By John Lasater, M.D., urologist with Urology of Virginia at Sentara Advanced Urology Center
| Dr. John D. Lasater|
NORFOLK - Whether following a cough, laugh or sneeze, or a sudden urge to void, accidentally leaking urine is no laughing matter for almost half of American women.
Urinary incontinence can affect many aspects of a woman’s being resulting in overall poor quality of life. Age, child birth and weight gain are just some of the factors associated with female urinary incontinence. Both men and women may also experience incontinence due to neurological disorders, including stroke or Parkinson’s disease.
More than a nuisance, incontinence can be embarrassing and life limiting for otherwise independent women. You may start by staying closer to home to be near a rest room or limit your exercise routine to avoid the embarrassment of wet clothes. In the very worst cases, incontinence can lead to low self-esteem, social isolation, depression and a general decline in health and well being.
Believed to be under diagnosed and under treated, your choice to just “live with it” may mean you’re leading a less satisfying life. For many women, ignoring the small leaks of stress incontinence can even contribute to the chance of gushes associated with urge incontinence —not being able to make it to the rest room in time. In fact, more women have a combination of both urge and stress incontinence, contributing to misunderstandings about the effectiveness of some treatments.
Every patient is unique. A successful treatment plan may include pelvic muscle exercises, behavior modification, medications, minimally invasive outpatient surgery or some combination of these. What is certain is that incontinence does not have to be tolerated. With so many options, one may expect to regain control in no time!
What are the symptoms?
Urinary incontinence is the unintentional release of urine associated with stress, urgency or a combination of both. With stress incontinence, a small to medium amount of urine is released during a cough, laugh, sneeze or some exercises that put pressure on the bladder. It is the most common type of bladder control problem in women.
Urgency incontinence occurs from an urgent need to urinate without the time to reach the toilet, even when very little urine is actually in the bladder. This kind of leakage can be extremely bothersome due to the large volume loss and soaking clothes.
Many women experience a combination of stress and urgency incontinence which may respond to a variety of treatments. Sometimes, the urgency component will resolve once the stress incontinence is handled.
What causes incontinence?
In women, incontinence can be caused by damage to the pelvic muscles that help expel urine due to the trauma of child birth, extra weight gain and age.
Who is affected?
Incontinence is no respecter of age – young women sometimes experience stress incontinence with exercise, especially after childbirth. As the years go by, overactive bladder symptoms and urgency incontinence may develop from not treating stress incontinence. Women from 19 to 85 are seeking help with this problem that affects their quality of life every day. Their lives and well-being are dramatically improved if they can achieve “staying dry.”
What can be done?
Your doctor may begin by obtaining a detailed history of your urination pattern and leakage history. A common tool is known as a “bladder diary” to help your doctor better understand your bladder function.
Urge incontinence may be improved with behavior modifications such as routinely emptying your bladder at certain times of day (even if you don’t feel the need to go), drinking less fluid, and avoiding caffeine and alcohol, which can increase urine output. Other options include pelvic floor muscle exercises known as Kegel exercises and medications to help manage overactive bladder.
Stress incontinence may also be improved with Kegel exercises, weight loss, and medication. However, some body changes and loss of pelvic organ support caused by the trauma of childbirth may require a minimally invasive surgical correction.
Recent advances in surgical technique mean most are done as an outpatient procedure. During a brief procedure, a synthetic “sling” is placed in the vaginal area to permanently support the pelvic organs as the pelvic tissues once did. Patients go home after a few hours and are back to fairly normal activities after about a week. With so many choices, you and your doctor can find the right one for you.
How successful are these options?
About 99 percent of the time stress incontinence is repaired with the sling and some urgency incontinence is at least improved. These solutions change women’s lives for the better. Many women wonder why they waited so long.
When is the right time to seek help?
Anyone experiencing the inconvenience of bladder control issues should seek help. It could markedly improve your quality of life and sense of well-being and restore self-confidence.
What are Kegel exercises?
Kegel exercises help strengthen pelvic muscles. If done correctly they can help prevent or even reverse bladder control problems.
Admittedly, it’s tough to know if you’re doing these exercises correctly. Special bio feedback equipment in your doctor’s office can help you train your muscles.
Kegel exercises involve squeezing the same muscles used during urination and to help stop urine midstream. The stomach and buttocks should not move with this flexing.
To do a Kegel, hold the squeeze for 3 seconds, then relax for 3 seconds. Repeat the exercise 10 to 15 times per session. For best results, do more than three sets of Kegel exercises every day.
John Lasater, M.D., is a board certified urologist with Urology of Virginia and a member practice of Sentara Medical Group. He is a diplomat the American Board of Urology and the National Board of Medical Examiners.
Visit Sentara Urology Services for more information on incontinence and other urological concerns.
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