Sometimes you've just to go. And it seems that the older you get, the more often this happens - with or without your conscious control. We're talking about something most people are loath to discuss, even with their doctors: urinary incontinence.
As many as 30 percent of people over 65 have one or more of the three forms of urinary incontinence. Although women are far more likely than men to experience incontinence, by the age of 80, the gender disparity disappears. Urinary incontinence is not just embarrassing: it can affect your entire quality of life, leading you to cut out activities and friends you love and even changing the way you feel about yourself.
But there's the thing: leaking urine and sudden strong urges to urinate aren't conditions you have to live with simply because you're getting older. There are excellent medical and lifestyle treatments for incontinence. The first step, however, is admitting you have a problem and contacting your doctor or nurse.
Together, the two of you need to work out what type of incontinence you have. There are three main types - urge, stress and overflow - although you can have more than one at a time, in which case it's called mixed incontinence.
Stress incontinence With stress incontinence, your involuntarily leak urine when you laugh, run, sneeze, cough or otherwise exert yourself. This is by far the most common form and occurs especially in women, often because of childbirth. If the pelvic-floor muscles (which hold everything in your reproductive area in place) become weak, stretched or otherwise damaged during pregnancy or labour, stress incontinence often occurs. But men aren't off the hook.
Stress incontinence is often their cross to bear after prostate surgery.
Overflow incontinence This is the second most common form in men. It occurs when something blocks the urethra, the tube leading from the bladder to the outside of the body. In men, the blockage is most often caused by an enlarged prostate, medically known as benign prostatic hyperplasia (BPH). With BPH, your prostate pinches the urethera closed like a clamp would pinch a garden hose. Pressure builds up until urine finally leaks out without your voluntary assistance. Don't be embarrassed about BPH: it's the most common health problem in men aged 60 and above.
Urge incontinence In this form of incontinence, the urge to go strikes as suddenly as a summer storm - and often with similar flooding. Urge incontinence can occur if you have a central nervous system condition such as Alzheimer's or Parkinson's disease or have had a stroke. It may also be related to increased sensitivity of your bladder muscles to a brain chemical called acetylcholine, which stimulates the bladder into action.
Treatment includes medication, surgery or behavioural therapies such as exercising and bladder retraining. Lifestyle and behaviour changes are more effective overall than the medical options, but they make take longer to work, require more effort and may not provide a complete 'cure'. Here's how to get started.
To reduce incontinence
Get into training One of the best treatments for urge or stress incontinence is performing pelvic-floor muscle exercises called Kegels. The beauty of these exercises is that they can be done anywhere, at nearly any time, and you never have to break into a sweat. Start by pulling in or squeezing your pelvic muscle as if you were trying to stop the flow of urine or keep from passing gas. Count to ten as you hold the contraction, relax and repeat. That's it! Try to perform at least three sets of ten contractions a day. Start out lying down, then once you're good at them, perform your Kegels while waiting in a queue, driving, sitting in church - you get the idea. In one study comparing Kegels saw their episodes of incontinence drop by 81 percent, compared with a 69 percent drop in patients taking prescription medication. The combination of medication plus Kegels, however, works best for urge incontinence.
Check your medication Certain types of medication can induce incontinence, including many diuretics, ashtma drugs, alpha blockers, narcotic pain relievers, anticholinergics, calcium channel blockers and ACE inhibitors for heart problems. If you aren't sure which types you take, ask your doctor for help.
Women, consider oestrogen Sometimes incontinence in middle-aged or older women is related to low levels of oestrogen. This hormone plays a role in the strength and overall health of the muscles that control the bladder as well as the bladder and urethra themselves. Talk to your doctor about using vaginal oestrogen. Because the oestrogen is inserted into the vagina via a cream or tablet, very little gets into your bloodstream, but enough gets to the urinary tract to help to reduce incontinence. One study found that 58 percent of women receiving topical oestrogen to the vaginal area three times a
What the doctor will say
If you want a doctor to solve your urinary incontinence problems, you may be offered either prescription drugs or surgery, depending on the type of incontinence you have.
