What works for Waterworks? Exercises, diet changes and behavioural techniques can all help alleviate incontinence Sometimes it seems like Lynn Lawson's bladder is throwing a tantrum like a two year-old -when she goes out in public, it will suddenly get down and start kicking the floor demanding to be released. It's as embarrassing and difficult to control as a real screaming toddler. "It got to the point where I couldn't even go out for a walk for 20 minutes without feeling like I had to find a washroom fairly often and fairly regularly," she says. Lawson (not her real last name) has incontinence. She isn't alone. Estimates vary, but many organizations say 25 per cent of women live with some degree of incontinence and seven per cent of women in Canada experience some form of moderate to severe leakage of urine on a daily basis. Lawson doesn't know any of them. Almost everyone, including Lawson, keeps this medical condition private. That is understandable but unfortunate, says pelvic floor physiotherapist Marcy Dayan, because people need to know they don't have to suffer. "What society needs to know is this is really common, and that it is treatable," Dayan says, adding that if everyone understood how common it is, businesses would probably be more compassionate about opening up their bathrooms to customers, friends would start sharing information with each other, and people would seek out treatment. As it is, living with untreated incontinence can be very debilitating, says Dayan. "People will map out toilet access before they leave the house. I have had people who won't dance because they leak when they dance. Or they stop running or stop playing tennis or stop golfing. It really affects people's quality of life." Lawson, who has a blend of incontinence symptoms, including leakage when she sneezes, laughs, coughs or lifts heavy objects, and the constant urge to empty her bladder, says she wouldn't go out unless she knew exactly where she could find washrooms. "I always knew where the washrooms were, and a lot of the time I would get to the washrooms and that would be okay, but then as soon as I'd leave I would have to turn around and go back in." Lawson took to wearing incontinence pads and always having replacements in her purse. Bladder issues dominated her thoughts.
"That is the point where I had to see if there was something I could do about it," she says. She saw her doctor, who referred her to a gynecologist who referred her to Dayan's clinic, which has three physiotherapists who deal exclusively with pelvic floor issues. There she learned to strengthen her bladder and pelvic floor muscles, how to calm her mind and bladder, and to eliminate foods that aggravated the sensitive organ. She has been going to the clinic every three weeks for three months, and no longer wears a pad when she goes out. "For the first time last week I actually went for a walk for an hour and a half and I felt absolutely nothing, which was unbelievable." "Incontinence is a condition, not a disease, and while the incidence increases with age, it is not a normal part of aging," says Dayan. "There is a lot more that people can do than just put on a pad," she says. Men get it too, and not just because of prostate problems. About 10 per cent of men have had incontinence unrelated to prostate issues at some point in their lives. Once you have it, it rarely goes away completely, but you can learn how to control it so that it no longer interferes with your life, Dayan says, adding that how you deal with it depends on the type of incontinence you have. IDENTIFYING THE PROBLEM There are two main types of urinary incontinence not caused by an underlying disease or medication: stress and urgency. People often have both. Those with stress incontinence leak when they are active. Depending of the severity, it could happen when they run, or jump or even walk. Fifty per cent of tennis players get it, so do 67 per cent of gymnasts and 85 per cent of trampoliners. For people with urge incontinence, the sensation of needing to urinate is overpowering. Sometimes certain places or sounds can trigger it. Running water is a common trigger, so is arriving home. Some experience it while trying on clothes in a store, others in a bank lineup. They frequently don't make it to the toilet in time. People with either type may also suffer with fecal incontinence, or gas incontinence. What Dayan finds discouraging is how many people accept the condition as a normal part of aging. They think of it as something they will just have to deal with. A 2003 study of all women found that nearly nine per cent of all respondents reported urinary incontinence, more than half of whom were below 55 years of age. Over half of the respondents had never consulted a physician about the condition. But sometimes, the treatment is very simple.
For example, people with urge incontinence have what is called an overactive bladder, which means that their bladder reacts to certain foods or drinks by going into spasms. Caffeine, carbonated drinks, alcohol, tomatoes, spinach, artificial sweeteners and citrus fruits all cause some bladders to react. "Caffeine gives you a double whammy because it's a diuretic so it gives you more urine, but it also affects the bladder muscle so when you have a little bit of urine in there it starts spasming rather than waiting to fill up." Often if a person eliminates the foods that their bladder reacts to, their problem disappears. "Coffee was definitely it for me," says Lawson. "I would drink three cups of coffee in the morning and have two cups of tea in afternoon. I have cut coffee almost out completely." Pelvic floor exercises called kegels also make a big difference for both stress and urge incontinence if done correctly. Unfortunately, studies show that 75 per cent of women don't do them correctly, even if given written or oral instructions. But with the help of a physiotherapist, 70 per cent of sufferers see improvement. For the remainder, a pessary can do the trick, at least for stress incontinence. "It's a vaginal orthotic," says Dayan. "It is inserted into the vagina and it provides a little bit of back pressure against the urethra. When it's in place you can still void, but it assists the pelvic floor muscle to stop urine from leaking out." Women who feel the pressure all the time might wear the pessary all the time. Others use it only during high-impact activities or if they're on their feet a lot. Behavioural techniques help with the triggers those with urgency often have. Needing to pee as soon as you put the key in your front door has nothing to do with your bladder, says Dayan. "That has to do with your brain. Sort of like Pavlov's dog. People learn to pee when they hear running water, when they get close to home or when they pass a toilet." Clients are taught to stay calm when they feel the urge, to purposefully relax and then relax their bladder. They also practice gradually increasing the time they hold on after feeling the urge. "What it has done for me so far has just been incredible," says Lawson. "I think now I have the tools I need to keep improving. It is 95-per-cent better than it was before. "This is definitely a service that women should know about." ÂŠ Copyright (c) The Vancouver Sun