Forty percent of women suffer from urinary incontinence. It is an embarrassing problem for anyone who suffers from it, but the good news is that there are very simple interventions available to alleviate the problem. The first step in evaluating urinary incontinence is to recognize it as a problem. Unfortunately, most women, even when questioned directly about this problem, won’t admit to it due to embarrassment or because they think it is a normal part of getting older, as many of my patients tell me. Most often, when my patients do admit to leakage they will tell me that it is not really a problem for them even when they are having to frequently wear protective pads. This may due to an incorrect fear that surgery is necessary to fix the problem.
Causes of Urinary Incontinence
It is important to know that there are several causes of urinary incontinence and that, most often, surgery is not necessary to treat it.
In order to develop a treatment plan for urinary incontinence, we have to identify the underlying abnormality. The first step in this process is to obtain the characteristics of the patient’s urinary function and leakage. Thereafter a physical exam is performed followed by obtaining a urine culture because the most common cause of incontinence is an undiagnosed bladder infection.
If the culture is positive, appropriate antibiotics will be prescribed and frequently that will alleviate the problem.
If the culture is negative, then there are several other common causes of leakage to be considered. The problems that we see most frequently in the office are genuine stress incontinence, overactive bladder, and intrinsic sphincteric deficiency. Fairly often, patients may suffer from a combination of these problems.
Treatments for Urinary Incontinence
Genuine stress incontinence and intrinsic sphincteric deficiency are typically characterized by urinary leakage when there is a strenuous physical event like coughing, sneezing or laughing. The amount of urine leaked during these events is usually smaller volumes, but can be enough to soak through clothing at times. The genuine stress incontinence component is a result of poor support of the urethra and lower bladder and weakness of the supportive muscles of the pelvis. Intrinsic sphincteric deficiency is caused by a loss of function of the urethral sphincter which is a circular band of muscles that encircle the urethra where it exits the bladder.
Overactive bladder is typically characterized by having a strong urge to urinate followed by an inability to hold the urine resulting in leakage prior to reaching the bathroom. This often results in a moderate or large volume of urinary leakage and may often soak a pad or clothing. This problem is typically caused by involuntary spasms of the detrusor muscle which is the muscle that contracts to empty the bladder.
The treatments for these problems vary and they are determined by the patient’s history, exam findings and sometimes by a test performed in the doctor’s office called urodynamics which is an assessment of urinary function to help discriminate between the varying causes of incontinence.
Genuine stress incontinence is often successfully treated by strengthening the muscles of the pelvis through a simple process called Kegel’s exercises. This can be done by the patient on her own, but the assistance of physical therapy, known as pelvic floor therapy, is usually much more beneficial due to the fact that many patients have difficulty performing these exercises correctly without the assistance of a physical therapist and biofeedback. We offer this outstanding therapy in the comfort and convenience of our office and our patients have an 80-90% success rate. If the leakage does not resolve with this intervention, a minimally invasive outpatient surgical procedure can be performed that will correct the problem over 90% of the time. However, with the success rate of pelvic floor therapy, this surgical intervention is infrequently necessary.
Intrinsic sphincteric deficiency typically requires surgical correction with the same minimally invasive procedure that can be used to treat stress incontinence, although we do see improvement with pelvic floor therapy in this patient group, too.
The disorder of overactive bladder may also respond to pelvic floor therapy or Kegel’s exercises, but less often than the previously mentioned problems because this is typically caused by bladder muscle spasms. These spasms are often aggravated by certain foods, such as caffeine – containing beverages, alcoholic beverages, artificial sweeteners, chocolate, spicy or acidic foods or medicines that contain caffeine or stimulants like Excedrin, Anacin, Dristan or Midol. So, eliminating these things from the diet or medicine cabinet can often reduce or resolve the problem.
If these interventions don’t work, there are quite a few medications that successfully treat the overactivity. These medications tend to target specific chemical receptors on the bladder muscle cells that are responsible for causing the muscle cells to relax. These medications typically work quite effectively with few side effects resulting in a marked reduction in leaking episodes.
If you experience urinary incontinence, please don’t be embarrassed to discuss this with us. We will gladly assess this problem with you and will assemble a diagnostic and treatment plan that will help you get your life back to the point where you won’t have to be worried about the embarrassment of leaking episodes, frequent trips to the bathroom or having to constantly wear protective pads. Realize that you really don’t have to suffer with this anymore and we are here to help you.