Urge incontinence Several prescription drugs can prevent the bladder from contracting, keeping urine where it belongs until you deliberately choose to release it. Studies find that these types of medication can reduce the number of incontinence episodes by up to 70 percent, curing the condition altogether in about 20 percent of people.
Stress incontinence In women, surgery to tighten and strengthen the pelvic-floor muscles, followed by pelvic-floor muscle exercises. can reduce incontinence episodes by between 88 and 94 percent. In men, however surgical treatments may be less successful, with studies finding an improvement range of between 36 and 95 percent. A major study comparing a minimally invasive form of surgery (in which a sling is used to hold up the urethra) to the more traditional procedure (in which the urethra and bladder are stitched to the pelvic wall) found the sling was much more effective in relieving stress incontinence.
Overflow incontinence The only real treatment for overflow incontinence is to treat whatever is blocking the urethra. In men, this usually means medication or surgery for an enlarged prostate.
week had far fewer episodes of urge incontinence than a placebo group. A new treatment uses a ring impregnated with oestrogen that can be worn in the vagina for up to three months, avoiding the need for daily dosing. Be aware that some oestrogen preparations can damage the latex of condoms or diaphgrams, though.
Get some training aids If you're still having trouble despite doing Kegel exercises, ask your GP about other techniques that could help you to improve the strength of your pelvic muscles. Your GP may be able to prescribe a set of vaginal comes. You insert a cone into your vagina for about 15
When embarrassment calls
'I have stress incontinence but I'm embarrassed to tell my doctor about it. How can I get the medical treatment I need if I can't even discuss it in a face-to-face examination?'
Join the crowd. More than half of all women with stress incontinence don't share their symptoms with their doctor, and by the time they're diagnosed, most have suffered with this condition for at least four years, studies show. Often, they don't bring it up because they don't think anything can be done, assuming it's a normal part of ageing. But incontinence is not a normal part of ageing and there are numerous treatments available to improve it. Instead of starting from scratch during a surgery visit, write your doctor an email or letter outlining your concerns and your symptoms. Include a schedule of all your bathroom usage and all the incontinence issues you experience over the course of a few days. Then make your appointment. When you turn up, your doctor can ask you any questions not answered in your letter, then the two of you can discuss treatment options.
minutes, twice a day, and try to keep it in. You start with the lightest-weight cone then increase to the next weight up, like a sort of internal strength-training exercise. Other vaginal devices may help to support the bladder neck and stop involuntary outflow.
Get on a schedule Your GP may refer you to a specialist for bladder training. This approach takes about six weeks and aims gradually to increase the length of time between your feeling the urge to urinate and actually doing so. Initially, you urinate every hour or two whether you need to go or not, then you gradually reduce the frequency, thus training your bladder to hold urine. This approach is best for urge incontinence, with studies finding that it is more effective than the major medication prescribed for the condition.
Ask about biofeedback This technique helps women to learn to exercise the correct pelvic-floor muscles to improve incontinence. A physiotherapist or continence adviser will show you how to use a special device that you insert into the vagina and which bleeps (or makes some other signal) when you are contracting the right muscles. Biofeedback plus pelvic-floor exercises seems to produce especially good results when combined with bladder training.
Get mildly shocked Your doctor can prescribe electrical stimulation, in which an electric current is applied directly to the pelvic floor, causing the muscles to contract and strengthening them.
Be lightly pricked Acupunture appears to be a safe, effective treatment for urge incontinence, reducing symptoms in four to six weeks of treatment. However, the relief is likely to be short term, and you may need additional follow-up treatments.
Lose a few pounds If you're overweight or obese, there's more pressure on the neck of the bladder, increasing the risk of incontinence. Losing weight can help.
Skip the tea We're not sure why, but tea drinkers seem more likely to experience incontinence than coffee drinkers. Although it's obviously not due to the caffeine, researchers aren't sure what causes it.
