Simple Changes, Big Results
By Kelly Burgess
Jaki Nett is a college professor, author and yoga instructor who learned to control her urinary incontinence. "It started gradually," Nett says. "I had an urge to urinate. I would go to the bathroom and very little came." Nett also had problems with leaks when she coughed, laughed or sneezed. She soon realized that this urge to urinate was becoming stronger and her ability to hold urine was becoming weaker. "As time passed, making it to the bathroom took up most of my thinking and planning," she says.
Nett realized she was dealing with a bladder control problem and wanted to do something about it. "I did not hide it," she says. "I talked to other women – friends, co-workers, family members and my yoga students, too. What I found was many women were suffering in silence."
In spite of its lack of attention, ongoing urinary incontinence is a very common condition. "Worldwide, more than 200 million people live with incontinence," says Dr. Linda Brubaker, of the Women’s Pelvic Medicine Center at Loyola University Medical Center in Maywood, Ill. In North America alone it is estimated to affect 19 million adults and 80 percent are women. Many people accept incontinence as an inevitable result of aging or childbirth, but in fact it is a medical condition that often can be treated, cured or managed.
The first step to controlling your incontinence should be to talk to your doctor. The National Association for Continence (NAFC) recommends beginning with your family physician or primary care doctor. However, you may also ask to be referred to a specialist such as a urologist (specializing in urinary conditions for both men and women) a gynecologist (specializing in female reproductive conditions) a urogynecologist, a geriatrician (specializing in the treatments of older people) or a gastroenterologist (specializing in the problems of the intestinal system). "Before making the appointment, ask if the doctor has a special interest in caring for people with incontinence," says John W. Utrie, Jr., D.O., specialist in urogynecology and pelvic reconstructive surgery at Aurora BayCare Medical Center in Green Bay, Wis. "See if they have a comprehensive program in place to deliver proper diagnostics, behavioral treatments, pelvic floor therapy or surgery." For help finding a doctor or specialist near you, check out the NAFC link at http://www.nafc.org/seeking-treatment/ and click on "Specialist Search."
When talking to your physician be sure to discuss behavioral modification options that may help you take control of your incontinence. These options can include:
According to the World Health Organization, a pelvic floor muscle therapy program – a structured program of pelvic incontinence exercises (Kegel exercises) and bladder retraining – has a 65 to 70 percent cure or improvement rate for urinary incontinence. Pelvic floor muscles support the bladder and help control urination. Kegel exercises and other forms of pelvic muscle therapy, such as electrical stimulation and biofeedback, are designed to improve bladder control in women by strengthening the muscles that control urination.
Kegel exercises are most successful when done regularly to maintain muscle control and can take up to four months to see an improvement. Performing a Kegel when sneezing, coughing, bending over or at the first urge to urinate may help minimize bladder leakage.
As a yoga instructor at Iyengar Yoga in the Napa Valley, Nett knows a great deal about pelvic floor muscles and found that she was able to control her urge to urinate through a unique technique she developed that works those muscles. Today, Nett is proud to say she no longer has to worry about dashing to the nearest bathroom and worrying about every little cough and giggle.
"Many patients can improve their incontinence symptoms by working on a Kegel exercise program on their own," says Dr. Kimberly Coates, of the Scott and White Clinic in Temple, Texas, who specializes in pelvic floor dysfunction. "However, there are patients who better benefit from working on pelvic floor muscle rehabilitation with a specially trained physical therapist or nurse. Talk with your doctor about what option is best for you."
Proper nutrition is important to controlling your incontinence and maintaining good health. A quick change you can make to reduce the severity of your incontinence symptoms is reducing the amounts of irritating "trigger" foods and beverages you eat and drink. Simply reducing or eliminating many foods and beverages that can irritate the bladder (including alcohol, caffeine, acidic fruits or fruit juices, tomato or tomato-based products, milk products, artificial sweeteners and spicy foods) can result in quick improvements in your incontinence symptoms and behaviors.
Discussing your diet with your doctor can be very valuable. "We have found at our institute that patients can frequently make a difference in their urinary leakage by modifying their diets," says Dr. Ted Benderev, of The Incontinence and Pelvic Support Institute in Mission Viejo, Calif. "This relatively simple change in diet can be particularly helpful in those cases where medicines are not enough."
Nett noticed a dramatic change after pinpointing a few foods that made her go more. "Colas and hot spicy food had to be eliminated from my diet when I knew the locations of bathrooms were in question," she says.
Drink More, Not Less!
Many people believe that restricting fluids is the best way to control incontinence. Restricting fluids may be not only be dangerous, but could aggravate the problem. Decreased fluids can lead to constipation, which could contribute to incontinence, cause dehydration or make the urine concentrated, which can irritate the bladder.
It is recommended that you drink at least 50 ounces (six to seven 8-ounce glasses) of fluids spread throughout the day, as large volumes at one time can fill the bladder too quickly and lead to urgency. Fluid intake can be reduced after dinner to help prevent nighttime accidents.
Excessive weight can also contribute to incontinence by adding pressure to the abdominal area. Research indicates a five to 10 percent weight loss in individuals who are overweight may decrease urine leakage. If your Body Mass Index (BMI) is greater than 25, and your waist circumference is greater than 35", you are considered overweight (www.cdc.gov). Check with your physician on what your optimal weight should be for your height and begin a weight loss program (formal or on your own) to begin tackling those extra pounds. Each pound you lose can result in positive changes for managing your incontinence, as well as help in warding off other obesity-related diseases.
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