urinary_incontinence

How to Stop a Leaky Bladder

A new CDC report puts the percentage of seniors living independently who experience some degree of urinary incontinence at four in ten – and looking at women alone, at more than half.  If you’re not among them, you can do something now to minimize your risk of springing a leak as you age; if you are, you can do something, too. That’s why we’re republishing this article about insurance-covered programs and home exercises that work. It’s worth a read.

 

Tell the truth: Have you ever leaked urine (even a little) when you sneezed or laughed too hard? Bet you have.

As many as 29 percent of people ages 60 to 70,  most of them women, have the problem known as stress urinary incontinence. And as we age, it can grow more troubling.

If you’re like most people with SUI, you’re probably too embarrassed to talk about it with your doctor – much less a spouse or friend.

According to the National Association for Continence, women typically wait more than six years after their first symptoms appear before getting a diagnosis for a condition that can be managed at home or with the help of a professional.

A 15-Million-Woman Problem

Medical Images, Universal Images Group/Science Photo Library

Medical Images, Universal Images Group/Science Photo Library

SUI is common among older women because the strains and tears of childbirth along with the postmenopausal atrophy of genital tissues weaken our pelvic floor muscles.

These muscles stretch like a hammock from your pubic bone to your tail bone. They hold the bladder, uterus and rectum in place and maintain pressure on the urethra – the tiny tube that allows urine to pass from the bladder. When those muscles weaken, any abdominal pressure can cause a leak, whether it’s just an occasional trickle or a mortifying flood.

Insurance Covered Programs Use Biofeedback & Kegels

Don’t assume you’ll have to live with incontinence as just another part of aging.

In pelvic floor rehabilitation programs around the country, including those at NYU Langone Medical Center  and Columbia University Medical Center in New York City, as well as those offered by independent physical therapists, women are learning how to do Kegels and other home-based exercises that can stave off incontinence and stop it from getting worse. These six-week programs are mostly or totally covered by insurance or Medicare.

Done correctly, Kegel exercises can help strengthen pelvic floor muscles and reduce or even stop leakage.

Trouble is, many women don’t know how to Kegels – or do them the wrong way, Sandy Kleinhandler says. Kleinhandler is one of the nurses who teach women to do Kegels the right way at the pelvic floor rehab program run by gynecologist Steven R. Goldstein, MD at NYU Langone.

Like NYU’s program, most of those around the country have several components: Urodynamic testing – a painless 10 minute test to measure the capacity, pressure and strength of the bladder and supporting tissues, which helps diagnose specific incontinence problems; muscle evaluation and Kegel instruction aided by biofeedback; and electrical muscle stimulation to both strengthen muscles and aid Kegel instruction.

(To find a program near you, Google “pelvic floor rehab program” + your city.)

The entire process is no more intrusive than a pelvic exam and there’s no discomfort at all – trust us, we tried it.

The biofeedback helps teach you which muscles to contract and how to contract them. It involves a vaginal probe about the diameter of a thin tampon and small electrodes, which are placed on the lower abdomen.

While you recline on a GYN examining table, the probe is inserted, and its small balloon-like tip is inflated. You’re then prompted to do a series of five-second pelvic floor contractions followed by ten seconds of relaxation. A readout on a computer monitor shows which muscles you’re contracting, and how well and how hard.

“The trick is to relax and not get uptight. We’re used to ‘feeling’ strong muscle contractions when we exercise. But here you gently contract, not squeeze,” Kleinhandler explains.

If you’re doing your Kegels right, the green line showing contractions will be fairly steady; squeeze too hard and it will rise and fall. That’s the toughest part: learning how to contract the pelvic muscles (not your abdominals or buttock muscles) and maintain the contraction.

Another form of biofeedback assesses the strength of nerve-muscle messages and if they’re the right ones. Mild electrical stimulation can help locate and strengthen the right muscles. You’ll also be given some at-home exercises to practice.

Programs like this don’t promise to “cure” incontinence, but will produce an improvement in less leaks or accidents, Kleinhandler says. “Seven out of ten women, even those in their 60s and 70s, tell me they have improvement. They feel in control and can come home, take their coat off and walk to the bathroom without starting to leak.”