Stub out the cigarettes Seveal studies have found a strong link between smoking and incontinence, particularly heavy smoking.
enlarged prostate - that man thing
Men, are you noticing that it's taking a bit longer these days to, well, go? Do you find yourself looking for the nearest bathroom like you used to look for attractive women? Are you producing a urine stream that's weaker than your sense of humour? Don't be embarrassed. Every other man your age probably has the same problem.
Technically, you're dealing with benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. It's the most common health problem in men aged 60 and older. The prostate, in case you didn't already know, is the gland that creates and releases the fluid that makes up much of your sermen. This gland surrounds the urethra, the thin tube that carries urine from your bladder to outside your body. As you age, you prostate gets larger ( a bit like your ears, and no, we don't know why that happens), pressing on the urethra and, like a clamp on a garden hose, turning a stream into a trickle.
Check first with your GP to rule out a more serious problem, like prostate cancer. If your GP confirms BHP, you may be offered medication or surgery, or you may be able to handle it yourself by doing the following.
Stop drinking - at least before you go to bed Set the alarm on your watch for 2 hours before your normal bedtime. That's your signal to stop drinking so you can sleep through the night.
Choose decaffeinated One cup of coffee in the morning is fine. But after that, aks for decaf. And leave out the caffeinated tea, chocolate and aspirin, too. Caffeine is a natural diuretic.
Check your pills If you're taking diuretics for high blood pressure or heart failure, talk to your doctor. A lower dose or even a different medication could help to reduce your frequent trips to the too. Along these same lines, ditch the decongestants and antihistamines. An unintended effect of these is to tighten the band of muscles around the urethra, making it harder to go.
Don't wait Don't try to hold it in. Visit the loo at the first urge so you don't overstretch your bladder.
Follow a heart-healthy lifestyle The same things that increase your risk of heart disease - being overweight, lack of exercise, high blood pressure, high cholesterol and diabetes - also increase your risk of BPH and make your symptoms worse. For specific recommendations on avoiding heart diesease or diabetes, check out our suggestions on next.
Try saw palmetto An analysis of 21 clinical trials involving more than 3,000 men concluded that the herb worked better than a placebo at improving symptoms of enlarged prostate and inadequate urinary flow and worked about as well as widely prescribed medication. Follow the package directions for the dose.
As many as 30 percent of people over 65 have one or more of the three forms of urinary incontinence. Although women are far more likely than men to experience incontinence, by the age of 80, the gender disparity disappears. Urinary incontinence is not just embarrassing: it can affect your entire quality of life, leading you to cut out activities and friends you love and even changing the way you feel about yourself.
But there's the thing: leaking urine and sudden strong urges to urinate aren't conditions you have to live with simply because you're getting older. There are excellent medical and lifestyle treatments for incontinence. The first step, however, is admitting you have a problem and contacting your doctor or nurse.
Together, the two of you need to work out what type of incontinence you have. There are three main types - urge, stress and overflow - although you can have more than one at a time, in which case it's called mixed incontinence.
Stress incontinence With stress incontinence, your involuntarily leak urine when you laugh, run, sneeze, cough or otherwise exert yourself. This is by far the most common form and occurs especially in women, often because of childbirth. If the pelvic-floor muscles (which hold everything in your reproductive area in place) become weak, stretched or otherwise damaged during pregnancy or labour, stress incontinence often occurs. But men aren't off the hook.
Stress incontinence is often their cross to bear after prostate surgery.
Overflow incontinence This is the second most common form in men. It occurs when something blocks the urethra, the tube leading from the bladder to the outside of the body. In men, the blockage is most often caused by an enlarged prostate, medically known as benign prostatic hyperplasia (BPH). With BPH, your prostate pinches the urethera closed like a clamp would pinch a garden hose. Pressure builds up until urine finally leaks out without your voluntary assistance. Don't be embarrassed about BPH: it's the most common health problem in men aged 60 and above.
Urge incontinence In this form of incontinence, the urge to go strikes as suddenly as a summer storm - and often with similar flooding. Urge incontinence can occur if you have a central nervous system condition such as Alzheimer's or Parkinson's disease or have had a stroke. It may also be related to increased sensitivity of your bladder muscles to a brain chemical called acetylcholine, which stimulates the bladder into action.
