By Scott M. Press, MD
More than 13 million people in the United States, male and female, young and old,
experience urinary incontinence. Urinary incontinence is the leakage of urine, which, when frequent or severe, becomes a social or hygienic problem. Conquering this disease begins with recognition of the problem and a consultation with a knowledgeable health care professional.
Women experience urinary incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract, account for this difference. Aging alone does not cause incontinence. It can occur for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation, and certain medicines can cause bladder control problems that last a short time. Sometimes incontinence lasts longer and may be due to weak or overactive bladder muscles.
During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. Spinal nerves control how these muscles move. Incontinence will occur if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
There are several different types of urinary incontinence:
• Stress incontinence happens when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements put pressure on the bladder. It is the most common type of bladder control problem in younger and middle-age women and can prevent women from actively participating in sports.
• Urge incontinence happens when people can’t hold their urine long enough to get to the toilet in time. Healthy people can have urge incontinence, but it is often found in people who have diabetes, stroke, Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis. It is also sometimes an early sign of bladder cancer.
To diagnose your problem, your physician will first ask about your symptoms and review your medical history. Your pattern of voiding and urine leakage often suggests the type of incontinence. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If your medical history does not define the problem, it will at least suggest which tests are needed.
Sometimes physicians prescribe medication to treat incontinence. There are medications available that prevent unwanted bladder contractions or tighten muscles to decrease the amount of leakage. Vaginal estrogen may be helpful in women after menopause. Some of these medications can produce harmful side effects if used for long periods. Talk to your physician about the risks and benefits of long-term medication use.
When other options, including treatment with medications, fail, surgery is a viable choice for the treatment of urinary incontinence. Weak bladder muscles in women can be alleviated with minimally invasive outpatient surgery. As a physician that specializes in urology, I regularly perform vaginal tape procedures with a tape made of a synthetic mesh. This tape is placed under the urethra, where it acts as a hammock, compressing the urethra to prevent leaks that occur with activities of daily living. As this procedure requires a small incision, it results in less pain and quick recovery. The procedure only takes about half an hour, and the patient leaves the hospital dry.
Sacral nerve stimulation is an FDA-approved electronic stimulation therapy that can be effective in reducing urge incontinence. A thin lead wire with a small electrode tip is surgically placed near the sacral nerve in the lower spine, which controls voiding function. A nerve stimulator then sends small electrical impulses continuously to the sacral nerve. The impulses act as a bladder pacemaker, reducing or eliminating urge incontinence in a high percentage of patients. This is a quick outpatient procedure that can be performed in the physician’s office or ambulatory surgery department in the hospital.
Today there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
Scott Press, MD is a board certified urologist on the Medical Staff at Eastern Long Island Hospital. For a consultation or appointment at the Gladys Brooks Medical Village in Greenport, call (631) 477-1885.
EASTERN LONG ISLAND HOSPITAL 201 Manor Place, Greenport, NY 11944 (631) 477-1000 FAX 477-8218