By John Moore, MD of Vista Women’s Healthcare
Can you imagine getting up to deliver a talk to your PTA or employees and having to worry about leaking urine if you happen to cough, sneeze or laugh? Do you know where every bathroom is at your favorite store? These are daily worries for millions of women. Urinary incontinence—the involuntary leakage of urine—is treatable in the majority of cases and should be discussed with your physician any time that it is a concern for you. Your primary care physician will either initiate treatment or make an appropriate referral, usually to a gynecologist or urologist, if necessary.
The two most common types of incontinence are stress incontinence and urge incontinence. Stress incontinence occurs with sneezing, laughing, coughing or exercising. It is usually caused by a weakening of the tissues that support the bladder or the muscles of the urethra. This weakening can be caused by pregnancy, childbirth or even just normal wear and tear from aging. Urge incontinence occurs when there is a strong, sudden urge to urinate and there is leakage before you can get to the restroom. It is also called overactive bladder and occurs when the muscles in the wall of the bladder contract too easily. The two types also frequently occur together, a situation referred to as mixed urinary incontinence. Incontinence may be associated with other symptoms such as frequent strong urges to urinate even if the bladder is not full, urinating much more frequently than normal and bed-wetting.
Identifying the cause of incontinence is essential to enable your physician to prescribe appropriate treatment for you. A thorough history and physical exam may identify treatable causes of incontinence such as bladder infections or medication side effects. A pelvic exam is necessary to detect loss of support of the bladder and urethra. In cases where the cause is not certain, your physician may ask you to keep track of how often and how much you urinate over several days. You may also be asked to undergo bladder, or urodynamic, testing to more adequately evaluate bladder function. Cystoscopy, where a thin lighted tube with a camera on it is inserted into the bladder is sometimes needed as well. These tests allow a very accurate diagnosis and help your physician determine what treatments will work for your incontinence and, maybe more importantly, which ones won’t!There are many options for treating urinary incontinence. Lifestyle changes such as weight loss, smoking cessation, reducing caffeine intake and treating a chronic cough may help. Bladder training by voiding on a more frequent “timed” schedule, whether you need to go or not, may reduce urge incontinence. Kegel exercises tone the muscles around the urethra and vaginal opening and often reduce both urge and stress incontinence symptoms. Physical therapy and biofeedback are sometimes used to help you learn which muscles to contract. Medications in pill, patch or gel form are often prescribed for urge incontinence and can help immensely. They may, however, have side effects such as dry mouth and constipation which are bothersome. Surgical therapy is usually reserved for stress incontinence and takes several forms. A bulking agent may be injected into the tissue around your urethra to help it stay closed, a procedure that is usually performed in the office. More invasive surgery to support the bladder and urethra is performed in the hospital and requires incisions in the vagina or abdomen. These surgeries include placing slings underneath the urethra or supporting the bladder neck and urethra with sutures placed lateral to them and tied to higher tissue to give support.
Finally, in cases where surgery is not an option, a pessary may be prescribed. This device is placed in the vagina to provide bladder support.
Incontinence can be an embarrassing problem but definitely a treatable one. Plan a visit with your physician today to discuss your concerns and regain your control!