Peter Rosenblatt, MD
Millions of women in this country suffer in silence with a medical condition that adversely affects their daily lives. Urinary incontinence may not be as serious to one’s health as cancer or heart disease, but it has an enormous effect on one’s social well-being. I’m sure there are many people in your life who are living with this condition, yet for some reason, many women don’t feel comfortable coming out of the proverbial closet and admitting they have this problem.
Women with urinary leakage are often too embarrassed to discuss this problem with their primary care providers, let alone their family members. Let’s face it; this is a discussion that doesn’t come up much at the dinner table, or at social events.
As a urogynecologist in the Boston area, I’ve been taking care of women with a host of pelvic floor disorders (PFDs) for 20 years. PFDs include conditions like urinary leakage, fecal incontinence, and pelvic organ prolapse (such as a “dropped bladder” or “dropped uterus”). Although these conditions are often thought of as problems of elderly women, nothing could be further from the truth.
The average age of my patients is somewhere in the mid-50’s, and it’s not unusual for women in their 30’s or 40’s to see me for these problems. When one considers that vaginal childbirth (and just being pregnant for nine months) and menopause are significant risk factors for the development of incontinence, it makes sense that we see many middle-aged women in our practice.
There are two major types of urinary incontinence: stress and urge. Stress incontinence is defined as urine leakage that occurs with sudden increases in pressure, such as coughing, sneezing, laughing, or exercising. Urge incontinence is leakage of urine associated with a sudden, strong desire to go to the bathroom. Think of a woman who needs to urinate, holding grocery bags and putting a key in the lock of her front door. A sudden urgency hits, and nothing can stand in the way of her getting to the bathroom! That’s urgency, or what we refer to as an “overactive bladder.”
One of the common myths about urinary incontinence is that it is an inevitable part of the aging process. Not true! Urinary incontinence is not normal – at any age – and certainly my patients in their 50’s need to know that they don’t have to live for the second half of their lives with this problem.
Another common myth is that there are no effective treatments for urinary incontinence. Also untrue! We have come incredibly far in our understanding of the causes, and in the development of treatment options, for urinary incontinence.
Stress incontinence:
Women with stress incontinence have many options for treatment these days, and although surgery can be very effective, it is not the only option. You’ve probably heard about pelvic muscle (or “Kegel” exercises), and it’s true, when done properly – and regularly – roughly two-thirds of women with stress incontinence will have significant improvement in their symptoms. Biofeedback, usually done with a pelvic floor physical therapist, is another effective option for women with stress incontinence.
For women who are interested in surgical correction of their stress incontinence, slings are by far the most commonly performed procedures today. Today’s sling surgeries are highly effective in long-term studies, and are most often performed as day surgery procedures under local anesthesia with some intravenous sedation (not general anesthesia). Although slings are made of synthetic mesh, this is not the same mesh you probably are hearing about on TV with all the legal commercials. Those ads are about “transvaginal mesh,” which is used to treat pelvic organ prolapse, not stress incontinence. Sling surgery may not be the best choice for every woman, but it’s a really good option for women who are done with childbearing and are seeking a permanent solution for their stress incontinence. Tellingly, the most common comment I hear from women at their post-operative visit is “why did I wait so long to have that sling?”
Urge Incontinence:
For women with urge incontinence (or “overactive bladder”), we usually start with behavioral management, Kegel exercises, dietary modification (like decreasing caffeine intake), and then consider medications, like the ones for which you hear relentless ads on TV. When these measures aren’t enough, we consider other options, like nerve stimulation or Botox injections into the bladder. I know these last two treatments may not sound very appealing, but they are actually quite effective, and have given many of my patients with urge incontinence a new lease on life.
Bottom line – if you or someone you know has a problem with urinary leakage, go ahead and ask your primary care physician for a referral to a specialist who takes care of women with these problems. That specialist may be a urogynecologist or a urologist – just make sure they have experience in evaluating and managing women with urinary incontinence. Truth is: urinary incontinence is a common condition, but it is not a normal or inevitable part of aging. This is a quality of life issue, and women should know that safe and effective conservative and surgical options are available today.