal childbirth frequently causes pelvic damage because the pressure of the fetal head displaces and stretches parts of the pelvic anatomy, most specifically, the vaginal walls. The strength and support of the vaginal walls determines the control of the urethra and urine flow. In the most severe cases of stretched vaginal walls, the bladder can prolapse, meaning it falls through the vaginal walls.
With the onset of menopause women can become estrogen deficient which can cause the vagina to thin and decrease the mucous and elasticity which prevent the urethral walls from closing very well. This lack of closure translates into lack of support for the urethra resulting in incontinence. This is the simple equation of incontinence: if the pressure in the bladder exceeds the pressure in the urethra, leakage can occur."
There are several types of incontinence:
Stress incontinence occurs when an action such as a cough, laugh or strain increases the pressure of the abdomen. If the pressure in the urethra does not correlate with the pressure in the abdomen a small amount of urine will leak out.
Urge incontinence involves the pressure of the bladder exceeding the pressure of the urethra and results in a chronic urge to urinate.
Overflow incontinence occurs when the bladder pressure overcomes the urethral pressure and is characterized by constant urination, with or without the sensation or urge to empty the bladder.
Just as there is not a universal type of incontinence, there is no unique cure-all for the problem.
Securing the "bottom of the bucket" of the pelvic floor is the key to stopping or decreasing leakage. This security can be attained temporarily through diapers, pads and other more current leakage devices. There are also noninvasive or surgical medical treatments to decrease or cure incontinence.
Nager said the choice of treatment is a personal matter, but believes there is one thing all women suffering from incontinence can do without visiting a doctor's office or drug store. Exercise. Not just sit-ups or walking, but exercises for the pelvis.
"Just like you need to exercise your limbs for good health, you need to exercise and strengthen your pelvic muscles," Nager said. The pelvic muscles, or "levator muscles," can be tightened by doing exercises called Kegels, which involve tightening the muscles used to start and stop the urinary stream. These exercises, most often prescribed to pregnant women, can be used as a prevention measure or a treatment for incontinence.
Nager suggests women, especially those who are already suffering from incontinence, work up to doing Kegels 100 times a day in 5 different sets. "There is an 85 percent recovery rate for women who do Kegels 30 minutes twice a day," Nager said. "The best thing about Kegels is you don't have to go to the gym to do them. You can do them anywhere and no one will even know."
Nager said not just women, but everyone, needs to come out of the closet about incontinence. "Too many people accept incontinence as a natural consequence of age and never seek help," he said.
The fact that it has been a social taboo is not the only problem. There has also been neglect in educating physicians and nurses about its prevalence and its treatment, Nager said. "The message needs to be sent that this problem can be cured, or at least improved."
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