By Gilda Morales, ANP, DC
This week’s column addresses incontinence, a condition that affects both older men and women. A related condition, overactive bladder, affects the same population and does much to interfere with a normal life. Incontinence is usually divided into two types, stress and urge. Stress incontinence occurs in those who are unable to control their bladder when sneezing, coughing, or laughing.
Urge incontinence is usually due to urinary muscle spasms, resulting in an inability to control one’s bladder, resulting in the symptoms attributed to an overactive bladder. Risk factors in this condition include age, with more than 75% of postmenopausal women having the condition, obesity, and having children, which cause laxity in the pelvic floor muscles.
There are some medications that can actually worsen the condition, especially in men. Medications that are prescribed for enlarged prostate, such as tamsulosin, or Flomax can actually cause or worsen the condition. Other medications that have been implicated include tricyclic antidepressants and opioids.
Treatment options include weight loss, with only an 8% loss resulting in improvement, avoiding caffeine, treatment of constipation, and use of mild laxatives to prevent constipation. Kegel, or pelvic floor exercises, bladder training by scheduling frequent voiding is sometime very effective. Medications such as Detrol LA, Ditropan XL are also quite effective by may produce adverse effects such as dry mouth and impaired cognitive function. In any case, a visit to your primary care provider is necessary to diagnose and treat and to rule out more serious conditions.