YOUR HEALTH
Exercises work for some people with urine leakage
DR. DONOHUE

DEAR DR. DONOHUE: I don't recall you writing an article on urinary incontinence. When I stand up or exert myself in any way, I have urine leakage. This happens mostly at night. I tried the Kegel exercises, but they didn't help. I have resigned myself to using pull-ups or male pads, but often they are not enough and urine runs down my leg or soils my pants. I am reluctant to attend any gatherings where I will have to move around. I feel handicapped. Please respond. -- R.B.

ANSWER: The loss of urine control is called incontinence, a common problem with aging. It comes in two varieties. Urge incontinence is urine leakage when sudden, forceful bladder wall contractions make people dash to the bathroom to avoid an accident.

Your incontinence is stress incontinence. When abdominal pressure is generated by coughing, sneezing, laughing or standing, or when a person strains to pick up a heavy package or push a hefty piece of furniture, the pressure (stress) forces urine out of the bladder. This kind of incontinence is often due to laxity of the muscles and support tissues that hold the bladder in place and of the muscle that acts as a closed door for the bladder.

Try the Kegel exercises again. When you void, deliberately stop the flow of urine. That act gives you the correct idea of which muscles you have to contract. When not urinating, contract those muscles and hold each contraction for three to five seconds. Gradually build to a hold of 10 seconds. Perform a series of 10 contractions, and do the exercises three or four times a day. Don't expect sudden success. It takes months before you'll see any improvement.

If exercises fail, then see a urologist. There are surgical procedures that can restore bladder control, and you might benefit from one of them.

DEAR DR. DONOHUE: Can you explain to me why men with an enlarged prostate gland cannot have a stent put in to relieve the blockage to urine flow? -- P.J.

ANSWER: You're a thinking man, P.J. A stent is a small, metallic device that expands when it's inserted into a place that has been narrowed. Stents are used to unblock blocked heart arteries and blocked arteries in other locations, like the legs. They seem like a natural solution to open up a urethra blocked by an enlarging prostate gland. The urethra is the tube that drains the bladder; it passes through the prostate.

Will it surprise you to learn that stents have been placed in the urethra to relieve prostate obstruction? They don't work so well. They often cause irritation and infections. They are difficult to remove, if that becomes necessary. They have benefited some men, but their popularity for urethral obstruction is not as great as it once was.

Both prostate enlargement and prostate cancer are discussed in one booklet. Readers can order it by writing: Dr. Donohue -- No. 1001, Box 536475, Orlando, FL32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL32853-6475. Readers may also order health newsletters from www.rbmamall.com. 2006 North America Syndicate Inc.

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