A grandmother rushes to the bathroom in order to make it there "on time."

A housewife declines to attend a social function for fear of having a bout with bladder leakage during the affair.

A new mom withholds her sneeze to prevent potential urine leakage.

While their lifestyles may be dramatically different, these three women have something in common: urinary incontinence. And there's more: each woman is enduring the condition in silence.

"I would estimate that about three quarters of the women I see suffered from incontinence for three to five years before seeking help," says Sam Hessami, M.D., assistant professor of obstetrics/gynecology at the New Jersey Medical School and founder of the Center for Female Continence and Pelvic Floor Disorders at The University Hospital. "What's particularly disheartening is that these women have carried an unnecessary burden because there are so many available treatments that can help them."

Incontinence is more common than most people realize, with nearly 17 million Americans suffering from the condition. It is one of the leading causes of nursing home admissions, with approximately half of all nursing home residents experiencing bladder leakage. Women are particularly susceptible: one in every four women ages 30 to 59 are affected to some degree.

What is Incontinence?

"Incontinence is one of several pelvic floor disorders," says Dr. Hessami. "It isn't a disease itself, but is actually a symptom that involves any type of uncontrolled, involuntary leakage of urine or feces. Causes are usually linked to conditions or illnesses of the pelvic floor region of the body including pelvic surgery, pregnancy, neurological disorders and degenerative changes to this area of the body due to aging."

The urinary system is composed of two kidneys, two ureters, the bladder and the urethra. The kidneys remove waste products from the blood and continuously produce urine. The ureters are muscular and tube-like in shape, and are responsible for moving urine from the kidney to the bladder. Once there, urine is stored in the bladder until it flows out of the body through another tube-like vessel called the urethra.

"The bladder expands and contracts somewhat like an air-filled balloon," explains Dr. Hessami. "When the bladder is full with urine and can no longer expand, it begins to contract and pushes urine out through the urethra. The base of the urethra is surrounded by a muscle valve mechanism called the urinary sphincter that stays closed to keep urine in or opens to allow urine out."

It is at this point, says Dr. Hessami, that the symptoms leading up to incontinence begin. The coordination between the bladder and the sphincter is achieved by messages to the muscles from the nerves and the brain. When injury or disease affects these nerve passages, incontinence can occur. However, as Dr. Hessami notes, incontinence is not merely a case of mind over matter, relying solely on the coordination between the sphincter, urethra and bladder. Causes are also linked to weak pelvic muscles.

"When the pelvic muscles that support the bladder become weak and cause it to drop down from its normal position, this leads to additional pressure on the urethra and can also lead to incontinence," he says.

The Types of Incontinence

A key to understanding incontinence is recognizing the different types. There are five basic types of urinary incontinence: stress, urge, overflow, mixed, and transient.

Stress incontinence occurs when pelvic muscles have been weakened or damaged and cause the bladder to leak. The most common form of incontinence, it can occur during coughing, laughing, walking, sneezing or strenuous physical activity, such as sports or lifting groceries.

"Stress to the pelvic muscles, including the sphincter and other pelvic muscles, can occur during surgery or childbirth," says Dr. Hessami. "When these muscles aren't at their full strength, incontinence is likely."

Urge incontinence (also called overactive bladder or irritable bladder) is the strong urge to urinate and is intensified by an inability to withhold the urine before reaching the bathroom.

"During urge incontinence, nerve passages along the pathway from the bladder to the brain are damaged and cause a sudden bladder contraction that cannot be consciously controlled. This uncontrolled spasm and contraction of the bladder is followed by urine leakage," says Dr. Hessami. "Causes have been linked to diabetes, strokes, Parkinson's disease and urinary tract infections."

Overflow incontinence occurs when the bladder reaches its capacity, can no longer withstand additional urine, and begins to leak it out. Overflow incontinence is a result of a weak bladder muscle that is unable to contract, or when a blockage causes the bladder to not empty properly when it is too full. A weak bladder muscle also may occur when the nerves to the bladder are injured after surgery. Diabetes complications, as well as other diseases of the nervous system, may also cause a weak bladder muscle.

Mixed incontinence occurs when patients have a combination of more than one type of incontinence. The most common type of mixed incontinence is stress/urge incontinence.

Transient incontinence (also known as functional incontinence) is the result of conditions outside of the urinary tract. While the urinary system may be normal, the use of prescription drugs, or in many cases, illnesses such as Parkinson's or Alzheimer's diseases, may inhibit a person's ability to physically go to the bathroom on her own.

Successful Treatments

Roughly 80 percent of urinary incontinence cases can be cured or improved. There are a variety of options available to treat incontinence including surgical as well as non-surgical options. They include behavioral therapies (such as Kegel exercises), medications, medical devices and surgery. Again, the most important step to treating incontinence is determining the exact form of incontinence.

