The Problem of Always Going Can Actually Be Gone for Many Women

Douglas Dewire, M.D., Urologist, Columbia St. Mary’s

Posted: Jan. 1, 2007

Physicians who specialize in treating incontinence – the unintended discharge of urine – can improve or even cure over 90 percent of women suffering from this condition. Yet too often women accept incontinence as a normal part of aging, or as a problem they just have to live with. That is absolutely not the case and now, more than ever, there is a host of treatment options available.

Incontinence is actually a fairly common problem, yet left untreated it affects a woman not only physically but emotionally by putting strain on her confidence and self esteem. Incontinence is not a disease, but rather a symptom of a physical problem that can usually be managed or cured.

In general, incontinence can be temporary or chronic. Temporary incontinence is usually caused by stress, medications or a urinary tract infection (UTI). For this type of condition, medications, therapy, or a combination of both usually provide a cure.

Chronic incontinence is a long-term problem that can be either managed or cured, depending on the underlying cause. There are two types of chronic incontinence women experience: stress and urge.

Stress incontinence is the accidental release of urine when a person coughs, sneezes, laughs or otherwise engages in activity that puts stress on the bladder. Stress incontinence is an anatomical problem in which the pelvic floor muscles become weak, causing the bladder to fall out of position, press against the vagina and obstruct the muscles that close off the urethra.

Although age does generally contribute to incontinence, other conditions such as pregnancy, weight and menopause can cause leakage.

Urge incontinence happens when the bladder muscle becomes hyperactive. With urge incontinence, discharge occurs because of a strong need to urinate, even when the bladder is nearly empty. This situation is caused by an actual muscle malfunction, emotional stress or a nerve condition, such as Parkinson’s disease or a stroke. Often, however, urge incontinence does not have an immediately obvious cause.

Treatment options

Today there is a wide range of treatment options for women suffering with stress incontinence, urge incontinence, or a combination of both. For stress incontinence, pelvic floor exercises such as the Kegel exercise (the repeated tightening and release of the pelvic muscles) and other physical therapy often takes care of the problem.

Surgery to prevent abnormal movement of the bladder also is an option. In a method called the Sling procedure, a synthetic mesh material is inserted to construct a hammock under the bladder and urethra, providing the necessary support. This outpatient procedure has a 90 percent curative rate and has been improved over the years to lower complication rates and shorten recovery times.

In the past, fascia, or the thin covering over the muscles in the legs, was the primary material used for the hammock. Today’s synthetic materials are actually stronger and allow physicians to avoid the extra surgical incision in the patient’s leg.

For the treatment of urge incontinence, often medication can be prescribed to calm the bladder muscle or desensitize the nerves controlling the bladder. Biofeedback therapy or pelvic floor massage, in which we teach the patient muscle control, also are common treatment approaches.

For more persistent urge incontinence, a patient may need to have a pacemaker, specifically designed for the bladder, surgically inserted to control frequent urges. A urethra bulking agent also is currently in development as another treatment option. Used in a gel or jelly state, the agent can be placed into the urethra to help it close properly.

Although incontinence is a fairly common problem, in my estimate 20 percent or more of women are still suffering needlessly from this condition. When proper treatment is sought, incontinence is a problem that can be cured or managed to a very satisfactory level.

Douglas Dewire, M.D.
Urologist
Columbia St. Mary’s
414-326-1745

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