DEAR DR. GOTT: I’m an avid reader of your daily column and hope you can offer me some advice about an embarrassing subject. I am a woman, 49 years old, somewhat overweight, with two teenaged children, both born by natural methods. I’m taking no medications other than a daily multivitamin and I exercise regularly by walking daily.
I’ve noticed that my urgent need to urinate has intensified and that I leak frequently. I recently considered joining an exercise class but realized it would be out of the question because the impact of even some light dancing would cause me to wet my pants. I once discussed this with my doctor and she quickly wanted to prescribe a medicine for me. Since she didn’t offer me an explanation as to why this is happening and I did not know anything about the drug or its side effects, I declined the prescription. Now I’m wondering if I should have taken it. Your thoughts would be most appreciated.
DEAR READER: Good for you! First of all, you were dissatisfied because you didn’t get an answer as to why you experience urinary urgency. It was completely up to your physician to fully inform you of the possible reasons for your symptoms. She failed in this respect. Then, you didn’t know anything about the drug or its potential side effects. That, too, should have been a part of the office visit. Unless you gave her an extremely detailed analysis of what is going on and a urinalysis and/or lab work was performed, that particular medication might not have been appropriate. I wholeheartedly commend you for taking the stand you did.
The possible reasons for urinary urgency are many, to include excessive hydration, some medications, a low-grade urinary tract infection, natural changes that occur within your body because of aging, bladder cancer or stones, a tumor, menopause, the consumption of caffeine, and more. I’ll briefly discuss each one mentioned.
We tend to drink more when it’s hot out or when we exercise. This can put a burden on the bladder. Urinary tract infections are common and can result in incontinence. Aging brings on a decrease in the capacity of the bladder to store urine. While you don’t indicate if you are going through perimenopause or menopause, you are likely producing less estrogen than you previously did. With the decreased estrogen production, the tissues of the bladder may deteriorate and result in incontinence. Bladder cancer or stones and tumors can be present. They are often accompanied by pelvic pain and/or hematuria (blood in the urine). Caffeine acts as a diuretic. It stimulates the bladder, causing sudden urgency. Muscle relaxants, blood pressure and heart medications might be to blame. The habit of smoking, consuming alcohol and caffeine, being overweight, having a kidney disorder or diabetes may also contribute.
I recommend you visit an urologist who may choose to order a urinalysis, draw blood, order a post-void residual test that will simply measure your urine output to determine how much urine remains in your bladder, or even a pelvic ultrasound. There is more extensive testing beyond this; however, keep in mind that your problem, while frustrating and embarrassing, is only a symptom of something that may likely be corrected very simply. Ask your physician about anticholinergetics to calm an overactive bladder, or the use of topical estrogen to help rejuvenate the tissues of the urethra and vagina. There are even tricyclic antidepressants, a urethral insert or pessary that might be prescribed to treat urinary incontinence. The underlying cause must be discovered so appropriate steps can be taken for control.
I’m sure he or she will begin ruling out possibilities with the simplest of testing first. In the interim, you might perform Kegel exercises to strengthen your urinary sphincter and pelvic floor muscles. This is accomplished simply by squeezing the muscles you would use to stop your urinary flow. Hold for the count of three, relax, and then repeat for a few minutes two or three times a day. Wear a pad to protect yourself from embarrassment. There is hope and help.
Readers who would like related information can order my Health Report “Bladder & Urinary Tract Infections” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
