Women’s Urinary Incontinence: How to Cope with Medication Side Effects

Medication is one of the foremost conservative therapies for treating women’s urinary incontinence, and yet the number of women who will actually take–and keep taking–medication for their urinary incontinence is shockingly low. Many women will start on medication but fail to continue taking it.

This is surprising since medication has been shown to be an effective form of therapy for women’s urinary incontinence. For instance, in cases of urinary urgency, antimuscarinic medication is effective in reducing wetting accidents by about two-thirds. That is quite a high rate of success for a conservative therapy!

So why don’t more women keep taking medication for their urinary incontinence? Two reasons: lack of initial effectiveness and side effects.

Why Medication Doesn’t Always “Work” for Women’s Urinary  Incontinence
The first and most immediate reason women fail to keep taking medication for their urinary incontinence is because they feel that the medication “doesn’t work.” It turns out that these women are somewhat justified in their feelings. For most women with urinary incontinence, medication can often significantly improve symptoms, but most often will not completely “cure” urinary leakage. Most women will experience a significant reduction of urinary leakage accidents, but only when the appropriate medication is taken.

If you have decided to work with your doctor to find a medication to alleviate your urinary incontinence symptoms, know that the first–or even second–type of medication you try may not prove immediately effective. You and your doctor may need to experiment with a number of different medications before you find one that produces noticeable reductions in your urinary leakage and urinary urgency symptoms. Knowing this ahead of time will allow you to be patient during the “trial and error” process.

In addition, since medication alone does not usually produce a strong enough effect, you may work with your doctor to create a customized conservative therapy plan that combines a number of types of therapy. For instance, many women find success in combining medication with weight loss, pelvic floor retraining, bladder retraining, and/or diet modification. Be patient … and persevere!

Coping with the Side Effects of Medication for Women’s Urinary Incontinence
The second reason that women stop taking medications for urinary incontinence, even if the medications prove effective, is because the side effects outweigh the benefits. The most common side effects from medications prescribed for women’s urinary incontinence include:

  • dry mouth
  • drowsiness
  • skin irritation from gels or patches

Dry mouth is the most common side effect from these medications. Fortunately, with a little planning you can alleviate this side effect. Try sucking on sugar free candies, rinsing your mouth, chewing sugar-free gum, or taking small sips of water to lessen the feeling of dryness. You can also try spraying your mouth with over-the-counter forms of “artificial saliva.” Do not drink a large amount of water, as this may worsen your urinary incontinence symptoms.

With medications that cause drowsiness, try taking your medication dose at night. The medication will help you sleep, and may actually decrease nighttime urinary urgency (nocturia). If you experience skin irritation with patches and gels, try changing the location where the patch or gel is applied. If all else fails, change to the oral form of the medication.

By knowing and planning for the side effects of medication, you can actually prevent most side effects–or at least alleviate them enough so that the medication can be effective without becoming an irritant. As always, work with your doctor. Don’t be afraid to raise the issue of side effects, ask questions about prescribed medications, or ask for a different medication if your current medication isn’t working as well as you would like. Your doctor can’t help you unless he or she knows what is working for you and what isn’t. Be your own best health advocate and keep working with conservative therapies until you find a “recipe” that is right for you and your urinary incontinence symptoms!

If you enjoyed this post, we invite you to check out our book, leave a comment, contact us, download our free ebook, or interact with us on Twitter and Facebook.

 

Tired of Being Publicly Humiliated by Women’s Urinary Incontinence? Bladder Retraining Can Help

This blog is part 3 of an 11 article series of 11 New Year’s resolutions that actually work and WILL improve your pelvic health. Get the full list of all 11 New Year’s resolutions HERE.

Browse any online forum about women’s health, and you will likely come across the subject of women’s urinary incontinence. While other women’s health issues certainly have their own aspects of pain, the women posting in the urinary incontinence forum use some very strong phrases that definitely describe their pain and suffering. See if any of these adjectives resonate with you, especially when you suffer from a urinary leakage accident in public:

  • soooo embarrassed
  • terribly confused
  • hate that ‘wet pants’ look
  • humiliated in public … can never return to that store
  • everyone was staring … wished I could just disappear
  • detest owning 30 pairs of panties and carrying a good supply in public
  • feel so alone and isolated

If any of the above phrases ring a bell with you, especially the last one about ‘being alone,’ we know exactly how you feel. We also know, as a urologist and physical therapist specializing in women’s pelvic health, that you are most definitely not alone! We have helped many women with the exact same problem–and same kind of suffering–and helped them get past that humiliating public urine leakage accident.

