Treating Urinary Incontinence
Are you a woman who hesitates to play a favorite sport, like golf or tennis, because the exertion sometimes causes "leaks"? Do you find yourself scanning the personal care aisle of the supermarket, shopping for hygiene products you never thought you'd need? You're not alone.
Studies indicate that 25% of women in the US between the ages of 30-59 deal with some form of ]]>urinary incontinence]]> (UI). The problem for many of these women is stress incontinence (SUI), an uncontrolled loss of urine triggered by the sudden exertion of laughing, sneezing, or other abrupt movement. Urinary incontinence can be traced to several causes, but bladder muscles weakened by childbirth and the loss of estrogen after menopause make middle-aged women especially prone to this type of urinary incontinence.
Don't assume that this is a problem that will be picked up on a routine visit to a doctor's office. In a study, doctors were asked how they identified patients with UI. The results of the poll showed that less than half of the general practice doctors included UI on the medical history form given to new patients. Only about half said that they always or usually included UI questions in their initial interviews with new patients. Surprisingly, relatively few of the general practice doctors even knew about a treatment protocol, outlined by the Agency for Health Care Policy and Research, that doctors can follow in the management of patients with UI.
To compound the problem, many women who experience UI resist seeking medical treatment. They may be embarrassed to discuss it, or may not consider it to be a "real" medical issue. If the variety of UI products for sale in the stores and advertised in magazines are an indication, women are very likely managing the problem themselves.
Ways to Treat It
The first step toward getting help is to make an appointment with a doctor who is familiar with the management protocol. A complete physical exam can identify possible causes and rule out other medical conditions, like infection or nerve damage, that can sometimes be a contributing factor. Because some drugs can trigger UI, it is important to bring a list of all your current medications to this initial visit.
Working with your doctor, you can determine if the incontinence is SUI, UI, or a mixture of the two types. If the incontinence is diagnosed as stress incontinence, one of the first treatment options that may be recommended is a program of exercises, called ]]>Kegel exercises]]>, designed to strengthen the muscles that control the bladder. Excess weight can aggravate the symptoms of UI, so weight loss might be part of the treatment plan. Another set of options for SUI are a variety of surgical procedures. There are also special physical therapy programs that can help with symptoms. Pure urge incontinence may be managed with drug therapy, often anticholinergic medicines.
There are several devices available that can help a woman physically control bladder function.
One is a support ring, or a pessary, that is inserted in the vagina to hold up the neck of the bladder, mimicking the effects of surgery with a much less invasive procedure. Another is a balloon-type device that inserts into the urethra (tube that allows urine to pass out of the bladder) and physically blocks the flow of urine. This one-use insert can remain in place for up to six hours or until urination occurs.
Neither of these devices is risk-free, though; the pros and cons of either device should be considered before making a decision.
There are several different surgical options available for treatment of stress incontinence. The choice of a procedure depends largely on each patient’s individual situation and preference. Common side effects include infections, local bleeding, problems with wound healing, or temporary need for the use of bladder catheter.
The most popular techniques include bladder neck suspension procedures and sling procedures that utilize synthetic materials to support urethra or bladder neck and prevent the incontinence.
Other treatment options include electrical stimulation of the muscles around the urethra, designed to increase muscle strength, and ]]>biofeedback]]>, which allows women to identify and tone the specific muscles that control bladder function. In some cases, collagen injections are used to treat UI. Collagen is an organic substance injected into the area around the urethra to swell the tissues, providing some resistance to leaking urine. This is only a temporary solution and injections must be repeated every few months to be effective.
Diet does not seem to be a factor in UI, although it may help to avoid alcohol and caffeinated beverages, such as coffee, tea, and cola drinks. It's not a good idea, however, to arbitrarily cut back on fluid intake in an attempt to deal with the problem. This is counterproductive because it concentrates the urine, making it more irritating on contact with skin.
The Next Step
If you are experiencing UI, don't wait for help to come to you. Get the facts. The National Kidney and Urologic Diseases Information Clearinghouse is a great place to start.
Most women dealing with the effects of UI could be significantly helped by medical treatment. For those women still trying to manage the problem on their own, relief might by as close as a phone call away.
National Kidney and Urologic Diseases Information Clearinghouse
National Association for Continence
Women's Health Matters
Fantl JA, Newman DK, Colling J, et al. UI in Adults: Acute and Chronic Management. Clinical Practice Guideline: Update 1996. Rockville, MD: Public Health Service, Agency for Health Care Policy and Research. 1996. AHCPR Publication 96-0682.
McFall S, Yerkes A, Bernard M, LeRud T. Evaluation and treatment of UI. Archives of Family Medicine. 1997;6:114-119.
Resnick N. UI. Lancet. 1995;346:94-99.
Smith ARB, Daneshgari F, Dmochowski R, et al. Surgical treatment of incontinence in women. In: Abrams P, Cardozo L, Khoury S, Wein A, eds.Incontinence. 2nd ed. Plymouth, UK: Health Publication Ltd. 2002; 823-826.
Taub DA, Hollenbeck BK, Wei JT, et al. Complications following surgical intervention for stress UI: a national perspective. Neurourology and Urodynamics. 2005;24:659.
1/11/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: AHRQ evidence report on treatment for overactive bladder in women 2009. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/clinic/tp/bladdertp.htm. Published August 2009. Accessed January 11, 2010.
Last reviewed January 2009 by ]]> Rosalyn Carson-DeWitt, MD]]>
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