DATE: Sunday, August 24, 1997               TAG: 9708220096

SECTION: DAILY BREAK             PAGE: E12  EDITION: FINAL 

COLUMN: IMPERFECT NAVIGATOR

SOURCE: ALEXANDRIA BERGER

                                            LENGTH:   72 lines

INCONTINENCE CAN OCCUR AT ANY AGE, HAVE MANY CAUSES

A RECENT medical magazine cartoon depicted a urologist's office. You see the nurse answering the phone. ``Urologist's office. Can you hold?'' she says.

Thirteen million Americans can't.

This often-kept secret, which causes humiliation, isolation, depression and fear, is known as incontinence, the unexpected and unwanted leaking of urine from the bladder.

It's time we bring this disabling subject out of the water closet and into the open.

Urinary incontinence does not just afflict the elderly. It can happen at any age and can be caused by a variety of conditions, some temporary, some permanent.

Temporary causes of incontinence are urinary tract infection, vaginal infection, constipation, side effects from certain medicines, drinking alcohol or caffeine, using diuretics (water pills) and ingesting some foods such as chocolate.

A more permanent cause is a weakness of the muscles holding the bladder in place that occurs after childbirth. The bladder itself or sphincter muscles may be weak. Overactive bladder muscles, enlarged prostate, hormone imbalance in women, neurological disorders and immobility also can be contributing causes.

It's important to identify which of the three types of incontinence you have:

Urge incontinence. The minute you feel the need to go to the bathroom, you can't get there fast enough. Water running or drinking a small amount of liquid sounds an alarm. You go to the bathroom frequently, and may even wet the bed. You're petrified of intimate relationships.

Stress incontinence. You lose urine when you exercise, sneeze, cough or laugh. Or you may leak urine when you get up from a chair, get out of bed or walk. Any activity outside the home scares you.

Overflow incontinence. You feel as if you never completely empty your bladder. You lose small amounts or urine day and night. You get up often, when asleep, to go to the bathroom. You spend a long time in the bathroom and have a weak, dribbling stream.

I asked renowned Virginia urologist Emil S. Sayegh, who treated Lyndon Johnson and Anwar Sadat, for advice.

``First, find the cause. Then devise a treatment program,'' he said. ``Surgery should be the last resort, unless there is a blockage.''

According to Sayegh, surgery to correct severely weakened pelvic muscles, return the bladder neck to its proper position, or enlarge a small bladder to hold more urine is about 70 to 85 percent effective. Injecting collagen around the bladder neck is another method of treating incontinence, but it's not permanent, he said.

``Male incontinence is usually due to prostate surgery, old age or other neurological injury,'' Sayegh explained. ``For men, an artificial sphincter can be surgically created which works very well when done properly.''

Sayegh urges healthy young women to learn how to do Kegel exercises.

``These are pelvic muscle exercies which can mean the difference between continence and incontinence in later life. It is absolutely imperative before and after they have children. This exercise should be a lifelong part of their daily routine. Medications, which stop abnormal bladder contractions or tighten sphincter muscles, are also very effective, as is biofeedback.''

Anita Dillion, who operates a Virginia-based rehabilitation agency bearing her name, agrees. Dillon's agency has joined with Southeastern Neurology Group to form one of the country's first mind-body comprehensive facilities. Her incontinence clinic teaches Kegel exercises in eight one-hour sessions.

``Patients should expect to reduce the number of accidents by 90 percent and be able to control bladder function,'' said Dillon. ``Biofeedback is used as a method of repatterning. We also use electrical stimulation. Watching people come alive again who have been severly depressed and frustrated makes the difference.''

So ditch the embarrassment and talk to your doctor. It all depends on you. MEMO: Write to Alexandria Berger, c/o The Virginian-Pilot, 150 W.

Brambleton Avenue, Norfolk, Va. 23510.

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