TREACHERY and disaster are descriptions of an incontinence emergency.

Scenario #1: You’re in a party. Everyone’s having a good time. Someone cracks a joke and you laugh loud and long like everyone else. Someone suddenly points a finger in the direction of your crotch. It’s wet. You’ve just urinated without knowing it. This is stress incontinence.

Scenario #2: It’s a long flight. You’ve taken the window seat and since the person occupying the aisle seat is sleeping, you decide to hold your pee. After awhile you think it’s time to go. You stand up and there’s a sensation of wanting to urinate, a felt bladder contraction and urine spills. Your underwear is wet. You didn’t make it to the lavatory on time. This is known as urge incontinence.

Both are examples of treacherous and disastrous urinary incontinence.

Normal urination. The human bladder deserves an hour in Discovery Channel just for doing what it does. The urination process has two distinct phases: Filling and storage and emptying. After urine is produced from the kidneys, it makes its way to the bladder. As urine fills the bladder it begins to stretch. As some point, usually when urine is about one cup or 200 ml, there is an urge to urinate. But as adults, we’ve gotten used to holding it until a more appropriate time. Normally, we can hold urine until 2 cups full (350-550 ml). To do this, there must be a properly working sphincter that can widen or shut an opening and a stable bladder wall muscle (detrusor). In urinating normally, the sphincter must be relaxed and the detrusor contracted.

Common Causes. Temporary causes of urinary incontinence are: Urinary tract infection (UTI), inflammation of the prostate (prostatitis), constipation and stool impaction causing pressure on the bladder, pregnancy, side-effect of medication especially diuretics and some cough and cold medicines, poorly-controlled diabetes. More worrisome are conditions that cause permanent or longterm urinary incontinence. These include: stroke, spinal cord injuries, pelvic prolapse in women (in which the bladder falls into the vaginal space often a result of multiple pregnancies); hypertrophied or large prostate in men, and cancer of the bladder.

Diagnosis. Don’t delay. Your favorite doctor can do basic tests like a urinalysis and a urine culture. Rather than fear the worst, an alarming episode of urine spill may just be an effect of infection or inflammation. A urologist is the expert, however, in this condition. The urologist is trained to do more in-depth investigations such as cystoscopy or inspection of the inside of the bladder, and urodynamic studies in tests measure the pressure and amount of urine flow. A uroflow measures the pattern of urine flow while a post-void residual is the amount of urine left in the bladder after urination

Treatment. Bladder retraining involves urinating on a schedule, usually at one hour intervals. Gradually, one increases the interval by half an hour until urination normalizes to every three or four hours. This "discipline" forces the person to empty his bladder on a specified time whether or not there is an urge to go. Kegel exercises consist of 10second contractions of the pelvic floor muscles followed by 10-second relaxations. How do you know it’s the pelvic floor muscles you’re working? While urinating, mid-stream STOP the flow. The muscles that do that belong to the pelvic floor. These are the same muscles to exercise. The doctor can also prescribe drugs that do a number of things based on what you need. There are medications to strengthen the sphincter, relax the bladder or increase bladder tone. Finally surgery is an option in cases where the bladder pathways (urethra or tubes, bladder neck or narrow portion) are obstructed or deformed. The supersized prostate may need to be shaved or removed if it is chronically pressuring the bladder.

Billboard. Congratulations to the new Dean of the San Beda College of Medicine, Noel G. Guison MD PhD. The new medical school, opened in 2002, is located in Mendiola and has been bucking the trend of dismal enrollment. The first year classroom will be full and noisy this year. Bedan clinical clerks (4th year) are already rotating in various hospitals in Metro Manila like the National Kidney Institute and the Jose Reyes Memorial Medical Center. For inquiries call Michelle at 7356011 loc. 4116.

Fact/Factoid. Classmate Martin D. Bautista MD from Guymon, OK sent this: "Alcoholic Tip #2: If you’re too drunk to drive, go to the nearest pizza take-out. Order a pizza and have it sent to your home. Hitch a ride when the pizza is delivered." (This must be a joke).