Treatment includes medication, surgery or behavioural therapies such as exercising and bladder retraining. Lifestyle and behaviour changes are more effective overall than the medical options, but they make take longer to work, require more effort and may not provide a complete 'cure'. Here's how to get started.
To reduce incontinence
Get into training One of the best treatments for urge or stress incontinence is performing pelvic-floor muscle exercises called Kegels. The beauty of these exercises is that they can be done anywhere, at nearly any time, and you never have to break into a sweat. Start by pulling in or squeezing your pelvic muscle as if you were trying to stop the flow of urine or keep from passing gas. Count to ten as you hold the contraction, relax and repeat. That's it! Try to perform at least three sets of ten contractions a day. Start out lying down, then once you're good at them, perform your Kegels while waiting in a queue, driving, sitting in church - you get the idea. In one study comparing Kegels saw their episodes of incontinence drop by 81 percent, compared with a 69 percent drop in patients taking prescription medication. The combination of medication plus Kegels, however, works best for urge incontinence.
Check your medication Certain types of medication can induce incontinence, including many diuretics, ashtma drugs, alpha blockers, narcotic pain relievers, anticholinergics, calcium channel blockers and ACE inhibitors for heart problems. If you aren't sure which types you take, ask your doctor for help.
Women, consider oestrogen Sometimes incontinence in middle-aged or older women is related to low levels of oestrogen. This hormone plays a role in the strength and overall health of the muscles that control the bladder as well as the bladder and urethra themselves. Talk to your doctor about using vaginal oestrogen. Because the oestrogen is inserted into the vagina via a cream or tablet, very little gets into your bloodstream, but enough gets to the urinary tract to help to reduce incontinence. One study found that 58 percent of women receiving topical oestrogen to the vaginal area three times a
What the doctor will say
If you want a doctor to solve your urinary incontinence problems, you may be offered either prescription drugs or surgery, depending on the type of incontinence you have.
Urge incontinence Several prescription drugs can prevent the bladder from contracting, keeping urine where it belongs until you deliberately choose to release it. Studies find that these types of medication can reduce the number of incontinence episodes by up to 70 percent, curing the condition altogether in about 20 percent of people.
Stress incontinence In women, surgery to tighten and strengthen the pelvic-floor muscles, followed by pelvic-floor muscle exercises. can reduce incontinence episodes by between 88 and 94 percent. In men, however surgical treatments may be less successful, with studies finding an improvement range of between 36 and 95 percent. A major study comparing a minimally invasive form of surgery (in which a sling is used to hold up the urethra) to the more traditional procedure (in which the urethra and bladder are stitched to the pelvic wall) found the sling was much more effective in relieving stress incontinence.
Overflow incontinence The only real treatment for overflow incontinence is to treat whatever is blocking the urethra. In men, this usually means medication or surgery for an enlarged prostate.
week had far fewer episodes of urge incontinence than a placebo group. A new treatment uses a ring impregnated with oestrogen that can be worn in the vagina for up to three months, avoiding the need for daily dosing. Be aware that some oestrogen preparations can damage the latex of condoms or diaphgrams, though.
Get some training aids If you're still having trouble despite doing Kegel exercises, ask your GP about other techniques that could help you to improve the strength of your pelvic muscles. Your GP may be able to prescribe a set of vaginal comes. You insert a cone into your vagina for about 15
When embarrassment calls
'I have stress incontinence but I'm embarrassed to tell my doctor about it. How can I get the medical treatment I need if I can't even discuss it in a face-to-face examination?'
Join the crowd. More than half of all women with stress incontinence don't share their symptoms with their doctor, and by the time they're diagnosed, most have suffered with this condition for at least four years, studies show. Often, they don't bring it up because they don't think anything can be done, assuming it's a normal part of ageing. But incontinence is not a normal part of ageing and there are numerous treatments available to improve it. Instead of starting from scratch during a surgery visit, write your doctor an email or letter outlining your concerns and your symptoms. Include a schedule of all your bathroom usage and all the incontinence issues you experience over the course of a few days. Then make your appointment. When you turn up, your doctor can ask you any questions not answered in your letter, then the two of you can discuss treatment options.
minutes, twice a day, and try to keep it in. You start with the lightest-weight cone then increase to the next weight up, like a sort of internal strength-training exercise. Other vaginal devices may help to support the bladder neck and stop involuntary outflow.
