Overactive Bladder

Ever Since I Had My Baby
by Roger Goldberg, M.D., M.P.H.

(Page 2 of 2)

Stress incontinence refers to the sudden accidental leakage of urine when you cough, sneeze, laugh, lift a heavy object, hit a tennis or golf ball, or quickly change your position - in other words, during any activity that creates pressure or stress in your pelvic area. Does this sound familiar? If so, it should come as no surprise - stress incontinence is the most common type of urine leakage in women aged thirty to fifty. Up to a third of women in their thirties report significant loss of urine during exercise. If you're a gymnast, tennis player, or aerobics enthusiast, in particular, maybe you've noticed leakage with sudden straining. More bothersome urinary incontinence, which can mean leakage during simple walking or light lifting, becomes a problem for around 15 percent of women under sixty-five, and closer to a third of women above that age. If you're severely stress-incontinent, you may even leak silently - in other words, when you're hardly exerting yourself at all, such as during a bumpy car ride or while bending down to tie your shoes.

Stress incontinence results from a urethra that lacks enough strength to hold back urine when the bladder pressure rises during physical exertion. As you'll learn in chapter 8, it is a condition whose roots begin with pregnancy and childbirth in many but not all cases. Most importantly, you'll become familiar with a broad range of strategies - including exercise, lifestyle tips, office procedures, and minimally invasive surgical options - allowing you to toss those pads and enjoy an active life without concern over keeping dry.

The Cost of Leaking

Can you believe there are more than fifty thousand hospital admissions each year for the treatment of stress incontinence? In the United States alone, over $1.14 billion is spent on stress-incontinence operations, and that doesn't include the cost of nonsurgical treatments. For each woman seeking treatment, a silent handful just lives with the problem.

Urge Incontinence and the Overactive Bladder

Linda

"Who's the kid here?" Linda asked me on her first visit to my office. "Here I am trying to toilet-train my daughter, wearing pads myself, and wetting them each time I run after her." A thirty-nine-year-old occupational therapist and mother of two girls aged two and a half and six, Linda was simply too busy to be bothered with these problems.

She'd been waking two or three times each night with a strong urge to urinate, and reaching the bathroom in time had become a serious challenge. During the workday, tired from her poor night's sleep, she found it increasingly difficult to make it through her patients' thirty-minute occupational-therapy sessions, and several times each week, she actually leaked urine on the way to the ladies' room. Linda began emptying her bladder every half hour to minimize her chances of an accident, and she routinely mapped the nearest bathroom wherever she was. She even started to wear dark, baggy clothes, just in case. "My husband hates to travel with me! He gets frustrated when we're on the highway and we have to pull over ... I know every bathroom in the city! It's taking the spontaneity out of my life." The problem also affected their relationship in the bedroom, as Linda's fear of leaking during intercourse was making it more and more difficult for her to relax and enjoy.

For two years, she had thought about finding a doctor to discuss the problem with. But somewhere between her older daughter's soccer practices and her younger daughter's preschool, she hadn't managed to act on that thought until now. Three weeks before our visit, Linda had been at her nephew's wedding. "There I am in this beautiful dress, and as I'm standing up from my chair, I have a huge accident. Thank goodness the dress was long and wide, and I was wearing a pad. But right then and there, I said to myself: 'Enough of this!' "

Across the top of her medical questionnaire, Linda had written, "I'm here because I need a bladder operation." Surprised by her assumption that these symptoms would require surgery, and curious to know whether that was the reason for her avoiding help all this time, I posed a few questions. Had she ever considered that she might not have a surgical problem at all? Was she aware that diet and exercise might be enough to control her symptoms, or perhaps physical therapy or a simple medication? Did she know how many other women were facing the same problem? As we continued that first office visit, Linda's expression spelled surprise, then relief, as she realized that one way or another, she might be feeling better soon.

Have you ever lost urine for no apparent reason, under stressless circumstances? Do you find yourself running to the bathroom with a strong urge that you sometimes can't control before reaching the toilet? Ever feel a sudden need to void when you hear running water, wash the dishes, or simply enter the house? Do you think of your bladder as undersized?

If so, you've probably experienced the other major type of urinary incontinence commonly affecting postreproductive women: urge incontinence, or the overactive bladder. An overactive bladder can occur at any age, even among women without any children. But it's more common after childbirth, following the loss of vaginal and pelvic supports, so it's a key concept to understand if you're coping with postreproductive pelvic symptoms. The overactive bladder can mean accidental leakage of urine for women who wet themselves during strong bladder urges; for others, the problem is urgency, frequency, and waking at night to void, as if the bladder were too small. In any of its forms, it can lead to a slow but steady withdrawal from an active daily life. According to a survey called the National Overactive Bladder Screening Initiative, sponsored by Pharmacoa & Upjohn, 26 percent of women with overactive bladder symptoms reported that they regularly avoided places and situations due to the concern that a bathroom may not be nearby.

Do these overactive-bladder symptoms sound familiar to you? The good news is that normal adult bladder behavior can be relearned, and urge incontinence can be controlled. In chapter 8, you'll learn all about the impact of simple habits and behavioral techniques, diet and medication, special exercises, electrical stimulators, magnetic chairs, implantable pacemakers, and more.

Copyright © 2003 by Roger Goldberg, M.D., M.P.H.

About the Author

Roger Goldberg, M.D., M.P.H., practices urogynecology and reconstructive pelvic surgery at the Evanston Continence Center of Northwestern University Medical School. He completed his residency at Harvard Medical School and his master's in public health training at Johns Hopkins University. He lives in Evanston, Illinois.