Addressing the most commonly asked questions about incontinence, this accessible reference discusses causes, types of incontinence, and how the condition is diagnosed. The wide range of treatment options is introduced, from pelvic floor therapy and bladder training to electrical stimulation, medications, and surgeries. Eleven million women in the U.S. are coping with urinary incontinence—half of whom are too embarrassed to discuss the matter with their doctors—and this guidebook provides encouragement, showing that in more than 80 percent of cases, treatment can improve or even cure the problem. Michael H. Safir, MD , is the chairman of surgery at West Hills Hospital and is director of the Center for Reconstructive Surgery at Miracle Mile Medical Center. He is a former assistant professor and section chief of reconstructive and female urology at New York Medical College. He lives in West Hills, California. Clay N. Boyd, MD, is a board-certified urologist and now works in the Division of Urology of LSU Health Sciences Center at Louisiana State University Medical Center. He lives in New Orleans, Louisiana. Tony E. Pinson, MD, is a board-certified urologist with a special interest in urinary incontinence and female urology. He is the owner of Pinson Urology and Continence Center, P.C. and a frequent urological consultant and adviser for many multinational companies. He lives in Jackson, Michigan. Overcoming Urinary Incontinence A Woman's Guide to Treatment By Michael H. Safir, Clay N. Boyd, Tony E. Pinson, Jack Kusler Addicus Books, Inc. Copyright © 2008 Michael H. Safir, M.D., Clay N. Boyd, M.D., and Tony E. Pinson, M.D. All rights reserved. ISBN: 978-1-886039-87-2 Contents Acknowledgments, Introduction, Part I Incontinence: An Overview, Chapter 1 Understanding Incontinence, Chapter 2 Causes of Incontinence, Chapter 3 Getting a Diagnosis, Part II Treatments for Incontinence, Chapter 4 Lifestyle Changes and Exercises, Chapter 5 Treating Incontinence with Medication, Chapter 6 Treating Incontinence with Surgery, Chapter 7 Living with Incontinence, Resources, Glossary, Index, About the Authors, CHAPTER 1 Understanding Incontinence Are you frustrated because you can't always control when you urinate? When you cough or sneeze, are you worried that urine might leak out? When you feel the urge to urinate, are you afraid you won't make it to the bathroom in time? If so, you aren't alone. Urinary incontinence is a common problem for millions of women. However, like many of these women, you may be too embarrassed to talk about it or even admit that you have a problem. In fact, you may feel that incontinence is something you just have to deal with. But it isn't! The more you understand about incontinence, the more you'll realize that it isn't considered normal and it isn't something you have to tolerate. Incontinence is simply the involuntary loss of urine. The amount of urine that leaks out and the frequency with which leakage occurs can vary greatly from woman to woman. You may dribble a few drops of urine, or you may experience uncontrollable wetting. You may experience leakage only occasionally, or you may find that it's become an everyday occurrence. No matter where you fall in this spectrum, the loss of urine is a problem that should be addressed. The Female Urinary System The urinary system processes your body's liquid waste by creating, storing, and eliminating urine. The system consists of the kidneys, the ureters, the bladder, the urethra, the urethral sphincter, and the pelvic floor muscles. When the system is working normally, the kidneys filter the body's liquids to create urine. The urine flows from the kidneys through two tubes called ureters that connect the kidneys to the bladder. The bladder stores the urine until you are ready to urinate. The urethral sphincter muscle is normally closed tightly to keep urine in the bladder until you are ready to urinate. The urethra is a short tube that carries the urine out of the body. When you urinate, muscles in the bladder contract or tighten, forcing the urine out of the bladder. At the same time, the urethral sphincter and the pelvic floor muscles relax, causing the urethra to open to allow urine to flow through it. When your urinary system is working properly, you can delay urination when a bathroom isn't nearby. When you feel the urge to urinate but can't get to the bathroom, your pelvic floor muscles tighten to keep the urethra closed. Normal urination also involves the nervous system. When your bladder is almost full, sacral nerves send a signal to your brain to alert you that it is time to urinate. Typically, the nerves send a signal before the bladder is completely full, giving you time to get to the bathroom while the bladder continues to fill. Types of Urinary Incontinence You may be surprised to discover that there are five types of urinary incontinence. Leakage is a symptom that i