That’s why we are writing this 11-part series on lifestyle changes that may significantly improve your urinary leakage issues. The key is to be persistent in your approach to relieving your symptoms. You can and should try some or all of the approaches discussed in this series. Some women respond well to one type of lifestyle change, while other women need a combination of multiple approaches before they see results. Finally, seek out a compassionate medical professional for a diagnosis and assistance.

In this article we talk about how to use a bladder diary so you can truly track your symptoms, since you can’t cure your urinary incontinence until you know specifics of your condition, down to the last detail. We then discuss how you can use bladder retraining, based on the information you learned from your bladder diary, as a conservative technique to relieve women’s urinary incontinence symptoms.

Keeping a Bladder Diary
The bladder diary (or voiding diary) is exactly what it sounds like: it is a record of your bladder habits. You may think you know absolutely everything about your condition, but when you start keeping a bladder diary, you may be surprised. Many women fail to notice crucial details of their urinary habits, and are surprised at how often they need to urinate, how many times a day they have strong urges, or the amount of water they drink. Most of these details fall by the wayside when there is a humiliating public leakage accident, or are simply filed under the category of “that happens a lot.” With a bladder diary, you will discover just how much is “a lot.” You will need these details so you can design a bladder retraining program that is customized to your unique condition.

To keep a bladder diary, simply track the following for a minimum of a week:

  • when, how much, and what kinds of fluids you drink (all fluids, especially caffeinated fluids)
  • when and how many times you urinate during the day
  • when and how many times a day you experience strong urges to urinate, whether you urinate or leak urine
  • how many times a day you experience leakage and how much you leak
  • the triggers that cause you to leak urine or experience strong urges (such as coughing or sneezing, hearing the sound of running water, or lying in bed)

Also record any other health issues you experience, even if you think they are not related to your urinary incontinence. Your doctor will want to know about these, as some may be caused by medications you take for other health conditions, or other lifestyle issues. Once you have at least a week’s worth of data, proceed to the next step: designing your customized bladder retraining program.

Designing Your Custom Bladder Retraining Program
Just as not all women start doing Kegels with the same level of intensity, your bladder retraining program should also be customized to your specific needs. A custom Kegel program is based on a woman’s current level of pelvic floor muscle fitness, including how long she can hold a correct contraction plus how many repetitions she can do. Your custom bladder retraining program will be based on how long your bladder can hold urine before you must urinate or have a leakage accident.

Bladder retraining is most effective if you have urge urinary incontinence (also called overactive bladder or OAB) or mixed urinary incontinence. The goal of this conservative therapy is to learn to delay your urination after you get the urge to urinate. Bladder retraining does work. According to the American Academy of Family Physicians, women who practice this method notice the following improvements:

  • increased amount of urine the bladder can hold
  • better control over the urge to urinate
  • more time (or delay) between bathroom visits

These improvements can definitely help prevent those embarrassing public leakage accidents. What’s even better is that bladder retraining is not a difficult technique to learn or use. Simply use the following steps to start retraining your bladder today.

1. Determine Your Urination Interval
The goal of bladder retraining is to delay your trips to the bathroom to urinate so that you urinate once every two to three hours during the day (this is considered a “normal” voiding interval). If possible, bladder retraining should also help you avoid trips to the bathroom at night so you can experience uninterrupted sleep until morning. In short, bladder retraining gives you control of your bladder by having you urinate on a schedule.

Before you can set a schedule, you need to first determine the current interval between trips to the bathroom to urinate. For most women we recommend setting the interval at one-and-a-half hours. However some women cannot hold their urine for this long in the beginning. To determine your customized interval, look through your bladder diary and calculate the average amount of time between trips to the bathroom. You will use this average interval in the next step.

2. Increase Your Urination Interval with Timed Voiding
Once you have this average, add 5 to 10 minutes to this interval to arrive at your starting interval. For instance, if your bladder diary tells you that your average interval is normally 45 minutes, set your starting interval at 50 or 55 minutes. That means you will attempt to hold your urine and avoid trips to the bathroom for 50 to 55 minutes. Once the interval has ended, go to the bathroom and urinate, whether you need to or not. This process is called timed voiding, and is the basic technique behind bladder retraining. This process trains your bladder to release urine only when you choose, according to your own schedule.

Most women need to set a timer, especially at the beginning, to remind them when the interval has ended. If you feel the urge to urinate before the interval is complete, try one or more of these techniques to delay urination:

  • relax and breathe in a deliberate manner
  • sit quietly, avoid moving or fidgeting
  • visualize a tranquil scene (without water)
  • think about another topic to distract your attention
  • do a series of Kegels if you know you can do a correct contraction

If you still cannot hold your urine until the interval is over, don’t worry. Run for the bathroom. When you return, reset your timer and start again. Bladder retraining, like any learned technique, takes practice so don’t worry if you can’t make it to the end of the interval the first few times. Once you are able to consistently hold your urine during your chosen interval, stretch the interval by 5 to 10 minutes at a time until you reach the goal of two to three hours.

