Episode 43: April 20, 2010
by Rob Lamberts, MD
I have noticed that people are much more at ease in talking about their urine than they are their poop. I am not really sure why this is the case--perhaps it’s the smell--but asking someone if they have problems when they pee just doesn’t evoke the same expression from people as does talking about their poop. There is one exception to this, and that is when urine comes out when it shouldn’t. That is a condition known as urinary incontinence. There are three types of incontinence I will discuss in this article: bed-wetting, which happens mostly in children, and two kinds of incontinence that happen in adults, stress and urge incontinence.
The fancy doctor word for bed-wetting is enuresis. Bed-wetting is a very common condition, affecting 15% of children age 5, still 10% of 7-year olds, and even 1-2% of children over 15. It’s not only common, it’s genetic. If both parents had a problem with bed-wetting, 1/2-3/4 of the offspring will have the same. So go ahead kids, lay this problem at your parents’ feet.
What Causes Bed-Wetting?
But it’s not fair for the parents to blame their kids for wetting the bed. Many parents seem to think that the child is simply too lazy to get out of bed and so chooses to sleep in a urine-soaked bed. They punish their children or shame them in an attempt to end this problem. That is a big mistake. The main problem with children who wet their beds is not laziness; it’s that they sleep so deeply that they don’t wake up when their bladder tells them they need to go. For some reason, the brain needs simply to get older for it to get aroused by a full bladder.
What Is the Cure for Bed-Wetting?
That means that the cure for bed-wetting is time. There are no magic medications that fix it, and shame doesn’t work either. Having the child wear some sort of absorbent undergarment is the best way to cope with it. The kids may resist this idea at first, but the alternative of sleeping in urine usually convinces them otherwise. There are a few medications that help children if they want to go to a friend’s house and not wear a pull-up, but these only work while they are being given; once they are stopped, the bedwetting resumes.
So don’t worry about bed-wetting. It’s really common and will go away on its own. The only time it needs to be brought to a doctor’s attention is when a child who has previously been dry through the night starts wetting the bed regularly, which may signify a medical problem.
Adult Urinary Incontinence
So what about adult incontinence? I do understand why it’s embarrassing to wet yourself, yet a very high number of adults with incontinence don’t seek help. That is too bad, because there are treatments that are very effective, meaning that incontinence doesn’t condemn you to a life of wearing Depends undergarments.
As I mentioned earlier, there are two main kinds of adult incontinence:
What is Stress Incontinence?
Stress incontinence happens when an increase in abdominal pressure--like when a person coughs--causes leakage of urine. That is the most common type of incontinence in younger women and in men who have had prostate surgery. It happens because the little muscle that closes the outlet of the bladder, called the urethral sphincter, doesn’t close with enough force.
What is Urge Incontinence?
Urge incontinence happens when a person gets the sudden need to urinate, but can’t get to the bathroom in time to prevent an accident. It’s more common in older women and is more socially significant in that it can come on at inopportune times.
Some lucky people have a combination of urge and stress incontinence.
Treatments for Urinary Incontinence
Being too embarrassed to see your doctor about incontinence is a mistake, especially because many of the treatments are very effective.
What can be done about these problems? My Quick and Dirty Tips for this article will cover what you can do about adult incontinence:
Tip 1: Get evaluated. There are a number of medical problems that can cause either stress or urge incontinence--especially if it comes on rapidly. Most people end up only giving a urine specimen, but occasionally more aggressive testing is needed to find the exact cause. Yes, the words “more aggressive testing” are a euphemism for “a test that may not be much fun,” but getting to the root cause can really help fix the problem.
Tip 2: Learn Kegel exercises. I’m not sure Mr. Kegel or his kids were thrilled to get the Kegel name hooked to bladder exercises, but doing them regularly really helps reduce or eliminate incontinence, especially stress incontinence. The basic procedure is to repeatedly stop the urine flow when you are going, then repeat the same muscle contraction throughout the day. Go to this link for more detailed instructions.
Tip 3: Medicate with care. There are a number of medications that can help, but they should be taken with care. When you take a medicine by mouth, the drug goes everywhere in your body, not just where you want it to help you. The most common medications for incontinence can cause significant side effects that your doctor should tell you about. Still, these medications are very useful and can improve your quality of life significantly.
Men, and especially older men, are sensitive to medications when it comes to being able to urinate. Certain medications, especially antihistamines, can make the urinary sphincter close too much, causing the very uncomfortable condition known as bladder outlet obstruction. When the prostate gland gets larger, a common thing in older men, it causes an obstruction to the bladder. These medications can add to that obstruction, totally blocking the outflow of urine. Be careful with medications.
Tip 4: If all else fails, ask about surgery
Women are prone to have problems with the muscles in their pelvis--from either childbirth or growing older--which can be fixed with a surgical procedure. The surgery is generally not invasive, and so doesn’t cause a lot of disability.
That’s it for incontinence. I hope all of these embarrassing subject articles on bowel problems and hemorrhoids have been helpful and have whet your appetite for the final subject: male problems. I’m still trying to figure out how I’m going to do that one.
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
Catch you next time! Stay Healthy!