Dear Doctor Column, August 13, 2001

Question:

I have been going to physicians for years for treatment of stress incontinence. I have tried lots of different medications and I do Kegel exercises (although I'm not sure I'm doing them right). The doctor has suggested collagen, but can't guarantee that it will be totally successful. Now, he's suggesting I wear a catheter, which seems extreme. I wear pads all the time. Isn't there anything that can be done without have to resort to surgery or wearing a catheter?

Answer:

Urinary incontinence at any age is not normal and, contrary to public opinion, most cases can be treated successfully. With current therapies, including behavioral techniques, biofeedback, medications, collagen injections and surgery, 90 percent of people can be cured or significantly improved.

Appropriate therapy for urinary incontinence depends on determining the cause. Incontinence can be brought on by weakened pelvic or sphincter muscles, urinary tract or vaginal infections, constipation or a weak or overactive bladder. In addition, certain drugs, such as diuretics, some blood pressure medicines, antihistamines, asthma drugs and sedatives can add to the problem.

Stress incontinence is the accidental leakage of urine that occurs with increased pressure on the bladder from coughing, sneezing, laughing or physical exertion. It develops most often in women in their 40s and 50s, usually as a result of weakened muscles and ligaments in the pelvis caused by childbirth.

Once the cause of the problem has been established, an appropriate treatment program can be devised. Stress incontinence frequently responds well to conservative treatment. Pelvic floor muscle exercises (also known as Kegel exercises), performed regularly, can strengthen these muscles and decrease or eliminate the problem in three-quarters of people with stress incontinence. The results are even better when the exercises are combined with biofeedback, a process that ensures you are exercising the right muscles, or with electrical stimulation of the pelvic floor muscles.

As you have discovered, Kegel exercises are simple in principle, but they require careful instruction and proper execution to be effective. If you do not think you are doing them properly, ask your doctor to clearly explain again how to perform them correctly.

Physicians add that weight loss, estrogen-replacement therapy in postmenopausal women, and treatment of underlying medical conditions often help stress incontinence, as well.

For severe problems that do not respond to these measures, surgery is available and can cure 90 percent of properly selected patients. Numerous surgical procedures (including collagen injections) are used for stress incontinence, all of which elevate or fix the point at which the urethra joins the bladder so that it constricts during increases in abdominal pressure.

We urge you to talk to your primary care doctor or your gynecologist for a referral to a continence program at a nearby hospital or medical center. These programs bring together specialists to deal with different aspects of incontinence, to ensure you get a comprehensive, individualized therapy program.

For more information, contact the National Association for Continence, www.nafc.org, or the National Institute of Diabetes and Digestive and Kidney Diseases, www.niddk.nih.gov/health/urolog/uibcw/index.htm.