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After all, who wants to admit they wet their pants; understanding urinary incontinence

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Urinary incontinence is one of the most common problems of aging. It instills, needlessly, the prospect of embarrassment and a fear of leaving the house. Comedians quip, “If you don’t know when you need to go, by the time you find out, you’ve already gone!” In fact, it’s no laughing matter when a sneeze, cough, or even just standing up causes urine suddenly to leak through your clothes.

Stress incontinence occurs when pressure in the urinary bladder is greater than the ability of the muscles to hold back the flow of urine. In men, it may be associated with aging, or the result of a radical prostatectomy for cancer of the prostate gland. For women, it’s often due to repeated pregnancies and the strain on pelvic muscles during labour.

Urge incontinence is the issue when you feel a sense of panic. “I’ve got to go quickly to urinate or I’m in trouble.” The sudden, intense urge to urinate is followed by an involuntary loss of urine. 

The risk factors include obesity, which increases pressure on the bladder and surrounding muscles, and smoking, where continually coughing exerts stress on pelvic muscles.

Constipation is another factor. Grunting and pushing with bowel movements of hard, compacted stools further injures pelvic muscles and causes nerves to become overactive, which increases the urge to urinate frequently. Taking 2,000 milligrams (mg) of vitamin C at bedtime triggers results. If it does not, increase to 4,000 the next night. Then eat a high fibre cereal and a hot drink in the morning. A bowel movement will follow. As a cardinal rule, don’t ruin your colon with laxatives.

Making changes in lifestyle can help to ease this problem. Decrease caffeine, alcohol and other diuretics. Stop smoking. Avoid acidic foods.

Remember dams that leak must be strengthened. So do exercises. Imagine trying to pick up a marble and hold it using the muscles in your pelvic floor. Do this eight times several times a day and continue daily for three months. Remember Rome wasn’t built in a day. This simple procedure usually improves incontinence as it bulks up pelvic muscles surrounding the urethra (the tube that carries urine to the outside) and helps to stop dribbling of urine.

If the muscles have become so weak that they fail to respond to this exercise your doctor may suggest electrical stimulation to trigger muscle response.

Artificial bulking agents made of biocompatible material are available to help improve urethral function. A cystoscope is inserted into the penis or vagina and the bulking agent is injected around the urethra. This may take two or three sessions to get the required result. But results are not as good in males who have had a radical prostatectomy.

If all this fails, surgery will be suggested. For women this usually means a vaginal operation, but some surgeons prefer an abdominal one. A sling operation is currently the most effective. The rationale behind this surgery is quite simple. By placing a sling under the urinary bladder, it will not only be lifted, but the procedure will also change the angle, decreasing the loss of urine.

For males with significant urinary incontinence that have had a radical prostatectomy, an artificial urinary valve can be inserted which closes the valve on a continual basis. A small pump implanted under the scrotum skin can open it.

Urinary incontinence is called a “closet problem.” After all, who wants to admit they wet their pants. But too many North Americans suffer from this disorder in silence when they should be getting help.

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Written by W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million.

His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!”

Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation.

Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health.

For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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