Urinary Incontinence

Unwanted leakage of urine in women is a very common problem. It is also a source of great embarrassment and therefore, often not revealed to the doctor unless specifically asked. Older women often think it is a normal part of aging and others may think there is nothing they can do about it. Still other women think that only surgery will help and they are either too old, not interested or have knowledge of others in whom surgery was unsuccessful. It is important to understand that incontinence is not a normal part of aging, that there are a variety of types of incontinence and that surgery is only one of the treatment options.

In younger, child-bearing age women, leakage of urine with coughing or exercising, commonly called stress incontinence, is the most common type of urine leakage. In the case that the quantity is not great and there is strong motivation pelvic floor muscle rehabilitation can provide significant improvement. We know that aging causes muscle weakness and the slight loss of urine may become a large loss with the advancing years. Pelvic floor rehabilitation after childbirth or pelvic surgery may help prevent leakage of urine by maintaining good muscle control.

If biofeedback therapy is not helpful or the condition is more advanced, surgery is 90% successful in the correction of stress incontinence. The good news about surgical repairs today is that they can be done usually on an ambulatory basis with a quicker recovery than in the past. Today, a small incision is made in the vagina and a sling is passed to help support the urethra from moving up and down with coughing or exercising. The sling acts like a hammock to support the urethra and prevent urine leakage. 100% dryness cannot be guaranteed but the vast majority of women are satisified with their results and report an improvement in their quality of life.

Urge incontinence is more common as women age. It is a sudden loss of control with a strong desire to urinate usually resulting in the loss of larger quantities of urine. Medical therapy is usually the first line of treatment although biofeedback has also been shown to be as effective in highly motivated persons. Medication will not help everyone and may have unpleasant side-effects such as dry mouth and constipation. In the case that urgency incontinence cannot be alleviated with medical therapy, Interstim or neuromodulation may be tried. Instead of working on the bladder muscle like the medication does, neuromodulation works on the nerves that go to the bladder. A nerve test is performed either in the office with local anesthesia or outpatient to see if the symptoms are improved. After a trial period of a few days, if the symptoms are at least 50% better, a permanent lead is placed with a battery that will last 5 years. It is totally reversible and the battery can be replaced as an outpatient procedure.

Interstim has also been used for people with urgency, frequency, interstitial cystitis and incontinence of stool due to irritable bowl syndrome. It has been used to treat over 50,000 people worldwide since 1994. Now because of a simplified approach it can be done on an ambulatory basis.

Not all urinary problems need medication, surgery or biofeedback exercises. Somtimes attention to diet with the reduction of caffeine and more regular drinking and voiding patterns may help to reduce the problem. The important thing is to discuss it with your health care provider who will be sensitive to your problem and be able to direct you where to get the help that you need. Urinary and fecal incontinence is a special field of interest and there are professionals who can better help identify the cause and find a suitable treatment for you.

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