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Health matters: Many causes and treatments for incontinence

Q. I'm embarrassed to ask about this problem, but my elderly mother frequently loses control of her bladder and wets herself. Can anything be done?

A. Unfortunately, your mother isn't alone—urinary incontinence is common in women in general, and elderly women in particular. Assuming that she doesn't have a urinary tract infection or other serious conditions like cancer, urinary incontinence may be helped by a variety of interventions, medications, and, in some cases, surgery. Simple interventions include pelvic muscle exercises, weight loss, regular voiding, avoidance of caffeinated and carbonated beverages, prevention of constipation, and avoidance of excessive fluids. Although your mother is elderly, pelvic floor muscle weakness following childbirth is a common cause of incontinence. In that case, there are exercises (commonly prescribed by physical therapists who specialize in women's health issues) that have been shown to be beneficial. If those measures don't help, there are about a half-dozen different medications that may provide some additional benefit. As with most medications, however, the potential benefits of the drug have to be weighed against the risks. Finally, depending on her particular circumstances, your mother might be a candidate for surgery. The most commonly employed surgery is a 30-minute procedure in which a mesh sling is inserted around the urethra (the tube that allows urine in the bladder to leave the body). The results of this procedure generally are quite good, with most patients experiencing resolution of their incontinence. There are several other procedures that also may be considered as alternatives to surgery. Of course, if your mother were to consider an invasive approach, she needs to see a specialist for further evaluation and discussion of her options.

Q. I've been bothered by a slow-to-heal leg ulcer. Any thoughts?

A. Ulcers of the lower-extremity affect between one and two out of 100 adults in the U.S., and often-- like yours—are slow to heal. It is important to distinguish leg ulcers (which usually are caused by problems with veins in the legs) from foot ulcers (which usually are caused by circulation or nerve problems, either alone or in combination). Foot ulcers are seen commonly in smokers and diabetics, since diabetes often damages the nerves going to the feet (causing peripheral neuropathy), as well as causes blockages in the leg arteries. Treatment obviously varies depending on the cause of the ulcer, but there are several general common-sense guidelines: Control weight, stop smoking, and control underlying conditions like diabetes. One approach that may help is "debridement"—the removal of the dead tissue on top of the ulcer. Antibiotics are not required to treat ulcers unless there is clear evidence of infection. There are many different types of wound dressings that can be used as well. For leg ulcers, in addition to wound dressings, various types of leg compression are helpful to reduce swelling, in combination with elevation of the leg as much as possible. For foot and other ulcers caused by circulation problems due to blockages in the arteries, using a balloon or stent (or surgery, in some cases) to reduce the blockages often is helpful to promote ulcer healing. Ulcers related to nerve problems often are caused by prolonged pressure on the foot (caused by wearing poorly fitting shoes, for example, because the patient doesn't feel the prolonged pressure). In these patients, off-loading of the pressure through the use of special shoes, casts, removable boots, use of crutches and walkers and the like may be helpful. Patients with foot ulcers should consider consulting a podiatrist or wound specialist who can evaluate whether their shoes are contributing to the problem. If these measures don't work, you should see a specialist who may recommend a variety of other treatments. The good news is that you do have options!

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.