BoomerGirl Diary

Dear Crabby:

I’m having a lot of trouble with my bladder. I’ve always been active, but I can no longer run or cough without serious leakage. Other than medications, is there anything else that I can do?

Nicole

Dear Nicole:

Urinary incontinence is a problem for a lot of BoomerGals, and one that many are afraid to talk about. Let’s face it, the only time peeing yourself is even marginally acceptable is when you’re laughing yourself sick with your best girlfriends over some crazy story. Embarrassing as it is to talk about, it is an important problem. Left untreated, it can cause skin breakdown and social isolation. Not to mention the cost of incontinence briefs.

Many of the causes of incontinence are related to aging, but incontinence is not considered a “normal and inevitable” part of aging. There are multiple types of incontinence, but let’s talk about what you’re experiencing — stress incontinence.

Stress incontinence is the involuntary loss of urine with movement such as sneezing, coughing, running or jumping.

Stress incontinence is caused when the muscles that control urine loss aren’t strong enough to hold back the tide in the presence of increased abdominal pressure. So things like jumping, coughing or sneezing can cause us to leak a little bit of urine. Up to 50 percent of women experience this from time to time, and frankly, we’re, er, pissed about it.

The usual players are implicated: age (of course), being female (eyes rolling, what else is new?), and childbearing (those pesky kids again — see column on varicose veins.) Two other factors that many people don’t consider at all that can play a role in incontinence are obesity, which puts pressure on the bladder and can result in weak abdominal muscles, and smoking, which increases hard coughing.

A lot of women manage this by wearing a pad and avoiding problem activities. I’m all for avoidance of running, but give up laughing? Never! And who are these jumping women and what are they jumping about? This strategy seems OK to many women at first, but they quickly tire of the cost and the associated physical problems. Isolation and embarrassment are also concerns.

The first step is to see your health care provider. She will ask you questions about your symptoms to discern if this is just stress incontinence, or if it might fall into another category of incontinence. There are medicines available, but I prefer to first send my patients to pelvic floor rehab, a physical therapy treatment plan that focuses on bladder training (they use very tiny barbells—kidding!) and also strengthening the muscles, with exercises that go way beyond Kegels. Many women improve with this treatment, which is usually offered by female therapists. A urology consultation is another possible step, and the urologist might do a series of tests, some easy, some a little, shall we say, dicier, (they involve Q-tips and your urethra, and that’s all I’m saying) to see if surgery or other less invasive procedures will help you.

The point is, urinary incontinence is NOT an expected part of growing older, and there is help out there. If you will speak to your health care provider about this common problem, even if you feel embarrassed, improvement is almost certain.