Like any other exercise program, the benefits aren’t immediate. With regular practice, it should take five to six weeks to “train” your pelvic floor muscles.

How important is the biofeedback part of the program? A 2011 study by the respected Cochrane Review compared pelvic floor therapy with biofeedback in 24 randomized trials. The researchers found that biofeedback provides additional benefits to pelvic floor muscle training.

But there are things you can do at home, too.

Home Exercises for Leaky Bladders

Visualization for Bladder Control

As well as biofeedback, Kleinhandler also teaches visualization, which patients do at home.

“Imagine your pelvic floor muscles and then visualize pulling up, as if you were using a zipper. Visualize drawing in those muscles as you pull the zipper up, but not pulling in your abdominals.” Or, she suggests, visualize pulling the strings of a drawstring purse at its neck.

If you practice Kegels lying in bed or on the floor, you can put your hands on your abdominals; you’ll feel them pull in if you’re not doing it right.

“Some women are told to do Kegels in the bathroom, trying to stop the flow of urine. But the flow and urge are stronger at the start and it’s hard for even a trained person to stop the flow. So it’s not the best place to practice,” she says.

Urge Suppression Diet

Kleinhandler also teaches “urge suppression” techniques and advises women on foods to avoid, since they can irritate the bladder:

  • Coffee, tea and cola drinks that contain caffeine.
  • Tomatoes and tomato products
  • Alcohol
  • Tobacco
  • Chocolate
  • Citrus fruits
  • Carbonated beverages
  • Artificial sweeteners.
  • Stimulants such as NoDoz

Urge Suppression Techniques 

Adapted from “Staying Dry: A Practical Guide to Bladder Control” by Kathryn L. Burgio, Johns Hopkins  Press.

When an urge strikes:

  1. Stop what you’re doing. Sit down, if possible, or stand quietly and remain still.
  2. Squeeze your pelvic floor muscles several times, but don’t fully rest in between contractions.
  3.  Relax your body, taking a few breaths.
  4. Wait until the urge passes.
  5. If it’s time to go to the bathroom, walk slowly to the toilet while you keep suppressing the urge. (Rushing may make you lose control of your bladder.)
  6. If it’s not time to “go,” continue to suppress the feelings of urgency with quick pelvic floor contractions until the feeling is gone. It will go away.

Home Devices for Kegels Available Online 

There are home devices you can buy over the Internet (for example, on Amazon) to help you learn and practice Kegels, but they are not covered by insurance.

  • Home biofeedback devices: These also measure contractions with a vaginal sensor and tell you if you’re doing Kegels correctly. Food and Drug Administration-approved systems (such as Myself or the PFX Pelvic Floor Exerciser) are available without prescription.
  • Vaginal weights: These range from $13 to $50. They come in various weights from 20 to 100 grams and in designs that vary from balls attached to a string, to colorful silicone cones or metal weights placed in a cone-shaped casing. The idea here is that if contracting the pelvic muscles builds muscle tone, contracting them against resistance (the vaginal weight) will help build muscle tone more effectively.

YouTube Videos for Kegels

You can find several videos on YouTube that purport to teach you Kegels. The series by Michele Fenway does a fairly good job. Watch Part 1 below and click here for the whole series.

 

At Home Exercises for Bladder Control

Basic Kegels (NYU Langone Medical Center)

  1. Sit comfortably with knees and feet slightly apart. Lean over. Resting your forearms on your knees. Relax and drop your head.
  2. Imaging you’re “passing wind” (or stopping the flow of urine), then slowly squeeze and lift the pelvic floor muscles up and in. Don’t use abdominal or thigh muscles to help.
  3. Relax. Breathe deeply. Let both front and back muscles go. Next trying squeezing from back to front. Concentrate on pulling pelvic muscle up and inward. Hold the contraction and then relax.
  4. Your initial goal is to hold the squeeze for 3-5 seconds, and relax another 3-5 seconds. Repeat 5-10 times during the day. Start with 50, then gradually increase to 100 a day.
  5. You can also do Kegels lying in bed, sitting down, or standing up at any time of day. Remember to breathe in and out.
  6. Try visualization to help.

 

What’s worked for you?

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