This month's newsletter is focused on incontinence. I hope that you find it educational and useful. If not interested, you can just delete the email or use the unsubscribe link at the bottom. 

Stress incontinence happens when physical movement or activity — such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine. Stress incontinence is not related to psychological stress. It is also the most common type of incontinence that affects younger women. 

Overactive bladder (OAB) is a “gotta go now” feeling. You have the urge to void even though your bladder isn't full. OAB can lead to a condition called urinary incontinence where you leak urine. 

Urgency incontinence is leaking after a sudden, strong urge to urinate that you cannot stop.

Normally, you should be able to sleep six to eight hours during the night without having to get up to go to the bathroom. People who have nocturia wake up more than once a night to urinate. Some physicians advise that you double-void, or urinate twice, right before bed. Go to the bathroom, then brush your teeth and go through the rest of your bedtime routine, then void again. Move any rugs or furniture you might trip over or collide with on the way to the toilet and use a night light to illuminate your path and reduce your risk of falling.

Incontinence, when left untreated and inadequately managed, can lead to rashes and other skin disorders. If overflow incontinence is not treated, it can lead to urinary tract infection. If severe enough, urinary retention can be a medical emergency.  

Problems with urine leakage may require you to take extra care to prevent skin irritation:

• Use a washcloth to clean yourself.

• Allow your skin to air-dry.

• Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections.

• Consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine.

• Ask your doctor about special cleansers made to remove urine that may be less drying than other products.

Make an appointment with your primary care provider if: You're embarrassed by urine leakage, and you avoid important activities because of it. You often feel urgency to urinate and rush to a bathroom, but sometimes don't make it in time. You often feel the need to urinate, but you're unable to pass urine.

You may get a referral to a gynecologist if you have: Trouble urinating (peeing), including getting started or having a strong flow of urine, pain, cloudy urine or blood in the urine. Changes in urination, like frequent urination or feeling like you always have to go.

For many people with urinary incontinence, the following self-help tips and lifestyle changes are enough to relieve symptoms.

1. Do daily pelvic floor exercises.
2. Stop smoking.
3. Do the right exercises.
4. Avoid lifting.
5. Lose excess weight.
6. Treat constipation promptly.
7. Cut down on caffeine.
8. Cut down on alcohol.

Focus on fluids & foods

• Drink more of your fluids in the morning and afternoon rather than at night
• Skip alcohol and beverages with caffeine, such as coffee, tea and cola, which increase urine production
• Remember that fluids come not only from beverages, but also from foods such as soup

Bladder irritants



Certain foods and beverages might irritate your bladder, including:

• Coffee, tea and carbonated drinks, even without caffeine
• Alcohol
• Certain acidic fruits — oranges, grapefruits, lemons and limes — and fruit juices
• Spicy foods
• Tomato-based products
• Carbonated drinks
• Chocolate

Foods that calm the bladder

The American Urological Association also recognizes some foods as potentially having a calming effect on sensitive bladders. These foods include pears, bananas, green beans, squash, potatoes, lean proteins, whole grains, nuts, bread, and eggs.

Magnesium and Vitamin D

Magnesium is important for proper muscle and nerve function. Some doctors believe better magnesium levels can reduce bladder spasms, a common cause of incontinence. Fruits high in magnesium include dried figs, avocados, guavas, bananas, kiwi fruit, papayas, blackberries, raspberries, and cantaloupes.

The daily value (DV) for magnesium 310-320 mg for women per day.

When it comes to helping you poop, magnesium citrate is considered the top choice. Bound to citric acid, this form is highly absorbable and has a slight calming effect for some people. Supplements with this form of magnesium are widely available and usually found in capsule or powder form.

Studies have found that low vitamin D levels are linked to overactive bladder. Overactive bladder is characterized by frequent urination, incontinence, nocturia (the need to urinate more than twice per night) and sudden, intense urges to urinate

Try bladder training

A bladder-training program usually follows these basic steps:

• Identify your pattern.
• Extend your urination intervals. Using your bladder diary, determine the amount of time between urinating. Then extend that by 15 minutes.
• Gradually lengthen the time between trips to the toilet until you reach intervals of two to four hours.
• Stick to your schedule.

Strengthen your pelvic floor

Your pelvic floor muscles and urinary sphincter help control urination. You can strengthen these muscles by regularly doing pelvic floor exercises, commonly referred to as Kegels.

Bladder neck suspension



Surgical interventions to treat stress incontinence are designed to improve closure of the sphincter or support the bladder neck. Surgical options include:

• Sling procedure. This is the most common procedure performed in women with stress urinary incontinence. In this procedure, the surgeon uses the person's own tissue, synthetic material (mesh), or animal or donor tissue to create a sling or hammock that supports the urethra.

• Injectable bulking agents. Synthetic polysaccharides or gels may be injected into tissues around the upper portion of the urethra. These materials bulk up the area around the urethra, improving the closing ability of the sphincter. Done by a urologist. 

• Retropubic colposuspension. This surgical procedure uses sutures attached to ligaments along the pubic bone to lift and support tissues near the bladder neck and upper portion of the urethra. This surgery can be done laparoscopically or by an incision in the abdomen.