Going with the Flow
A range of treatments provide solutions for female urinary incontinence
By Sanchita P. Yadalla, M.D., FACOG
Many women can recall with a smile their teenage escapades and gossip sessions punctuated with giggling fits and the inevitable comment: “I laughed so hard, I almost wet my pants!” As we age, however, urinary incontinence is anything but a laughing matter.
Stress incontinence is a type of incontinence that involves involuntary leaking of urine from the bladder when it’s under pressure. This condition can develop as the muscles that support the bladder become weaker due to the natural aging process, childbirth or certain medical conditions.
More than 15 million women in the United States have stress urinary incontinence. A Kaiser Permanente study funded by the National Institutes of Health found that one in three women experiences stress incontinence, and the percentage of affected women increases with age. The study surveyed more than 4,000 women aged 25 to 84 – the most extensive research on the subject to date.
Stress incontinence occurs when pressure is placed on the abdominal area by physical activity such as coughing, sneezing, laughing, exercising or lifting a heavy object. When the muscles that hold the bladder and control the flow of urine don’t function properly, accidents can happen – especially if the bladder is full. Stress incontinence affects more women than men, and can range from an occasional problem to a medical situation that affects your daily routine by limiting your participation in social, work or exercise activities.
The most common cause of female stress incontinence is damage to tissues or nerves in the pelvic floor area during childbirth – which may show up immediately after having a baby, or several years later, after menopause. The condition is common among women who have multiple vaginal births and whose bladder, urethra or rectal wall protrude into the vaginal wall, a condition known as pelvic prolapse.
Age-related changes in the strength and function of muscles can make a woman more susceptible to developing stress incontinence. At menopause, the loss of estrogen means that the tissues of the vagina and urethra are more fragile.
Other medical conditions and lifestyle habits can affect the form and function of the bladder and lead to stress incontinence: urinary tract infections, diabetes, chronic bronchitis or asthma, chronic constipation, previous pelvic surgery (such as a hysterectomy), and obesity. Contributing lifestyle factors include excess caffeine or alcohol consumption, smoking – and therefore, frequent coughing – medications that increase urine production, and high-impact exercise.
More than 60 percent of women with stress incontinence put off discussing the condition with their doctor for a year or more, due to embarrassment, anxiety or lack of knowledge about available treatments. Many women assume that the condition is simply something they must deal with as part of the aging process.
Years ago, surgeries for incontinence were more invasive and painful, involving a long recovery period. The good news is today, there are a variety of treatment options. More than 85 percent of female incontinence cases are treatable, according to five-year data gathered in the United States, Europe and Australia and published last year in the International Uro-Gynecology Journal.
Your doctor can help ease your symptoms with dietary recommendations, a regimen of muscle training exercises, medication or surgery; or, you may be referred to an urologist for further treatment.
Non-surgical treatment includes lifestyle changes – limiting caffeine, losing weight or quitting smoking – or exercises that strengthen the pelvic floor, known as Kegel exercises. Electrical stimulation and biofeedback helps revitalize injured or tired muscles. Hormone creams can restore tissues to their former thickness and renew their support capabilities.
Bladder surgery is an option to provide support or lift the urethra back to a normal position, which aids in urine retention. However, newer, minimally invasive vaginal surgeries and outpatient procedures give women many more options than ever before.
For more information, visit www.LockHavenHospital.com and click on the Health Resources link for more information about incontinence, as well as a variety of other health care topics.
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About the Author: Sanchita P. Yadalla, M.D., FACOG is a board certified OB/GYN and Fellow of the American College of Obstetricians and Gynecologists. Dr. Yadalla is accepting new patients at Haven Healthcare for Women, Lock Haven Hospital, third floor. For appointments, contact Haven Healthcare for Women at 570-893-5043