PRESCRIPTIONS
3 options work best for those with urinary incontinence
By Landis Lum
Q. I leak urine when coughing or getting up from a chair, and even when I just hear the sound of running water — it's so embarrassing! Is there anything I can do about it?
A. This query is so apropos, as it's Women's Health Month, and up to half of women have urinary incontinence, often after childbirth. Sometimes the problem occurs accidentally, either after coughing or sneezing (stress incontinence) or with putting hands in water, or simply out of the blue (urge incontinence). About 50 percent of women coming to their family doctor will have stress incontinence, 10 percent urge incontinence, and 40 percent have both. It can cause isolation and depression, and can lead to falls and even hip fractures. It is also often seen with prostate enlargement or after surgery in men.
And we're all so ashamed to tell our doctors. But we should, as there are effective treatments. The three best are pelvic floor muscle (Kegel) exercises, biofeedback, and open colposuspension surgery.
"It has taken the fear out of my daily life. I have gone from a feeling of helplessness to a feeling of encouragement. I no longer have the shame of accidents." So said Concetta, a 59-year-old woman, after learning Kegel exercises at the Physical Therapy Continence Program at Kaiser's Honolulu Clinic. There, she learned how to properly contract the right pelvic muscles and thereby strengthen the sphincter, or valve, that prevents urine from leaking out.
It's not that easy — one study found that one fourth of women "taught" Kegels were actually contracting the wrong muscles! And these exercises must be performed regularly.
Therapist Christina Yeh says 10 to 20 contractions three times a day is a typical "prescription," and that after good control is achieved, 10 to 20 contractions a day may suffice.
Other places in town with specially trained continence therapists (and biofeedback capability) are Fukuji and Lum Physical Therapy and the Kapi'olani Women's Center. HMSA and Medicare cover it.
"I found the therapy very helpful ... Seeing the biofeedback from the computer and the encouragement of the therapist was very helpful," said Helen, another Continence Program success. Helen could see graphs of her own muscle contractions to see if she was contracting the right muscles, and saw she was getting stronger each week. But like Concetta, she also needed to continue these exercises at home. Queen's and Straub can also do biofeedback.
So overcome your shame, get help and get your freedom back! Men, too!
Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; ohana@honoluluadvertiser.com; or fax 535-8170. This column is for information only; consult your health provider for medical advice. Articles and photos submitted may be published or distributed in print, electronic or other forms.
