Springing a leak

What you need to know about urinary-incontinence treatment.

By Jill Case

Finally, women are beginning to talk about a problem that millions have: incontinence. Whether it’s leaking a small amount of urine when laughing or coughing, or feeling a sudden, strong urge to urinate, many women are dealing with the symptoms of incontinence. November is Bladder Health Awareness Month, and {Austin Woman} wants to help by educating women about this problem and highlighting the hope that’s available through treatment.

Many things can cause incontinence, including pregnancy, childbirth, menopause, medications, infection, nerve damage or other symptoms associated with aging. Any of these things can cause the muscles and nerves that hold or release urine to weaken or malfunction, allowing a release of urine.

If you are experiencing symptoms of incontinence, you shouldn’t hesitate to talk to your doctor. This is a common problem and nothing to be embarrassed about, and your doctor can offer many different options, depending on the extent and severity of your symptoms, to help alleviate the problem.

Lifestyle Changes and Behavioral Changes

In some cases, your doctor may want you to try to make some changes in your lifestyle. For example, your doctor may suggest you lose weight because being overweight puts extra pressure on the bladder. Dietary changes include eliminating all carbonated beverages, coffee, tea and alcohol since these drinks have been shown to contribute to symptoms, as can drinking too much liquid. Finally, quit smoking! Smoking has been shown to make symptoms more severe and may double your risk for developing incontinence.

Bladder Retraining

Bladder retraining is another non-invasive way to treat urinary incontinence. Your doctor will help you establish a schedule for urination, usually beginning with urinating every 60 to 90 minutes, whether you feel that you need to or not, then extending the time in between. This process, practiced for several months, may help eliminate leakage.

Pessaries

These are removable devices that your doctor fits and inserts while you’re in the office. They are also used to treat pelvic organ prolapse. When the device is in place, it helps reduce leakage from stress incontinence by repositioning the urethra. Your doctor will show you how to remove, clean and reinsert the device.

Medications

Depending on your symptoms and the type of incontinence you have, your doctor may prescribe medications that can help relax bladder muscles, prevent muscle spasms or block signals to the nerves that can cause urinary urgency and frequency.

Biofeedback

Some women benefit from biofeedback, a process through which they learn to become more aware of how their bodies functions and feel. During biofeedback, a therapist attaches an electrical patch to the bladder and urethral muscles. This is not painful. The internal patch is linked to a screen that allows you and the therapist to see your muscles contracting, helping you to learn to control your muscles. If you have biofeedback with electrical stimulation, your therapist will use mild electrical stimulation to directly stimulate the pelvic-floor muscles.

Physical Therapy

There are physical therapists who are specially trained to help women with the symptoms of incontinence. They use different exercises and tools to help strengthen the pelvic-floor muscles. The therapist teaches women how to perform exercises using vaginal cones, biofeedback and electrical stimulation.

Vaginal weights, or cones, are tampon-shaped weights in different sizes. Your therapist may have you insert these weights and then practice tightening the muscles around the vagina to hold them in place. You progress by using increasingly heavier weights.

Your therapist may also use biofeedback and electrical stimulation, which is another form of biofeedback.

Neuromodulation (Interstim)

The Interstim Therapy system is used for people with urge incontinence to provide neuromodulation. Neuromodulation involves stimulating the sacral nerves, located near the tailbone in the spine, which control the bladder. After a trial period, the doctor inserts a small pacemaker-size device under the skin in the upper back that delivers mild electrical pulses to help the brain and the sacral nerves communicate. This minimally invasive surgical procedure is usually performed in the office or surgery center under local anesthesia.

Injections

Your doctor may suggest injecting bulking agents like collagen into the tissues located around the bladder and urethra. These materials can help thicken the tissues and also close the bladder opening. The procedure is done under local anesthesia in the office or surgery center. Injections have been shown to work for stress incontinence.

Botox

Women with urge incontinence or overactive bladder may benefit from Botox injections. Botox is injected into the bladder muscle while you’re in the office or surgery center. Your doctor will use cystoscopy, a procedure in which the doctor inserts a thin, lit tube into the urethra and bladder so she can see precisely where to place the Botox injections, usually between 15 and 20 spread evenly across the bladder surface. Botox works by relaxing the bladder muscle.

Surgery

If non-surgical or minimally invasive treatments don’t work, your doctor may suggest surgery so your bladder is supported in its normal position. Most of these surgeries are done laparoscopically or robotically and are minimally invasive with no abdominal incision. The type of surgery is determined by what kind of incontinence you have and the severity of your symptoms. Your surgeon will also take into account the factor(s) that is causing the problem.

The most important thing to remember is to speak up and seek help. Treatment is available for incontinence, and reaching out to your doctor can dramatically improve your quality of life.

What You Need to Know About Surgical Bladder Mesh

You may have seen the commercials on television from lawyers talking about the dangers of bladder mesh, but you shouldn’t let these ads scare you away from seeing a specialist about your urinary incontinence. First, it’s important to remember that there are many treatments available for incontinence that aren’t surgical, so you may not need surgical bladder mesh. Secondly, the mesh is FDA-approved, and a recent study in the {Journal of the American Medical Association} found that only about 3 percent of patients experienced complications and/or needed follow-up surgery due to problems associated with surgical bladder mesh.

The FDA offers guidelines for women who may need surgery that involves surgical bladder mesh. They recommend having a thorough discussion with your health-care provider when considering this type of surgery since the outcome of your procedure will be better if you choose an experienced and skilled surgeon. The study published in {JAMA} also found that patients whose surgery was performed by a surgeon who does not do this surgery routinely had a 37 percent higher rate of complications.

To learn more about the questions you should ask your physician, visit fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/urogynsurgicalmesh/ucm345230.

Types of Urinary Incontinence

There is more than one type of incontinence, and women usually have one of these three types:

Stress incontinence is the most common type of incontinence in women, and is often caused by changes experienced during pregnancy, childbirth and menopause. Laughing, coughing, sneezing, exercising or even lifting heavy items can put pressure on your bladder, which causes urine leakage.

Urge incontinence is the type that causes a sudden, strong urge to urinate, followed by leakage. This can happen while you’re asleep, after drinking water or even when you hear water running. Overactive bladder sometimes causes urge incontinence. OAB is a condition that causes symptoms such as the need to urinate frequently (more than eight times a day), the urge to urinate immediately and suddenly, and waking up at night to urinate.

Mixed incontinence causes many women to experience two types of incontinence at the same time. Most often, they have symptoms of both stress and urinary incontinence.

The good news is that there are many treatments available to help women cope with the symptoms of urinary incontinence. Family physicians, gynecologists, urogynecologists and urologists, along with trained nurse practitioners and physical therapists, can all help you improve your quality of life by providing treatment and support.