Get on a schedule Your GP may refer you to a specialist for bladder training. This approach takes about six weeks and aims gradually to increase the length of time between your feeling the urge to urinate and actually doing so. Initially, you urinate every hour or two whether you need to go or not, then you gradually reduce the frequency, thus training your bladder to hold urine. This approach is best for urge incontinence, with studies finding that it is more effective than the major medication prescribed for the condition.
Ask about biofeedback This technique helps women to learn to exercise the correct pelvic-floor muscles to improve incontinence. A physiotherapist or continence adviser will show you how to use a special device that you insert into the vagina and which bleeps (or makes some other signal) when you are contracting the right muscles. Biofeedback plus pelvic-floor exercises seems to produce especially good results when combined with bladder training.
Get mildly shocked Your doctor can prescribe electrical stimulation, in which an electric current is applied directly to the pelvic floor, causing the muscles to contract and strengthening them.
Be lightly pricked Acupunture appears to be a safe, effective treatment for urge incontinence, reducing symptoms in four to six weeks of treatment. However, the relief is likely to be short term, and you may need additional follow-up treatments.
Lose a few pounds If you're overweight or obese, there's more pressure on the neck of the bladder, increasing the risk of incontinence. Losing weight can help.
Skip the tea We're not sure why, but tea drinkers seem more likely to experience incontinence than coffee drinkers. Although it's obviously not due to the caffeine, researchers aren't sure what causes it.
Stub out the cigarettes Seveal studies have found a strong link between smoking and incontinence, particularly heavy smoking.
enlarged prostate - that man thing
Men, are you noticing that it's taking a bit longer these days to, well, go? Do you find yourself looking for the nearest bathroom like you used to look for attractive women? Are you producing a urine stream that's weaker than your sense of humour? Don't be embarrassed. Every other man your age probably has the same problem.
Technically, you're dealing with benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. It's the most common health problem in men aged 60 and older. The prostate, in case you didn't already know, is the gland that creates and releases the fluid that makes up much of your sermen. This gland surrounds the urethra, the thin tube that carries urine from your bladder to outside your body. As you age, you prostate gets larger ( a bit like your ears, and no, we don't know why that happens), pressing on the urethra and, like a clamp on a garden hose, turning a stream into a trickle.
Check first with your GP to rule out a more serious problem, like prostate cancer. If your GP confirms BHP, you may be offered medication or surgery, or you may be able to handle it yourself by doing the following.
Stop drinking - at least before you go to bed Set the alarm on your watch for 2 hours before your normal bedtime. That's your signal to stop drinking so you can sleep through the night.
Choose decaffeinated One cup of coffee in the morning is fine. But after that, aks for decaf. And leave out the caffeinated tea, chocolate and aspirin, too. Caffeine is a natural diuretic.
Check your pills If you're taking diuretics for high blood pressure or heart failure, talk to your doctor. A lower dose or even a different medication could help to reduce your frequent trips to the too. Along these same lines, ditch the decongestants and antihistamines. An unintended effect of these is to tighten the band of muscles around the urethra, making it harder to go.
Don't wait Don't try to hold it in. Visit the loo at the first urge so you don't overstretch your bladder.
Follow a heart-healthy lifestyle The same things that increase your risk of heart disease - being overweight, lack of exercise, high blood pressure, high cholesterol and diabetes - also increase your risk of BPH and make your symptoms worse. For specific recommendations on avoiding heart diesease or diabetes, check out our suggestions on next.
Try saw palmetto An analysis of 21 clinical trials involving more than 3,000 men concluded that the herb worked better than a placebo at improving symptoms of enlarged prostate and inadequate urinary flow and worked about as well as widely prescribed medication. Follow the package directions for the dose.
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