By Roy Epstein, M.D.
Hallmark Health Medical Associates
As women age, urinary incontinence is common, but can be stressful. Dr. Epstein’s team can help you control symptoms.
Do you scout out the bathrooms every time you enter a new building? Avoid road trips because it takes so long to get somewhere because you have to stop for bathroom breaks on the hour? Dread long work meetings because of the urge to “go”?
I hear these stories often from my patients. About 13 million Americans experience urinary incontinence, or loss of bladder control, and women are more than twice as likely to have it as men. Yet many women are too embarrassed to tell their physician about these problems. They think it’s just part of the aging process. While it’s more likely to happen the older you are, it can happen at any age. But you don’t have to suffer from it.
There a several types of urinary incontinence, and once we diagnose which type or combination of types you are suffering from, we can tailor a treatment plan to combat it and get you back to fully living your life. Treatment can range from lifestyle changes to medication to surgery.
Treatment depends on the type of urinary incontinence you have. Let’s take a look at the treatments we use for four common types of urinary incontinence, as well as what works for all of the conditions.
1. Stress incontinence
For women who leak urine when they laugh, cough, sneeze, or move, we can insert a pessary or perform surgery to fix the problem.
A pessary is a silicone or rubber disc that is placed in the vagina to help hold up the bladder and prevent urine leakage. The ring is designed to fit your anatomy, and you should not notice it or feel it if it’s fitted properly. The pessary is not permanent and should be removed regularly for cleaning, so there is some time commitment involved, although fairly minimal. The pessary can eliminate urinary incontinence in certain patients who are past the age of menopause.
One of the common surgical procedures we perform is placing a single-incision sling. We make a one-inch incision inside the vagina and place a narrow strip of mesh between the bladder and the urethra. The mesh also helps keep the urethra closed. There is no pain after this procedure and it works immediately. Women generally see a 90 percent improvement rate and a 76 percent cure rate with the single-incision sling.
One thing to consider with these slings is that they may not last forever, so a second procedure may be needed. It also may be best to wait to do a sling procedure until after you are done having children, because a vaginal childbirth may ruin the sling.
The single-incision sling is not the one you hear about during late-night lawsuit commercials. That’s a much different procedure for a different issue called pelvic organ prolapse, in which the uterus, rectum, bladder, urethra, small bowel, or vagina fall out of their normal positions. In those procedures, the incision and sling are much bigger. If you are suffering from pelvic organ prolapse, there are surgical options to repair it.
2. Urge incontinence
Urge incontinence is the strong, sudden urge to urinate, often when you’re at your front door with the key in the lock, trying to make it to the bathroom in time. We have several options to treat this condition:
- Lifestyle modification and physical therapy
- Medication to stop the bladder from unexpectedly contracting
- Botox injections into the muscle of the bladder
- Percutaneous nerve stimulation, in which we apply an electrical current to the ankle
- Sacral neuromodulation, in which we apply an electrical current next to the spine with a permanent implant
3. Overflow incontinence
Women who face this condition leak urine while sitting or lying still, without added pressure from coughing or movement. Treatment for this type of incontinence is similar to treating stress incontinence. If you have overflow incontinence, we’ll likely prescribe a pessary (a silicone or rubber disc inserted in the vagina to hold the bladder up) as our first line of treatment.
If we find the pessary to be ineffective, other treatments include surgical procedures or sacral nerve stimulation, which our urge incontinence patients also find effective.
4. Mixed incontinence
As its name implies, mixed incontinence (a combination of one or more types of incontinence) is treated in a variety of ways. Some of my patients find success with lifestyle modification and need nothing more. For others, the only thing that works is medication.
There are many medications designed specifically for the different incontinence symptoms, and we’ll work with you to find the right combination to control them. Some of the issues medication may help with include:
- Calming an overactive bladder
- Relaxing the bladder muscles
- Increasing the amount of urine the bladder can hold
- Reducing irritation in the pelvic floor muscles
- Helping the bladder empty more completely
5. Treatments for all types of urinary incontinence
Lifestyle modification can help all types of incontinence. I recommend these first steps to my patients:
- Lose weight if you’re obese.
- Stop smoking.
- Decrease or stop consuming caffeine, alcohol, and carbonated drinks.
- Manage constipation.
Pelvic floor muscle exercises, also known as Kegel exercises, often are touted as helping with urinary incontinence. While this technique of strengthening the muscles that help control urination can be effective, they have to be done three times a day, every single day. If you let up or stop, the improvements you may have seen will disappear quickly. So, while there’s nothing wrong with Kegel exercises, few people have the time to do them enough to actually reap their benefits.
We can refer you to a pelvic floor therapist who can help you with the exercises and possibly use biofeedback to help you. This involves a vaginal sensor that helps you isolate the correct muscles to contract in order to do Kegel exercises correctly.
Another option is to prescribe vaginal estrogen, which women in menopause often find helpful for with urinary incontinence.
If you’re experiencing mild urinary incontinence, or if medical treatments don’t completely eliminate the problem, there are products that can help with the inconvenience of urine leakage. A pad or protective garment can be worn under your clothing, and most are not bulky, meaning no one else would ever know you were wearing them.
Depending on how much urine is leaking and how often you change the product, you may experience skin irritation. This can happen if your skin stays wet for long periods of time, so for more severe urinary incontinence, it might not be feasible to rely solely on an absorbent product.
I know urinary incontinence can be embarrassing to talk about. But if it’s limiting your social interactions or keeping you from doing the things you love, don’t let a little embarrassment keep you from getting the treatment you need to get back to living your life the way you always have.
If you want to talk about urinary incontinence treatment options that may work for you, schedule an appointment or call our Pelvic Care Center at 781-213-5215.
Tags: incontinence, OB/GYN, women's health