Running for the restroom?

Q: I know that drinking plenty of water is important for many reasons – weight loss, skin, etc. My problem is urinary leakage. So, I don’t drink enough water, especially when I am exercising. Also it’s a pain to have to wear a protective pad all the time. Any suggestions other than surgery? Thank you.

A: You are absolutely right that drinking plenty of water is important for your health. And you are not alone in dealing with the problems of an overactive bladder. About 17 million Americans have problems with urgency, frequency, or even loss of urine from a hyperactive bladder.

The first question to figure out is whether your loss of urine is related to this entity of overactive bladder, or whether it’s more related to an anatomical problem of urinary stress incontinence (and the typical complaint there is, “I can hold my urine fine, until I cough or sneeze, and then I leak”). The more typical complaint from the person with an overactive bladder (note I say person, not woman, because men can have hyperactive bladders, too) is, “All I have to do is think of going to the bathroom, and then I just have to get there immediately, or else”.

There are medical diagnostic tests that can be used to differentiate between the two conditions. However, you can try some simple measures first. Kegel exercises, where you squeeze the vaginal muscles tight, hold it for a few seconds, then relax, are helpful, and the more you do the better. I encourage to put a sign on the car dashboards to remind to Kegel at stoplights or while waiting to pay tolls. One friend advised me to do them while pumping gas, and now I do. For a woman with the anatomical problem of her bladder falling down, sometimes insertion of a tampon into the vagina before exercising will help. Some women benefit by insertion of a rubber ring called a pessary before exercising – your gynecologist can fit you for one of these.

But for the woman with an overactive bladder not related to her anatomy, simple medication will help. There is a new drug out called Detrol which is fairly effective for relaxing the nerves that fire off out of control and make you want to go to the bathroom all the time. Dry mouth can be seen as a side effect, but most people tolerate it fairly well. So if your symptoms seem to be more a case of bladder overactivity, talk to your caregiver about some medication intervention.

What you have in your mind?