Mrs. B. started having a leaky bladder after her third child, notably whenever she laughed heartily. The problem worsened as she aged, and by the time she was in her 60’s, she was wearing a pad purchased at the local pharmacy. Mrs. B. finally came in to the doctor for help and asked about medicines she had seen advertised on TV and in magazines that promised to help prevent incontinence. The doctor first referred her to physical therapy to help her learn pelvic muscle exercises and, after a second patient plea, also prescribed the medication requested. The patient didn’t do the exercises but took the medicine which was quite expensive. Over the next three months she noted some minimal improvement with leaky bladder, but she still needed pads, and she began experiencing other problems. They were side effects of her incontinence medication and included constipation, dry eyes and mouth, blurry vision, insomnia, headaches, and depression. She had also recently fallen several times.
This is not an uncommon story. About one third of all women over 60 experience some level of urinary incontinence; this is twice as often as in men. Incontinence in women is generally the result of previous pelvic surgery, childbirth, and/or menopause. In men, it is generally the result of benign or malignant prostate growth blocking the urethra and bladder exit, which can cause an over-expansion of the bladder. If the dilation persists for too long, this, in turn, can cause loss of bladder contracting strength and worsen the incontinence problem.
In men, it is important to remove the blockage by either shrinking the prostate with medication or surgically opening the pathway before the bladder is over-expanded for too long. In women, the medications are much less helpful and have safety issues, especially in older women. The best thing women can do is to start with pelvic floor muscle strengthening exercises and the sooner the better. Also, there are bladder training techniques, pelvic surgeries, and even bladder stimulation devices that can help. Experts advise slow tightening and relaxing the pelvic floor muscles 200 times a day . . . whenever you think of it. An excellent reminder is to make it a habit of tightening the pelvis whenever you smile, and smile often. That would help women and men alike.
Bottom line: especially in women, medications for incontinence are often only marginally helpful and carry with them hefty side effects and cost. Pelvic floor muscle strengthening exercises are more effective than meds, without side effects, inexpensive, and underutilized. Do it with a smile so you can laugh without worry.