It might be that you no longer go to see a comedy at the movie theater for fear the laughter will cause an accident. Or you dream of vacationing in another country, but don't think you could make the long flight without the embarrassment of urinary incontinence.
Problems with incontinence, the loss of bladder control, are not gender specific. Both men and women can suffer from problems that end in leaking or wetting and interrupting the way you live and socialize.
Patients who suffer a stroke, have Parkinson's or other neurological problems such as multiple sclerosis can be impacted by incontinence at any age.
"There are all sorts of social aspects that make people seek treatment," says Dr. Dennis Pessis, past president of the American Urological Association and professor of urology at Rush University in Chicago.
There are different kinds of incontinence. Stress incontinence, Pessis says, is due to the weakening of the urethra muscles or when the related sphincter muscle loses its position. Both genders can suffer stress incontinence. This is when urine leaks during laughter, coughing, or during strenuous exercise, Pessis explains.
Urge incontinence, also a problem for men and women, involves the bladder muscles squeezing and contracting at the wrong times. There is also overflow incontinence in men and women when urine leaks from a too full bladder or from the bladder not fully emptying during urination.
Some urinary incontinence can be controlled with medication, surgery, exercises known as Kegels that can be done by both men and women to improve the pelvic floor muscles, and physical therapy for women. Women are more likely to suffer incontinence at an earlier age due to pregnancy and childbirth.
For men incontinence isn't typically seen until age 50 or older and is related to issues such as prostate enlargement or prostate cancer. This is overflow incontinence, Pessis says. Medication and surgery can help in these cases as well.
Most patients typically start with their general practitioner or gynecologist who can prescribe medications and exercises. If the problem does not correct or is a more serious issue they will be referred to an urologist for an assessment.
Medication and surgery are not always the answer. More and more women are becoming aware of the benefit of physical therapy with those specially trained to treat urinary incontinence, says Marianne Ryan, PT, OCS (orthopaedic physical therapist) and spokeswoman for the American Physical Therapy Association. Fewer people are aware that physical therapy treatment also helps with men who have incontinence.
The physical therapy available for incontinence is designed for both women and men and Ryan says the appointments take place in a private room and starts with a history, a thorough biomechanical evaluation, as well as finding out the severity of the problem.
Patients can expect an external evaluation that helps the PT see if there are any areas where alignment is off, muscle weakness in other areas, decreased flexibility or nerve issues from the back to the feet. Next is the internal evaluation that involves looking for muscle tenderness and pain through manual finger palpitation.
Patients often will have exercises to do at home and others may work on behavioral changes. Some behaviors could be something a patient is doing without realizing it such as holding their breath while lifting heavy objects or racing to the bathroom when it isn't necessary, Ryan explains.
Because obesity is the most common cause for incontinence, Ryan says a PT might suggest more movement and nutrition counseling as well.Ryan says she is seeing fewer patients who are embarrassed or uncomfortable talking about their incontinence.