(Jan. 25, 2006) -- It's embarrassing. It happens at the most inconvenient of times, and millions of women suffer from it, mostly in silence. Every month, women come into my office depressed and exasperated because they have urinary incontinence.
45 year-old Debbie has two teenagers. Her incontinence started after the birth of her second child. "Every time I cough or laugh, I leak. I have to wear pads all the time," she cries. "Sometimes my clothes get wet and I just want to die from embarrassment."
Urinary leakage can occur at any time. If you do leak, this can mean that you may have a serious problem. The good news is that most incontinence problems can be treated, improved and sometimes even cured! Identifying the causes and treatment options requires certain tests and a physical examination. Some doctors have a questionnaire that they have patients fill out to help pinpoint your problems. A thorough history of your daily habits provides information that may help physicians better understand and treat your problem.
The first thing, though, is you have to get help. Believe it or not, up to 64% of the people with incontinence symptoms are not doing anything at all to help manage their condition.
There are three kinds of incontinence and they can occur separately or together.
Incontinence can also occur in association with neuromuscular disorders or with a diabetic condition. These diseases involve an inherent damage to nerves and therefore carry a lower cure rate.
Because the symptoms of a bladder infection can mimic those of urinary incontinence, some women walk around thinking they have one problem, when it’s really another.
Rachel, a 38-year old patient of mine, came to visit me complaining that for the last six months, she always felt like she had to go to the bathroom. This is one of the key symptoms of urge incontinence. She swore she had incontinence because one of her friends had a similar problem.
As an elementary school teacher, Rachel’s job duties included being out on the playground for extended periods of time each day and accompanying the children on field trips. “I’m scared to death of going on a field trip because a bathroom may not be nearby!” she exclaimed. In fact, Rachel experienced panic attacks over this. As it turned out, she had an easily-treated bladder infection and not incontinence.
In evaluating the bladder, the first and foremost order of business is to rule out a bladder infection or urinary tract infection (UTI). Usual symptoms of a UTI are frequency (having to urinate often), urgency (feeling like you have to go) and dysuria (painful urination). Some women have infections and yet they have minimal-to-no symptoms other than those of pressure and/or urinary leakage. A simple urine test can identify the type of infection and help the doctor decide which antibiotic treatment will work best to resolve the problem. With UTI’s, patients usually report resolution of the leakage after antibiotics are taken.
As for actual incontinence, there are several tests that can be performed in the doctor’s office. These include the Q-tip test, a bladder stress test and a pelvic exam. If more than type of incontinence is suspected, bladder function tests are needed (these are called urodynamics) to differentiate which kind(s) exist.
It is extremely important to evaluate behaviors that can have a negative impact on bladder function. Holding urine in for too long is a common habit that many women have. It is a bad one! Over-stretching the bladder can cause leakage to occur because it has exceeded its capacity. By going to the bathroom more often and not holding your urine, you can avoid this problem.
Caffeine consumption in any liquid form (coffee, tea, soda, hot chocolate) can irritate the muscle in the bladder and cause it to go into spasm. It can also make you feel like you have to go (just think about how often you go to the bathroom after your morning cup of coffee.) Caffeine also dehydrates your body. For every cup of caffeinated beverage you drink, you’ll void 2 cups of urine. Cut back the number of cups of coffee you consume; switch to decaf or herbal beverages; mix club soda or seltzer with orange juice or grape juice for a chemical-free drink. All of these tricks can all help your bladder feel and function better.
For women who get up during the night to urinate, cut back on your evening fluid consumption. Stop drinking after 7 pm and avoid caffeine after dinner. This should help you get a better night’s sleep as well. Caffeine also worsens PMS (premenstrual syndrome) symptoms. By dropping your daily soda intake and adding 1000 milligrams of calcium per day, you’ll feel like a new woman within a matter of weeks. Your body will thank you in many ways.
Lastly, none of us drink enough water. It is important to keep your body hydrated so that it can function at its best by providing us with tears, saliva, sweat, vaginal lubrication and urine. Eight to 10 glasses is a lot to drink in a day, but if you break that amount down over 12 to 14 hours, you can put it into better perspective. Try drinking a glass of water with each meal and snack and one to two glasses with exercising. Herbal iced teas, flavored waters (you can make your own by adding slices of cucumber, orange, grapefruit, lime and lemon), juices with seltzer or club soda are good ways to get your fluids in without feeling like you are drowning.
There are surgical options available for women who suffer from SUI and who continue to have symptoms after changing simple behaviors. If, after ruling out a UTI, cutting back on caffeine, practicing Kegels and using vaginal estrogen cream (when appropriate; usually in peri-menopausal or menopausal women who may have some vaginal dryness) , leaking is still occurring to the point that it interferes with your lifestyle, then surgery can significantly reduce or eliminate the problem altogether.
How do you know which surgical option is right for you? That depends on your concerns as well as on your physical exam. If you haven’t had children and you have no other complaints, SUI is easily treated by collagen injections that are strategically placed on either side of the bladder neck for added support. The injections are performed as an outpatient in an urologist’s office. Alternatively, a sling procedure which places a piece of material underneath the bladder neck to support it can be entertained. The sling procedure can be performed through the vagina. Also, a laparoscopic Burch bladder neck suspension procedure can be considered. The Burch procedure works by supporting the bladder neck from the sides, and approaches it from above instead of below.
If, on the other hand, like most women after childbirth, you have other concerns, e.g. decreased sensation with intercourse, problems with bowel function (hemorrhoids, constipation, inability to move bowels without putting pressure on the back wall to help them evacuate), or problems with tampons or partners staying inside the vagina, surgery can absolutely help. Women with significant pelvic relaxation (vaginal looseness) can benefit from the anterior and posterior repair procedures. Or, even better, they can benefit from Laser Vaginal Rejuvenation, an outpatient procedure accomplished with the laser that not only addresses Stress Urinary Incontinence and bowel function, but also takes care of pelvic relaxation and thus enhances sexual gratification.
With any surgery related to the bladder, there are factors that can affect the results. Weight gain can cause SUI to return. Tissue integrity is unpredictable unless you have had previous surgery and problems resulting from this. Heavy lifting and chronic coughing from pulmonary problems, such as allergies or asthma, can cause an increase in abdominal pressure which, like smoking, can have a negative impact on the success of the surgery. Aging, gravity and hormones are other factors that can have an impact on the recurrence of SUI.
Taking care of yourself and your health is crucial to maintaining good body image and function.
Women don’t have to live with wearing pads, being afraid of dancing, having sex or exercising for fear of embarrassing accidents. Proper evaluation and treatment will improve how you feel and function. Take back control today!
(Read another article on Stress Urinary Incontinence written by Dr. Hailparn.)
Dr. Troy Robbin Hailparn was the first female Board-Certified OB-GYN in the U.S. trained in Laser Vaginal Rejuvenation and Laser Reduction Labiaplasty. She is Medical Director of the Cosmetic Gynecology Center of San Antonio (formerly the Laser Vaginal Rejuvenation Institute of San Antonio). Dr. Hailparn has performed over 3,500 vaginal rejuvenation, labiaplasty and other cosmetic gynecology procedures since 2003. To contact the Cosmetic Gynecology Center of San Antonio, call 210-615-6646 or use our contact form. We're happy to answer your questions or help you book a consultation with Dr. Hailparn.
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