Treatment Options Help You Take Control of Urinary Incontinence

For older adults, increased urinary frequency is fairly common. “As people age, in general, the bladder does lose some of its capacity,” says Jonathan M. Vapnek, MD, associate clinical professor of urology at Mount Sinai School of Medicine, according to Mt. Sinai's Focus on Healthy Aging. “The bladder gets a bit stiffer and therefore, it does not hold as much. You can certainly expand it to the same amount, but you can get urgency earlier and that’s one of the reasons why people, as they get older, will urinate more frequently.”

However, while increased urinary frequency is a normal consequence of aging, urinary incontinence (UI) is not.

The Journal of the American Medical Association reports that the condition affects about 200 million people worldwide. At least one out of every 10 people over the age of 65 experiences UI. Despite its prevalence, the stigma surrounding UI causes many people to hide the fact that they have the problem, even though it can significantly affect their quality of life.

In order to control incontinence, you must understand the basics of urination. The bladder muscle stores urine, and the urethra is the tube through which the urine passes as it exits the body. When urination occurs, the bladder muscle contracts, pushing the fluid out, and the pelvic muscles that keep the urine from leaving the urethra relax, allowing the urethra to open and the urine to flow out of the body. The major types of urinary incontinence occur when there is a problem with either the way the bladder muscle contracts or the ability of the urethra to open fully or stay closed.

To determine which treatment is best for you, talk to your doctor about which of the four types of UI you are experiencing:
Stress incontinence. Stress incontinence refers to urinary leakage that occurs with increased abdominal pressure caused by activities such as exercising, laughing, or sneezing. Women who have given birth vaginally may experience structural damage that affects the ability to “hold in” urine. In addition, postmenopausal women produce less estrogen, and according to Dr. Vapnek, “That’s a big thing. When women hit menopause there is not as much estrogen, and there is an atrophy that occurs causing weakness not only of the vagina, but also the bladder and the urethra.”

Although it’s more common in women, stress incontinence also can occur in men who have undergone radical prostatectomy (removal of the prostate due to cancer). The prostate is a gland that surrounds the urethra, and removal of the gland can affect urination.

Pelvic floor exercises (shown on page 7) can help prevent stress incontinence. An antidepressant called imipramine (Tofranil) is sometimes used to treat stress incontinence. It works by relaxing the bladder muscle and contracting the muscles in the bladder neck, making it easier to control the release of urine. Success rates with this drug are not extremely high and therefore researchers are exploring alternative treatment methods for stress incontinence.