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Help for Women with Urinary Incontinence

Always have to go?

By Alexandra Rogers, MD, Urology

Pads? Thicker pads? Depends? Rubber pants? Surely there must be better, more civilized options for urinary leakage! If you’ve ever had this thought, then keep reading. If not, then consider yourself one of the lucky ladies and go enjoy another cup of coffee, tea or other bladder irritant of your choice.

Urinary incontinence is estimated to affect as many as 50% of middle-aged and elderly women. Incontinence is defined as the involuntary loss of any amount of urine. Incontinence is generally described as either stress incontinence, urge incontinence or mixed incontinence. Stress urinary incontinence (SUI) is the symptom of involuntary urine leakage that occurs with exertion. For some women, SUI may occur with something as common as standing up from a sitting position; for others it may occur with laughing, coughing, jumping or exercising. Urge urinary incontinence (UUI) is the symptom of urine leakage that is immediately preceded by a sudden, compelling desire to urinate that is difficult to postpone and results in leakage. UUI may occur when a woman arrives home and puts the key in the front door and realizes she needs to urinate, when she runs her hands under running water or without any inciting event at all. Mixed urinary incontinence (MUI) is the combination of SUI and UUI.

The causes of SUI can include pregnancy, childbirth, obesity, smoking, muscle damage, trauma and aging. A cause of urinary urgency and frequency is often not identified, but can include consumption of bladder irritants and behaviors, neurologic diseases such as multiple sclerosis, history of a stroke or spinal cord injury or Parkinson’s disease.

There are many treatment options for incontinence. The best treatment for each woman depends on factors such as the type and severity of incontinence, her medical co-morbidities and her expectations. Conservative first-line treatment option for stress urinary incontinence is pelvic floor exercises such as Kegel exercises (isolated pelvic floor muscle contractions). The most common procedures for the treatment of SUI are a mesh sling that is surgically placed under the urethra for support (typically an outpatient procedure) or an injection of a bulking agent into the urethra which can often be performed in a doctor’s office.

Treatment for urinary urgency, frequency and / or urge incontinence first and foremost includes behavior modification – limiting bladder irritants, limiting excessive fluid intake, timed voiding (making sure to void regularly and not ‘holding it too long’). Behavior modification may be combined with prescription medication and pelvic floor physical strengthening. If these treatment options fail or a woman cannot tolerate the side effects of the medication, sacral neuromodulation (Interstim) or intravesical botulinum toxin A (Botox) may be an appropriate third-line choice. Both are FDA-approved for patients with refractory urinary urgency/frequency symptoms.

If you are dealing with any type of incontinence, consider talking to your doctor about available options.

rogers-a-wr.jpgDr. Alexandra Rogers specializes in Adult Urology, including: Female Incontinence, MaleVoiding Dysfunction, Pelvic Organ Prolapse, Post-Prostatectomy Incontinence, Sacral Nerve Stimulation, General Voiding Dysfunction, Pelvic Floor Rehabilitation and Complex Urodynamics. Dr. Rogers attended Wake Forest University Medical School and completed her urology residency at the Mayo Clinic in Jacksonville Florida. Dr. Rogers recently completed a female urology fellowship at the Tower Urology Institute for Continence at Cedars Sinai in Los Angeles.

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