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  • Patricia Anstett

Let’s Chat About Incontinence

Do you urinate a lot, leak when you cough or laugh, or have to rush to get to the john?

Join the club - and it’s a very big one. Some 33 million American men and women have urinary incontinence of one form or another. It’s a big enough problem that there are even birthday cards that joke about it, for those of a certain age.

That’s because incontinence increases with age, particularly in women. About four of every 10 women 65 or older have a problem with their bladders. Low levels of estrogen after menopause contribute to women developing overactive bladders. But younger women may also have bladder control problems because of pregnancy and other conditions. Men may develop problems from benign prostate conditions or from prostate treatments.

It’s been a closeted subject for years, but now, it’s out in the open and there’s plenty of help to reduce or get rid of the problem, particularly for what is called urge incontinency – rushing to get to the bathroom.

So, I’ll out myself here. In the last year I found myself, along with others, rushing to the bathroom after jumping around and kicking a lot in my Zumba water aerobics class. I convinced myself to tell my success story when I witnessed the tell-me-please reactions of my water aerobics classmates, in the locker room, after I’d lowered my voice to tell a friend I had found help. A few whipped out their cell phones to take pictures of the business card of my Henry Ford physical therapist, Jennifer Ostrowski, who explained the issue to me clearly and compassionately. I also was fortunate enough to find a female Henry Ford urologist, Dr. Samantha Raffee, who was equally helpful and understanding.

With their guidance, I no longer rush to leave a 45-minute exercise class. I was surprised how little it took on my part and how quickly I got results in the struggle to defeat urge incontinency.

Three things helped me the most.

1.Cut back on caffeine and alcohol

Because caffeine and alcohol both cause you to urinate more, reduce your intake, as I did. Cutting back to cup of coffee in the morning brought me immediate results.

2.Consider Medicine

Raffee prescribed me a 50-mg dose of Myrbetriq, a daily pill for overactive bladders. A side effect is a possible increase in blood pressure. I take a small dose of medicine for borderline hypertension but Myrbetriq did not worsened the problem. I was able to cut my 50 mg dose of Myrbetriq to 25 mg after Raffee did a non-invasive ultrasound test and found that I was retaining a bit too much water in my bladder.

3.Retrain the bladder

I trained myself, as Ostrowski advised, to urinate less often – holding it for an hour for the first week, then building up to longer

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periods. Presto. That worked amazingly well. Turns out the brain responds to the bladder when you go too much, sending signals to go. You can do the opposite by training your brain to send signals less frequently. Normal bladder frequency is every two-to-four hours.

Some women as well as men benefit from Kegel exercises – simple exercises to tighten and release pelvic floor muscles. Many of us learned them in pregnancy. It’s wise to get help from a physician or physical therapist because it’s easy to do them incorrectly and you may have a type of incontinency that is worsened by Kegel. To make sure you are tightening the right muscles, stop your urine midstream. If you can do that, you’ve identified the right muscles to work on.

To do a Kegel, tighten those muscles initially for five seconds, then relax them for five seconds. Repeat four-to-five times, working up on subsequent days to contracting and relaxing the muscles for 10 seconds. Repeat three times a day in repetitions of 10, according to one of several handouts Ostrowski gave me. Don’t make a habit of using Kegel exercises to start and stop urinating. That can lead to incomplete emptying of the bladder and increase the risk of a urinary tract infection.

Losing weight helps because excess pounds weaken your bladder and nearby muscles. Even smoking cessation helps, doctors say. Avoid foods that irritate the bladder, including tomatoes, some dairy products, spicy and heavily seasoned foods, chocolate, walnuts and peanuts. Stay hydrated, as the bladder can weaken if you don’t drink enough fluids. But limit fluids within two-to-three hours before bedtime, to avoid getting up to go - after you have gone to bed.

Veterans journalist Patricia Anstett was a Detroit Free Press medical writer for 22 years, inducted in the Michigan Journalism Hall of Fame.

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