Saturday, June 7, 2014

Female Urinary Incontinence: No Laughing Matter

Female incontinence is not a laughing matter. 

Female incontinence is so common among women 40 and over, people crack jokes about it. But, if you’re among the women who suffer from female incontinence, it’s really not funny. Nor are you suffering alone. It’s estimated that more than 40% of women over 40 experience some kind of urinary incontinence.

Incontinence is a condition that can really impact the quality of life for some women – making them fearful of leaving home or engaging in social activities. At Minnesota Women’s Care we make it clear to our patients that there is no need to suffer from urinary incontinence. There are treatments available that work. There’s hope and there’s help.

About Female Incontinence: Types and Causes 

Not all urinary incontinence is the same nor is it always caused by the same thing. It is more common during pregnancy, after childbirth and in post-menopausal women, but that’s not the rule. It can happen to any woman at any time.

Most women experience one of these more common types of incontinence alone or in combination: 

Stress Incontinence: Indicated by leaking of small amounts of urine while coughing, sneezing, exercising or other movements. It is often caused by a weakening of the pelvic floor muscles – the muscles that hold the bladder in place. When the pelvic floor muscles weaken or have been damaged, urine leaks from the bladder into the urethra during certain movements. Stress incontinence can also be caused by bladder prolapse – sometimes called “fallen bladder” - when the bladder descends into the vagina to varying degrees.

Overactive Bladder (Urge Incontinence): Indicated by leaking of urine at unexpected times in response to abnormal bladder contractions. Sometimes Overactive Bladder (OAB) can present without actual leakage. Some women suffer from frequent or urgent urination caused by muscle spasms in the bladder.

Mixed Urinary Incontinence: The most common type of incontinence Women with this suffer from a mixture of several forms of incontinence. Often both stress incontinence and Overactive Bladder. 

Female Incontinence: Four Things to Do Right Now 

First of all, wearing pads or special undergarments is not a solution. Our objective is to get to the root of your incontinence issues – not just to cope with the symptoms. Depending on your situation, these four solutions may have an impact on your symptoms:

Pelvic Muscle Exercises: These simple exercises – called Kegels – are used to strengthen the muscles near the urethra. Taking a few minutes each day to do these exercises can help to reduce or cure stress leakage. Ask your healthcare provider to help you isolate the correct muscles if you’re unsure.

Weight Loss: If you are overweight, the extra weight can cause bladder control problems. Talk with your health care provider about a diet and exercise program to help you lose weight.

Dietary Changes: Certain foods and drinks can cause incontinence, such as caffeine (in coffee, soda, chocolate), tea, and alcohol. You can often reduce incontinence by restricting these liquids in your diet.

Timed Voiding or Bladder Training: These techniques may help you to train your bladder to hold urine better. In timed voiding (urinating), you fill in a chart of when you urinate and when you leak urine. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak.

Female Incontinence: Effective Treatments for Women 

If diet and exercise do not alleviate the symptoms, we offer a range of treatments depending on your particular needs and choices. This includes:

Urostym Pelvic Floor Rehabilitation System: This system provides biofeedback that assists patients with localization of the pelvic floor muscles necessary to strengthen the pelvic floor and provides direct electrical stimulation of the pelvic floor muscles to help strengthen them. It also helps to assess the pelvic floor function to guide therapy. We have found this helpful for women who thought they were performing Kegels, but had not isolated the correct muscles.

Intone: This new product, provided by our office for women to take home, provides biofeedback, electrical stimulation, measurement of the degree of “squeeze”, and a log of the patients exercise results. The device is used daily for 12 minutes for 9 weeks, then twice a week. During office visits, we connect the patient’s Intone device to the office computer and are supplied a detailed report of how often they exercised and how effective the routine was. This allows us to offer better coaching to improve results.

Cystoscopic Botox Injections: Though recently approved by the FDA for bladder use in the treatment of OAB, many physicians, including myself have been using this for years based upon sound evidence of the procedure’s safety and efficacy. Approximately 80% of women treated with Botox injections in the bladder with have resolution of the uninhibited bladder contractions resulting in urge symptoms and incontinence. The procedure is not permanent. The effect of Botox will last 6-9 months in most patients. Consequently it needs to be repeated. However for the woman living attached to the bathroom and suffering from embarrassing uncontrollable urinary leakage this is acceptable. This can be performed in our office or the surgery center.

Urgent PC: During this in-office procedure, a small needle is placed near the ankle to stimulate the tibial nerve. It results in satisfactory symptoms improvement for 60-80% of women. The needle placement is not painful as the need is very fine “acupuncture size”. After 12 weekly treatments maintenance treatments are performed every 1-4 months dependent upon the patient’s return of symptoms.

Interstim: This implanted device is like a pacemaker for the bladder. Once implanted, the device will work for 5 – 10 years before the battery needs to be replaced. The implantation occurs in two stages. First we’ll determine if the device will significantly improve your symptoms. If it does, we proceed with stage two. For patients who are unable to tolerate medications, Interstim has provided dramatic symptom relief.

Urethral Bulking: This procedure involves insertion of a filler product, often collagen into the urethral opening to narrow the opening of the bladder. This can be an effective option for those experiencing symptoms from Stress incontinence but is not a treatment for urge incontinence.

Medication: Certain medications can reduce many types of leakage and new drugs are frequently introduced for the treatment of OAB. One such new development is Myrbetriz, a drug that works by relaxing the bladder wall. It can be used in combination with other medications.

Female Incontinence: Surgical Treatments 

There’s been much controversy of recent about the use of mesh to repair bladder issues. Let's clarify: there is a tremendous difference between using a small amount of mesh for a sling procedure to stop urinary leakage and using more mesh for prolapse repairs. Sling procedures for the treatment of stress incontinence are considered gold standard therapies and were not called into question with the FDA letter regarding mesh. The letter was primarily pertaining to use of larger sheets of mesh for vaginal repairs secondary to prolapse. As noted above there are several other options for stress incontinence that do not require surgery. However in many patients a sling surgery is the most appropriate.

Female Incontinence: The Bottom Line 

Incontinence Therapy is an individualized decision after discussion with a physician. A board certified Female Pelvic Medicine and Reconstructive Pelvic Surgeon (urogynecologist) is the best to help guide a patient through this decision. There are 10 in the state of Minnesota. I am proud to say that I am one and can offer my patients the most current help available.

More than anything, I want women to understand this: You do not need to suffer with urinary incontinence. The impact it can have on your daily life – and on the life of your family – is much too great. There are many treatments available and they work.

Melvin Ashford, M.D.