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Spring 2006 Incontinence in Women: Nature Doesn’t Always Help, But Surgery CanUrinary incontinence. The bad news is the best way to avoid it is never to have children and don’t age. The good news is that medical and surgical advances mean there are many ways to treat it. For generations urinary incontinence has been a taboo subject, but women are becoming more open and realizing it’s not something to hide. The National Institutes of Health estimates 8.5 million women suffer from urinary incontinence. There are two main categories of incontinence: urge (or overactive bladder) and stress incontinence. Urge incontinence is the involuntary loss of urine associated with a strong desire to empty the bladder and can often be treated effectively with medication. Stress incontinence is the involuntary loss of urine during coughing, sneezing, laughing, jumping, or anything that increases intra-abdominal pressure. Women may suffer from one or the other, or a combination of both, said gynecologist Susan Peeler, M.D., medical director for Women’s and Children’s Services at AAMC. Since the cause of incontinence involves the vagina, pelvic floor, and the bladder, the treatment is often a combined approach by a gynecologist and a urologist, she said. “The risk factors for incontinence include having vaginal deliveries, being pregnant with large babies, chronic coughing (smokers or asthmatics) and obesity. Jobs that require heavy lifting can strain and weaken the pelvic floor muscles even more,” she said. Dr. Peeler said while every woman’s anatomy and history is unique, she can quickly assess a patient, and then, if necessary, refer her to a urologist. Urologist Edward Zagula, M.D., said, “Lots of women I see have suffered in silence. Many wear pads or diapers because their mother and grandmother did. But it doesn’t have to be that way.” His assessment includes a voiding history, physical exam and urine analysis. Further testing could include cystoscopy and cysometrics to evaluate the function of the bladder. With this information, the type of incontinence can be determined and treatment with biofeedback, exercise, medication or possibly surgery can be recommended. Biofeedback is electronic stimulation to the muscles of the pelvic floor that can help patients regain some more function. Kegels are exercises that also strengthen those muscles. “For women with urge incontinence, the new drugs on the market are having great results.” However, Dr. Zagula said that many women with stress urinary incontinence have such weakened walls that none of these options is optimal. Surgical techniques to help incontinence have improved over the years to include minimally invasive techniques, which have a shorter recovery, smaller incisions, and better material for sutures that absorb into the body and help hold the bladder in place. This surgery, called a transvaginal tape or TVT, is replacing earlier procedures (e.g., MMK, Burch, Raz and Stamey) and is having positive results. The benefit of TVT is the substance used to create the support that absorbs into the pelvic muscles providing additional support. The goal, however, is the same: to stabilize the pelvic floor by placing a sling or mesh tape under the bladder neck and urethra (the tube through which urine exits the bladder). The urethra should maintain a tight seal to prevent involuntary loss of urine, but for women with stress urinary incontinence, a weakened pelvic muscle floor cannot support the urethra in its correct position. Often the urologist and gynecologist will work side by side during a surgery. Dr. Peeler said she will often build a “platform” and repair the pelvic relaxation by repairing any tears in the muscles and fascia, then turn the surgery over to the urologist, who is able to insert the sling through two small incisions in the pelvic region. For more information or a referral to a gynecologist or urologist, call askAAMC at 443-481-4000. Incontinence in Men, Too! According to the National Institutes of Health, an estimated 22 percent of men 65 years or older and 1.5 percent of men younger than 65 years suffer from some form of incontinence. Like women, men can suffer from stress and/or urge incontinence. And also like women, men can control incontinence through medication, exercises, biofeedback and/or surgery. Dr. Zagula said, “In men the problem is usually related to the prostate gland. In younger men this is usually inflammatory while in older men it can be related to enlargement or cancer.” For more information, talk to your primary care physician or call askAAMC at 443-481-4000. |