"The initial consultation is crucial," says Dr. Hessami. "Determining the type of incontinence is a key component of prescribing the most suitable form of treatment. During this assessment, a patient's medical history, physical examination results, blood chemistries, urine analyses and other diagnostic tests are reviewed to make a diagnosis."

Behavioral Therapies

Behavioral therapies are used to help patients learn new behaviors that will assist them in regaining control over urination.

The most common behavioral therapies are Kegel exercises --exercises that strengthen the pelvic floor muscles --and biofeedback, a computerized training process that aids patients in becoming aware of and controlling the muscles involved with urinating.

"The goal with behavioral therapies is to increase resistance in the sphincter and urethra," explains Dr. Hessami. "These type of therapies, particularly with the Kegel exercises, are most commonly used to treat stress and urge incontinence. With this treatment approach, patients strive to tighten the pelvic floor muscles that control urination."

Typically, patients are asked to sustain a contraction for at least 10 seconds, followed by an equal period of relaxation. These exercises should be performed 30 to 80 times a day for at least eight weeks.

"These therapies work best for patients who are motivated and willing to invest the time and effort that they require," notes Dr. Hessami.

Studies have also shown that incontinence patients can also modify their diets to help reestablish normal urinating patterns. Caffeine and alcohol have been known to intensify urge incontinence, so beverages such as tea, coffee, alcohol, as well as chocolate and nicotine, should be avoided.

Medications

Medications are best suited for patients suffering from urge incontinence since they work by relaxing the bladder muscles to stop abnormal contractions. Common urge incontinence medications include antibiotics, which treat infections; anticholinergics, which treat bladder spasms; and estrogen, which can often keep the lining of the urethra plump and toned --particularly for postmenopausal women.

"The key drawback with drugs is that there can be some side effects, including severe dry mouth, blurred vision, and constipation," says Dr. Hessami.

Medical Devices

There are a number of non-surgical medical devices that have proven to be very successful in treating stress incontinence. One such device is the catheter or urethral plug. A tampon-like device, the catheter is inserted by the woman into her urethra until she needs to urinate.

"The catheter is about one-fifth the size of a tampon, and is shaped similar to a balloon-tipped cylinder," he described. "The balloon part of the device actually holds the catheter in place and prevents leakage. Once the woman needs to urinate, she simply pulls on the string that hangs from the bottom of the catheter and removes it. After urinating, she then inserts a new catheter."

The downside to the catheter is that studies have shown that there is a high rate of urinary tract infections associated with its use.

Another medical device for incontinence is a cup that induces suction in the walls of urethra, holding them together during stressful activities. The suction cup is placed in the area of the urethral opening located slightly above the vaginal opening. Once in place, the labia folds over this cup and cannot be seen or felt. The woman removes the suction when she needs to urinate. Once washed with soap and water and dried, it can be reused.

"The suction cup has shown a lower urinary tract infection rate," informs Dr. Hessami.

Surgical Options

As with most medical conditions, surgery is typically a treatment of last resort. When conservative therapies, such as Kegel exercises, medication and devices are unsuccessful, or when incontinence cases are more extreme, surgery may be necessary. The type of surgery will depend on several factors including the type of incontinence experienced by the patient as well as the cause. The most common are bladder neck suspensions, sling procedures and collagen injections.

Breaking the Silence

For nearly five years, Jean Rivera knew she had a problem controlling her bladder. And during those five years, she dealt with it the way millions of women do --alone.

"I was too embarrassed to say anything about it," says the 57-year-old mother of five. "I just dealt with it in my own way."

Her own way was using various types of absorbent products. But over time, the problem became worse and she knew something was very wrong.

Ms. Rivera finally decided to discuss the bladder leakage with her gynecologist. While she admits the initial conversation was embarrassing, she knew that the leakage she experienced whenever she sneezed, coughed or did anything too strenuous was intensifying. After an initial examination and consultation, her gynecologist referred her to Dr. Hessami.

"Ms. Rivera had all the classic symptoms of stress incontinence," recalls Dr. Hessami. "After learning more about her medical history, having her complete a thorough physical examination combined with a series of X-rays, blood chemistries and urine analyses, I determined that the best source of treatment for her would be a sling surgical procedure."

Rivera, who resides in Newark and is a native of Trinidad and Tobago, summarizes her bladder since the surgery as "perfect."

"I feel like I have my freedom again," she says. "I don't worry about whether something I'm doing is going to make me have an accident."

"As I told Ms. Rivera, bladder leakage is not normal at any age," says Dr. Hessami. "That's why it is so important to seek help and correct the problem before it becomes severe".

Don't ignore those occasional accidents - get help now at the Center for Female Continence and Pelvic Floor Disorders at The University Hospital. Call (973) 972-9801 for an appointment.