If you rush to the bathroom, but don’t quite make it, you are not alone. About 3.3 million Canadians experience some degree of incontinence, although even this is only an estimate because many people don’t admit to incontinence or just accept it as a normal part of aging.
The two most common types of incontinence are stress and urge.
In stress incontinence, the leakage of urine is caused by a sudden pressure like a sneeze or a laugh, or a weakening of muscles so they in turn keep the bladder from emptying.
Pregnancy, older age, menopause in women, and prostate problems in men account for most cases.
Urge incontinence (or overactive bladder) happens when you have the urge to go to the bathroom, but just don’t make it. With age, urge incontinence becomes more common.
You shouldn’t ignore incontinence. There may be an underlying cause that can be corrected.
Urinary tract infections, kidney stones, prostate problems, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and even diabetes may cause urinary problems. If the condition cannot be remedied, good control of it will reduce incontinence.
A variety of drugs are available to treat incontinence. The most-often-used drugs are the alpha blockers. They do just what their name suggests: blocking alpha receptors in the detrustor muscle which sits above the bladder.
When the detrustor muscle contracts, it causes the bladder to empty. But with less muscle activity, the bladder doesn’t empty as readily.
You may be familiar with some of these drugs, for example tolterodine, oxybutynin, solifenacin, fesoterodine. There are extended-release formulations that need only to be taken once a day, and if one fails, trying another may work.
Unfortunately, side effects can limit their use, for example urinary retention, dry mouth, changes in your eyesight, or constipation.
The newest drug which is indicated for overactive bladder is mirabegron. It is a beta 3 receptor antagonist, which means it directly inhibits nerves in the bladder smooth muscle. The result is relaxed bladder smooth muscle which is then less likely to cause a wetting accident.
As with any drug, side effects may limit its use, for example headache, blurred vision, tiredness, dry mouth, constipation, or diarrhea.
Often, drug treatment is not successful. Side effects may mean you stop the medication or alternatively you may have another condition or take another medication that means you cannot take the incontinence drug. Or, you may not feel that the drug treatment is effective because you still have symptoms.
Some estimates place drug discontinuation rates for incontinence at 50 per cent within the first year of use.
Obviously, non-drug approaches to incontinence play a major role, with or without medication. Try keeping a “bathroom” diary to help you identify any activities, foods, or drugs that contribute to incontinence. Then avoid them.
Weight loss and smoking cessation can both help reduce symptoms. Developing good toilet habits such as regular toilet times will help train your bladder. Strengthen your bladder muscles with Kegel exercises, and don’t forget that there are a variety of discreet pads and briefs.
Incontinence may mean you need to rush to the bathroom, but it shouldn’t confine you to your home.