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Sufferers can find bladder control treatment

Janet Reiss has an embarrassing problem. For most of her adult life she has lived with an uncontrollable urge to go to the bathroom frequently. “There were times where I could literally go every ten or fifteen minutes,” Reiss says. “There were days when I could have gone to the bathroom, come back into the family room, and five minutes later felt like I could go again.”

A COMMON DISORDER

Urologists like Dr. Stuart Chalfin, MD see lots of patients like Reiss. One in ten women over the age of 65 suffer from a sub-category of incontinence called frequency/urgency syndrome. “It’s very miserable to live with,” says Dr. Chalfin. “You begin to gravitate around the bathroom, and you begin to center your life around the bathroom.”

DIFFERENT DISORDERS

Frequency/urgency syndrome, (also known as overactive, unstable, uninhibited, irritable, or hyperactive bladder), is categorized as urge incontinence. It includes a neurological component. Stroke, Parkinson’s disease, multiple sclerosis, other illnesses, along with old age, can damage the central nervous system, affecting control over urination or “voiding.”

Stress incontinence, the most common form of incontinence, is the involuntary loss of urine due to pressure on the abdomen from coughing, sneezing, lifting, or walking. It occurs mostly in older women. “It is structural as opposed to neurological,” says Dr. Chalfin.

Any form of incontinence is treated in a ladder approach, with the most conservative methods employed first, followed progressively by at step up to more serious treatments, surgery being among the most invasive.

EMBARRASSING PROBLEM

One of the biggest problems about incontinence is that so many sufferers fail to seek treatment, either because of embarrassment or because they mistakenly believe that effective treatments don’t exist. The odor (in some cases), the constant bathroom trips, and the feeling of having to stay housebound, can contribute to clinical depression. To address the situation, the American Urological Association and related organizations have launched long term public awareness efforts in recent years.

Most sufferers can hold their urine until they can make it to the bathroom, but for those who too often find themselves in a predicament--in traffic with no restroom in sight, for instance--adult diapers are often the only alternative.

CURING INFECTION

Treating frequency/urgency syndrome can involve medication, especially in cases where there is inflammation from various diseases. Muscle relaxants like oxybutynin chloride can slow the urge to urinate.

REGAINING CONTROL

Severe cases can lead to surgery. In recent years more natural alternatives have been emphasized which, studies show, work for the majority of patients. One behavioral approach uses biofeedback to teach women exercises to strengthen the muscles involved with bladder and urinary control. Physical therapist Teresa Cramer employs the method, using what are known as Kegel exercises, with her clients in order to build up the pelvic muscles. “It gives them a better understanding of the muscles that are so much deeper and something they can’t see and they can’t really feel,” says Cramer.

CENTRAL NERVOUS SYSTEM

The physical therapy also involves breathing exercises that calm the central nervous system which is the major culprit in this syndrome. Patients are given a strict schedule for going to the bathroom. The method is usually successful. In six to eight sessions, most patients like Reiss actually reclaim control over their body. “Sometimes I get the urge, but what she taught me was to ignore it, and it would go away, and it does,” says Reiss. “The span between visits to use the bathroom increased quite a bit, from every hour to maybe between two and a half to three and a half hours,” she says.

Physical therapy involving biofeedback costs between $60 and $100 dollars and is often covered by insurance. It is estimated that direct costs for incontinence in the United States total $11.2 million dollars among people living at home and $5.2 million among nursing home residents.

ELECTRICAL STIMULATION

For patients who can’t find relief with conservative measures there is another option called electrical stimulation, a subspecialty within urology. According to Dr. Chalfin, this method is based on the fact that “perhaps some the patients where we thought the bladder was the culprit, the culprit is really in the central nervous system.”

A pacemaker-like device is implanted under the skin, which sends electrical signals to correct the neurological malfunction and calm the bladder. “When you send input into the central nervous system, you block these reflexes via a complex mechanism,” he says. “You send that electricity to the areas where these reflexes are working and it’s like a switch that turns off. That reflex can not function; it cannot be hyperactive anymore.”

On the physiological level, the advantages of biofeedback retraining, physical therapy, and neurostimulation is that the pelvic floor--the muscles that support the bladder and close the sphincters--is calmed and the spasticity that triggers the desire to urinate is removed. Says Dr. Chalfin, “You’re treating more than the source of the problem, whereas the drugs only treat the bladder and not other organs that are present in the pelvis.

DIETARY CHANGES

Since certain foods can make incontinence worse, sufferers are urged to avoid foods high in potassium like bananas, citrus fruits, tomatoes, and spicy foods. “Foods that are rich in potassium are very irritating to linings that are not functioning well,” says the San Diego-based doctor.

While Janet Reiss misses some of her favorite foods, gaining back control over such an important bodily function has been worth the sacrifice. “For me to go two and a half to three and a half hours is a big difference from between fifteen minutes to an hour,” she says.