3. Once in the Bathroom Empty Your Bladder Completely
One of the keys to successful bladder retraining is to empty your bladder completely when you do finally urinate. Some women do not fully empty their bladders when they urinate, and this can interfere with the success of bladder retraining. To ensure that your bladder is completely empty, urinate until you feel your bladder is empty. Wait 10 seconds, and then lean forward. Try to urinate again. You may be surprised by the amount of urine that was still in your bladder. By leaning forward, you change the angle of your pelvic organs, especially the bladder neck, which allows any remaining urine to be released.

Coping with Women’s Urinary Incontinence Requires Patience and Persistence
Patience and persistence are the two “P’s” of success when coping with this humiliating, embarrassing, and downright inconvenient condition. As you commence your bladder retraining program, practice both patience and persistence. Be patient with yourself when you don’t make the interval or continue to suffer from leakage accidents. Retraining takes practice. Be persistent, as well. Stick to your voiding schedule like clockwork. We suggest you stick with your bladder retraining program for at least 40 days.

Continue logging your results in your bladder diary. Your bladder diary will help you notice even minor improvements in bladder control, and these changes should be celebrated! Any increase in bladder control is worth the effort that goes into a bladder retraining program. Also remember that bladder retraining is only one of many conservative therapies for women’s urinary incontinence. If bladder retraining doesn’t relieve your symptoms to your satisfaction, consider trying a combination of therapies (read all about them in this complete guide).

If you enjoyed this post, we invite you to check out our book, leave a comment, contact us, download our free ebook, or interact with us on Twitter and Facebook.

 

Did You Know Your Ankle Bone is Connected to Your Bladder?

For those of you familiar with the song “Dry Bones” by the Delta Rhythm Boys, this may sound pretty funny! After all, the song never mentions the bladder. In fact, the song is all about bones and has lyrics more like this:

“Well, your toe bone connected to your foot bone
Your foot bone connected to your heel bone
Your heel bone connected to your ankle bone
Your ankle bone connected to your leg bone
Your leg bone connected to your knee bone
Your knee bone connected to your thigh bone
Your thigh bone connected to your hip bone
Your hip bone connected to your back bone”

You’ll notice that this song is all about bones … not a single mention of the bladder at all. But for women with urinary incontinence, you could say that the ankle bone is connected (sort of) to the bladder. Really!

Women’s Urinary Incontinence: The Ankle Bone and the Bladder
By now you are probably wondering what we’re talking about when we connect the ankle bone to the bladder. It turns out that there is a nerve in your body, called the percutaneous tibial nerve, that is located just above your ankle bone. This nerve is part of the nervous system that controls the action of your bladder. By using a therapy called percutaneous tibial nerve stimulation, which sends a gentle electrical current into the nerve, doctors have been able to alleviate symptoms for women with overactive bladder or urge urinary incontinence.

More About Percutaneous Tibial Nerve Stimulation
This conservative therapy is a wonderful option for women with overactive bladder or urge incontinence, especially those women who have not had much luck with behavior modification or drug therapy. Usually performed by a urologist, this therapy can also be delivered by nurses or physician assistants who have received the appropriate training.

For the procedure, your doctor will have you elevate your leg while in a sitting position. A very fine needle is then inserted just above the ankle bone into the percutaneous tibial nerve. A mild electric current is delivered via this needle for 30 to 60 minutes per session. Don’t be surprised if your toes or foot flex gently during the treatment as this is perfectly normal. You may also feel a mild tingling sensation in your foot or around your ankle. Most doctors recommend four treatments per week, with the total therapy lasting between eight and twelve weeks.

Two studies (the OrBIT trial and the SUMiT trial) have shown that tibial nerve stimulation is effective in decreasing the frequency of urination by 20% in women who need to urinate at least eight times every 24 hours. In addition, women report a 36% reduction of the severity of their symptoms, as well as a 34% improvement in the quality of life. Other improvements as a result of this therapy include reductions in urinary leakage accidents, frequency, and urge. Those are pretty solid success rates, so if you have overactive bladder or urge incontinence, you may want to ask your doctor about this form of therapy.

So you see? The ankle bone is indeed connected to the bladder!

If you enjoyed this post, we invite you to leave a comment, contact us, download our free ebook, or interact with us on Twitter and Facebook.