For many women, incontinence is an embarrassing, traumatizing problem. Pads and protective undergarments become painfully important in their lives, and it’s hard for others to understand the stigma they feel.
But many patients tell me they hesitated for a long time before seeking help, and surely other women never do. Why? Because they’re afraid the only option is surgery.
That’s just not so. Surgery is often last resort after multiple treatment options. Let’s review some of the most common ones.
The two most prevalent types of incontinence are stress incontinence and urge incontinence. Stress urinary incontinence usually involves the loss of small amounts of urine because of a sudden exertion, such as sneezing or hitting the ground while running.
That’s usually a problem of the urethra, which carries the urine out of the bladder and acts like a valve. If the muscles surrounding it aren’t strong enough to keep it closed, women can lose urine. So we use therapy such as Kegel exercises and electrical stimulation to strengthen the pelvic floor muscles. We also can inject substances called bulking agents into the urethra to strengthen it. That is an office procedure that doesn’t require anesthesia.
Sometimes diet can be a factor, as spicy or acidic foods can irritate the bladder.
Urge incontinence usually involves a large loss of urine or even the complete emptying of the bladder without warning. It is more common — and a bigger problem. It can cause a really large accident, even overwhelming a pad and soaking through clothes. But behavioral therapy can often help inhibit the bladder from squeezing out its contents at the wrong time.
Sometimes diet can be a factor, as spicy or acidic foods can irritate the bladder. A strategy called time voiding encourages women to go to the bathroom on a set schedule, rather than waiting for the urge to strike.
Medications that act as muscle relaxers can prevent, or at least delay, the bladder from contracting. Botox injections can accomplish the same result. So can repeatedly stimulating a nerve in the ankle using an acupuncture needle. This nerve stimulation technique can actually prevent bladder contractions, as can using an implantable nerve stimulator to alter nerve function from nerves leaving the lower back or sacrum.
There are many causes of incontinence, including childbirth, back or nerve problems, menopause and simply aging, although this malady can occur at any age. The challenge is to tailor treatment to each patient’s distinctive situation, to the point that if she’s not cured, she’s satisfied with the progress, so that stigma can fade away.
Doctors have more tools than ever to do that.
For more information, see this article in Baylor Innovations magazine.