Ask an Expert: Controlling Urge Incontinence

Q: "You know how when little kids realize they need to go to the bathroom, it needs to be now? I've become that way: I need to go often, and there's no delaying – otherwise I end up with an adult version of 'an accident.' I'm afraid of ever being very far from a restroom! Am I stuck with this for the rest of my life?"

Answer from Nancy H. Sullivan, CNM, MS:

It's so good you are asking, because you can improve or even resolve this problem, and the sooner you deal with it, the better.

The medical term for involuntary loss of urine is "urinary incontinence," and there are a several types. You are describing urge incontinence, sometimes called an overactive bladder. Normally, the bladder muscle contracts when your bladder is full, which signals it's time to urinate. With urge incontinence, the detrusor contracts randomly, creating this urge even when the bladder is far from full.

Unless you short-circuit this false urge, the bladder will start emptying. And with urge incontinence, the bladder frequently empties completely once the process starts, leading to the accidents you describe.

Overcoming bad habits
Your bladder can be overactive for any one of a number of reasons: a temporary problem such as a bladder infection, a major illness such as Parkinson's or diabetes or bad bladder habits that you can learn to overcome.

Bladder training is the first line of treatment to turn around these bad habits. Bladder training involves learning to overpower the urgent urge to urinate. This enables you to regain control of your bladder so it's not controlling you. Give yourself six to eight weeks to accomplish this.

A few prescription medicines are also available, two in pill form and one in a patch. They work to relax the smooth muscles that line the bladder. Like all medications, they have side effects. Unless your situation is complicated by other health concerns, it's best to begin with bladder training.

A very new option is an implantable medical device that stimulates the sacral nerves that control the bladder. This procedure is reserved for stubborn cases that do not respond to bladder training or medication.

Bladder boot camp
Most people go to the bathroom five or six times a day. With urge incontinence, you may be voiding every hour or even more frequently. Your goal is to void every three or four hours. Over time, you'll achieve this by a) overcoming the immediate urge to urinate and b) gradually stretching your bladder. A typical bladder can comfortably hold about two cups of urine.

Here's how to work with your bladder to make it behave. (Follow these steps during the day; at night, just get up and go to the bathroom.)

1. Do not rush to the bathroom. When you dash to the bathroom at the first, premature urge, you lose the ability to make the urge go away. Note: "Premature" means you've gone to the bathroom within the previous two hours and you haven't drunk something that over-stimulates the bladder or is a diuretic. If you have a cup of coffee, for example, you can't wait two hours!

2. Instead, immediately squeeze your pelvic floor muscles. You may know this as Kegel exercises. If you need a refresher on Kegels, go to the American Physical Therapy Association (APTA) web site. Squeezing your pelvic floor muscles enables your body to overcome the errant contraction. The urge to urinate will peak and then subside in about a minute.

3. Make a choice. If you can only hold it another couple of minutes, that's OK. Calmly walk to the bathroom and go. You are in control. Or check the clock and try to hold off. The goal is void no more than every three hours. You'll need to gradually work your way to this mark. For example, if you're voiding every hour, first work on extending to every 90 minutes. If you're voiding every half hour, initially work your way to 45 minutes.

4. Stay aware. As you stretch your bladder and learn to overcome random contractions, keep with the program. Practice Kegels. Avoid foods and beverages that irritate your bladder.

Here are some other points to help you achieve a healthy bladder:

Limit your irritants.
You may decide your that your morning cup of coffee or tea, or your caffeinated soft drink is worth it to clear your head and get your bowels moving. That's OK; but limit yourself to just one.

Drink but don't drown.
The advice to drink lots of water has flooded our culture. That's fine for most people, but it's too much if you have bladder problems. Don't push yourself to down a gallon of water a day. Unless you are working outside in the heat, four or five glasses of water or other non-caffeinated, non-sugared drinks a day are enough. What goes in must come out. Milkshakes, soup, Popsicles and watermelon all count as liquids. It's natural to have to go to the bathroom afterwards. Liquids take anywhere from 20 minutes to a few hours to work their way to your bladder, depending on several factors such as the type of fluid, the health of your kidneys and your blood pressure.

Other factors can be involved.
Diabetes, dementia and neurological problems such as Parkinson's can lead to urge incontinence. Put aside any embarrassment you may feel and discuss your situation with your health care provider.

Study up.
I recommend two terrific books, one is "The Urinary Incontinence Sourcebook," by Diane K. Newman. The other is "Women's Waterworks, Curing Incontinence," by Pauline Chiarelli, Ph.D.