Dr. Cecile Storrie received her medical degree from the University of Texas Health Science Center at San Antonio Medical School in 1985. She completed her urology residency at Oklahoma University Health Sciences Center in Oklahoma City in 1990 and has since been in private practice in the suburban Dallas area. Dr. Storrie is board-certified in urology. She has been active in clinical drug research since 1997, and she especially enjoys participating in urology studies.

Help Your Incontinence Today!

Believe it or not, our behavior in large part determines how well our bladders keep urine inside.  And so do other factors we can control, such as diet,  constipation, menopause, urinary tract infection (UTI), chronic coughing associated with cigarette smoking or respiratory disease, and obesity.

How does our behavior cause or worsen incontinence of any type?  In a nation obsessed with drinking 6 to 8 glasses of water per day, the answer is obvious to physicians who evaluate and treat incontinence: water in, water out. 

While drinking extra water may seem to dull the appetite or clear up skin blemishes, it is not vital to our health.  In fact, there already exists a mechanism to regulate our fluid balance perfectly; it's called thirst.  Sometimes we can't recall having had much to drink in the course of a day, yet don't seem thirsty.  It's because most of what we've put in our mouths is water.  For example, fruits and vegetables are 95% water, meat is 90% water, and even dried fruit is 20% water.

Much of our thirst can be satisfied without additional water, let alone other fluids such as coffee, tea, and soft drinks. Intentionally drinking extra fluids is unnecessary and can lead to incontinence.

Consider the woman who has committed to becoming "healthier" - promising herself that she'll down 6 to 8 glasses of water per day, but probably in addition to the tasty fluids to which she's accustomed: coffee at breakfast, diet soda in the afternoon, wine at dinner.

Her bladder becomes full much faster than is convenient for her schedule.  She ignores the urge to void (empty the bladder) and may eventually lose this sensation altogether. (Have you ever said to yourself, "A minute ago I had to go really badly, and now, I don't even feel it!") Finally, her bladder can't hold another drop and she has to go now!  Hurrying to the bathroom with a bladder "filled to the brim" is like running with a full bucket of water: Some of it sloshes out, no matter how careful you may be!

This "overflow incontinence" can be prevented by going easy on oral fluids (drink only when thirsty), never ignoring the urge to void, and voiding every 2 to 3 hours even if there is no natural urge to do so.

Some women believe that holding the urine in for prolonged periods makes the bladder "strong."  In truth, the muscular sac that makes up the bladder becomes thin and weak when stretched repeatedly to hold large volumes of urine.  This bladder loses sensation and won't notify its owner of impending fullness and the need to void, leading again, to overflow incontinence. 

This weak, tired bladder can also lose its ability to empty completely,  decreasing the space available to store urine.  So this woman must void often AND has overflow incontinence. When this situation is incorrectly diagnosed as "itty bitty bladder syndrome," the drugs typically prescribed can further weaken the bladder.  Don't let yourself get caught in the "bad bladder behavior" trap - void often, never ignore the urge, and drink only when thirsty.

As mentioned, drinking excessive fluids will worsen any type of incontinence because the bladder spends much of its time full. A bladder that never empties completely is always at risk for leakage.

Consider stress incontinence - when a physical stress, or force, is applied to the bladder and leakage results.  What provides the stress?  Usually it is the diaphragm, punching the abdominal organs with a cough or laugh, or pushing hard against the organs when lifting a heavy object or straining for a bowel movement.  The abdominal organs then push on the pelvic organs, including the bladder.  Extra weight - fat around the intestines, fat on the abdominal wall - push on the bladder, too. 

Repeated actions that result in force applied to the pelvic organs will eventually weaken the pelvic floor (muscles), which supports these organs.  Activities such as abdominal exercises, weight-lifting, chronic coughing or throat-clearing take a toll on the pelvic floor, causing it to sag, as do pregnancy, childbirth, and gravity.  Then, the poorly supported bladder will leak when its owner coughs or bends over, picks up a child, or moves about quickly while sporting extra pounds around the middle.

• Lessen the risk of incontinence by keeping the bladder empty (see suggestions for overflow incontinence). 
• Avoid stresses that precipitate leakage (e.g., give up smoking and the smoker's cough).
• Avoid activities that weaken the supporting pelvic floor (control constipation to avoid straining for bowel movements, treat respiratory illness which results in coughing, avoid weight-lifting and abdominal exercises, etc.).

Even when the pelvic muscles are weakened and stress incontinence results, some effort can be made to strengthen the pelvic floor to provide better support and lessen incontinence.  Just like the weightlifter who develops bulky muscles from working out, the woman who practices "Kegel" exercises can strengthen her pelvic floor.  While descriptions may differ, the Kegel is a procedure where one squeezes the pelvic floor for 10 seconds, rests for 10 seconds, and squeezes again.

Kegel exercises, when done properly and frequently enough, can help about 1 out of 3 patients with mild incontinence.  Because there are pitfalls, which render the exercise ineffective, it is best taught by the physician during pelvic examination to be sure it can be done correctly.

For some women, medicines can help reverse stress incontinence.  Drugs called "alpha stimulants" can make the bladder neck squeeze more tightly to prevent incontinence.  Newer, safer alpha stimulants are being developed in clinical trials right now. Estrogens, applied topically to the urethra (the exit tube from the bladder to the outside world) or taken orally, cause the walls of the urethra to close more completely, impeding the leakage of urine.

Another type of incontinence we can improve with behavior change is urge incontinence: A woman has the urge to void, followed by leakage that she is unable to hold back.  Urinary tract infection (UTI) is a common cause, and warrants investigating even if there are no other symptoms, such as pain with voiding.  Low levels of estrogen in a woman's bloodstream may also lead to urge incontinence.  Similarly, certain dietary excesses (artificial sweeteners, acidic foods, caffeine, alcohol, etc.) may be irritating to the bladder and lead to urgency and incontinence.  Rarely, a new-onset neurological disorder (such as spinal cord compression or multiple sclerosis) may be the culprit.  We should seek evaluation of urge incontinence, but medication should only be used after all causes, including "bad bladder behavior" are eliminated.

Stress incontinence, urge incontinence, overflow incontinence-- no matter the type, changing our behavior can help.  Proactive women can lessen or stop   incontinence altogether by going easy on fluids, voiding every 2 to 3 hours even if they have no urge to do so, and never ignoring the urge to void.   Becoming replete on estrogens, quitting smoking, preventing constipation, and losing weight are behaviors that really work, as may Kegel exercises when done properly.

Behavior modification, including seeking solutions, is often difficult and may not solve the problem of incontinence altogether.  The good news is that there are medicines available to help.  Especially promising are the newer alpha stimulants, being developed today for stress incontinence.

Lastly, what about surgery for incontinence?  Surgery is the most expensive treatment, in terms of risk and dollars.  Sometimes it may still be the best option, given certain circumstances.  But remember that holding the urine, challenging the bladder with large volumes, and weakening the pelvic floor via activities that do so merely continue to disrupt bladder function and may cause permanent damage which even surgery cannot repair.

For more information on incontinence, click here.

Created: 8/17/2002  -  Dr. Cecile Storrie