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An expert answers questions about urinary incontinence

Even though many women (and men) suffer from it, urinary incontinence is still rather a taboo subject and doesn’t receive much attention. Jean-François Hermieu, urologist at the Bichat teaching hospital in Paris, answers those questions that you don’t dare to ask.

1. Do all types of urinary incontinence have the same cause?

Questions on incontinence
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Dr Jean-François Hermieu: No the causes of may be varied and there are three principal types of incontinence:

  • Stress incontinence, which is caused by weakness of the perineum and urinary sphincter muscles that keep the bladder closed. When these muscles can no longer fulfil their functions, an increase in abdominal pressure (coughing, sneezing, physical effort, laughing etc.) may lead to leakage of urine;
  • Urge incontinence, which is caused by disorderly bladder contractions and results in an uncontrolled and pressing need to urinate;
  • Mixed urinary incontinence, that is the combination of stress incontinence and unstable bladder activity.

2. Doesn’t incontinence only affect elderly people?

Dr Jean-François Hermieu: By no means! Anybody can suffer from urinary incontinence, from bedwetting young children through to young adults aged 20 to 30, most of who have bladder urge incontinence, and elderly people. At specific times in their lives, women are especially susceptible to incontinence.

Childbirth may for example put a lot of strain on the perineum. Most of the time, women just need to get a little retraining to reduce post-partum urinary incontinence. Another high-risk stage of life is menopause due to hormone deficiency. Elderly people are also especially prone to incontinence owing to aging tissues, bladder and muscles, more particularly the sphincter muscles. The blame may also lie with other factors, such as neurological diseases and medications that disrupt bladder control.

3. Is incontinence a common condition, or am I an exception?

Dr Jean-François Hermieu: Incontinence is anything but an isolated phenomenon. An estimated 6 million UK adults and 500,000 UK children suffer from urinary incontinence. Yet this subject remains very much taboo and has long been conveniently dismissed as untreatable. However, thanks to the information circulated by the media and personal experiences shared on health-related forums, things are changing. There are now solutions to these problems, thus it’s essential to talk about it.

4. I can’t seem to control myself. Many times I’ve come dangerously close to wetting myself and have made it home just in the nick of time. Why does this happen to me?

Dr Jean-François Hermieu: This situation is referred to in medical parlance as “the keylock syndrome” or “the doormat syndrome”. As soon as you get to the door of you house, you have a reflex of contracting your bladder, which therefore empties itself. This may also be triggered by other situations, such as the falling of the rain, putting one’s hands into a cold liquid, the sound of water flowing and so forth.

The best way to avoid this problem is to urinate regularly, which also diminishes risks of urinary infection, and to empty the entire contents of your bladder. The worst thing you can do is urinating only twice a day, in the morning before going to work and in the evening when you’re back home. Prolonged perineum contraction often makes it possible to lessen or remove the need to urinate.

5. Lately, my girlfriend has been feeling urgent needs to urinate. Leakage can occur at any time and she says she can’t hold it back. Can you help her?

Dr Jean-François Hermieu: This pressing need to urinate is characteristic of urge incontinence. It can happen in a variety of situations: after sensory stimulation (water, cold etc.), under specific psychological circumstances (stress for instance), or emotional situations (uncontrollable laughter, fright, orgasm etc.) This type of bladder hyperactivity is most common in young women and rarely results from other underlying conditions.

Men tend to have retention rather than leakage problems. In a majority of cases, men with urinary issues should see a urologist as these problems might be traceable to organic dysfunctions (mainly prostate problems).

6. Is incontinence really preventable?

Dr Jean-François Hermieu: Many urinary incontinence problems are attributable to poor urination habits such as holding back urine too often or for too long, or going to the toilet too frequently. This can start at school age with young children reluctant to go to the toilet on accounts of poor cleanliness standards or because they fear being poked fun at. The problem is, they’ll try to urinate very quickly, in an incomplete and uncomfortable way, which is unhealthy for their bladders.

An ideal way of treating incontinence is to use a urination log, in which the patient is asked to set down the amount of liquid consumed, the number of visits to the bathroom and the quantity of urine passed over a specific time period. This log will then be used to prescribe a case-specific treatment for the patient.

7. After childbirth, I was advised to interrupt urination by intervals in an effort to control it, but since then I’ve read about this being an unsafe practice. What’s the truth?

Dr Jean-François Hermieu: This is a bad habit and you should by all means give it up. While this may be interesting to ‘tone up’ the perineum, the act of urinating, stopping and resuming the flow of urine is harmful to the bladder. It prevents complete and uninterrupted voiding of the bladder, which is detrimental to the urination mechanism.

8. Due to incontinence, I’ve been advised to stop drinking tea and coffee. Are such dietary recommendations really effective?

Dr Jean-François Hermieu: The most beneficial lifestyle factors would be not to hold back urine and to urinate regularly with the purpose of “educating” your bladder. Certain foods do have a stimulating effect on the bladder: coffee and tea, but also white wine, champagne, pepper, hot pepper and spices. These should be consumed in limited amounts if you have urinary incontinence problems.

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Posted 20.12.2010


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