Q. What are the symptoms of urinary incontinence and how is it treated?
A. By Amy Rosenman, M.D., board-certified gynecologist specializing in urogynecology and pelvic floor problems at Saint John’s Health Center
Stress incontinence is the involuntary loss of urine or leakage, when someone sneezes, coughs or during exercise. Incontinence and prolapse – – the dropping of the bladder or a bulge at the vaginal opening which interferes with emptying the bladder — is not a normal part of the aging process. Most cases of urinary incontinence occur in women in their forties and fifties and are often caused by damage to the pelvic floor as a result of childbirth.
Most women are not comfortable speaking with their physician about incontinence. But if women start to plan their lives around their bladder and stop participating in normal activities, they should see their primary care doctor. If that doctor cannot help, they will refer them to someone who can – this often means seeing an urogynocologist or urologist with expertise in pelvic floor problems.
There are a variety of treatments for incontinence, including “training the bladder” to hold more fluid and to help with urgency and frequency. “Kagle” exercises are pelvic floor muscle strengthening exercises often utilizing biofeedback as a teaching tool.
The best news is that hese training exercises work. In women with mild to moderate cases of incontinence, after 6 months of pelvic floor muscle strengthening 75% of women are “dry” or substantially drier.
In cases where the strengthening exercises are not successful, patients can be treated with neuro-stimulation (electrical stimulation to the surface of the body) either directly in the vaginal area or on the ankle. There are also medications to help with frequent urination and urgency.
For activity-related leakage there are very effective surgical procedures. Today, the gold standard is a minimally invasive surgical technique developed in the nineties – the “Transvaginal Tape Procedure.” In this procedure, a 1⁄2-inch incision is made in the vaginal tissue under the tube that carries urine out of the bladder. A very small piece of nylon-like mesh tape is placed through the incision. The patient is ambulatory and regional anesthesia or light general anesthesia is used for the procedure. The only limitations placed on the patient after this procedure is that she cannot lift anything weighing more than ten pounds for two months following the surgery. Otherwise, she may resume most normal activities in a few days.
Prior to the introduction of this less invasive procedure, surgery was much more invasive and required hospital stays and a longer recovery period. Older procedures were only 75% – 80% successful and, after five years some recurrence of incontinency was common. The Transvaginal Tape procedure is 90% successful without recurrences noted after 10 years.
Dr. Rosenman and her partner, William H. Parker co-authored “The Incontinence Solution: Answers for Women of All Ages,” for women to understand that the incontinence is not a normal function of aging and they do not need to live with the condition.
Amy Rosenman, M.D. is a urogynecologist at Saint John’s Health Center, and is President of the American Urogynecology Society Foundation. For more information about Dr. Rosenman and other Saint John’s services please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call
1-888-ASK-SJHC.
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