By Timothy L. Chase, MD, FACOG, FPMRS
Many women leak small amounts of urine from time to time. Leakage of urine can happen with specific movements during pregnancy or events such as coughing, sneezing, or exercise. Other women feel the urge to urinate and cannot get to the bathroom in time. When either symptom becomes frequent or severe enough to affect your daily living and lifestyle, it is called urinary incontinence.
Urinary incontinence is a medical condition and is not just “a normal part of getting older.” It is a widespread problem that affects millions of women of all ages. The good news is that there have been dramatic improvements in the treatment of urinary incontinence in recent years.
The key to solving this problem is getting a proper diagnosis. Once you know what type of incontinence you have, the more effectively it can be treated. There are three main types of incontinence: stress incontinence, urge incontinence, and mixed incontinence. If you leak when you cough, laugh, sneeze or exercise, it is most likely stress incontinence. If you suddenly get the urge to go to the bathroom but cannot get there in time, it is probably urge incontinence. The third type is a combination of the two.
Stress incontinence can be treated with pelvic floor exercises, vaginal inserts, and surgery. Surgical treatments for stress incontinence have greatly improved. The pubovaginal sling is an outpatient surgery that has been available for several years now, and it is intended to last a lifetime. For this surgery, general anesthesia is not required and can usually be completed in 20 minutes with the patient going home the same day without a catheter. Many patients can return to work a day or two after surgery.
Urge incontinence is treated primarily with bladder retraining and medications. For a long time, if those options didn’t help or had too many side effects, then you just had to live with the problem. Fortunately, we now have additional options such as neuromodulation therapy and bladder Botox. There are two neuromodulation therapy options. One is a comfortable series of weekly treatments in the office. The second is a more permanent option called Interstim, which functions as a bladder pacemaker. Bladder Botox is a minor procedure where Botox is placed directly in the bladder muscle. This intervention helps to block the nerve signals that trigger urge incontinence. This can be done in the office or at an outpatient surgery center.
Urinary incontinence is a very common problem. Fortunately, there are new, effective ways to treat it. No one technique is suitable for everyone. Just as each of us is an individual, your doctor must personalize your treatment. If urinary incontinence affects you, please see your doctor to benefit from the latest medical advancements in bladder health.
Timothy Lee Chase, MD graduated from Bowman Gray School of Medicine. An Obstetrics and Gynecology Residency was completed at New Hanover Regional Medical Center. His special areas of interest are Female Pelvic Medicine and Reconstructive Surgery. Board Certified in Urogynecology and OB/GYN, Dr. Chase’s practice is Glen Meade Center for Women’s Health.