Inconvenient Incontinence: Getting Control of the Leak
October 2019 Issue
One of the most dreaded conditions for women (and men) is incontinence. Unwanted and untimely waste leakage is a problem that ranges from being inconvenient to completely embarrassing. Though it’s usually a topic discussed jokingly in women’s circles, urinary incontinence is truly no laughing matter, and fecal incontinence is even worse. Both conditions can change a person’s lifestyle, making them not want to go out or socialize as much because of the chance of unwanted leakage. The good news is incontinence is not inevitable with age. In addition, there are many effective new treatments to consider. Read on to learn the various conditions of leakage—as they are not the same—and what you can do about it!
Eve A. Ashby, DO, FACOOG
Beaufort Memorial Lowcountry Medical Group
Stress Incontinence: Coughing, Sneezing and Laughing, Oh My
Stress incontinence is the leaking of urine caused by increased pelvic pressure, which commonly occurs when laughing, sneezing, jumping, or even just going down stairs.
If this is intermittent and doesn’t require wearing a pad, then usually it can be treated with lifestyle changes. For instance, weight loss (in overweight women), dietary changes (decrease consumption of alcohol, caffeine, and carbonated beverages), avoiding constipation and smoking cessation have all been proven to improve incontinence.
Pelvic floor muscle exercises such as Kegel exercises, supervised pelvic floor therapy with a health professional, weighted vaginal cones and biofeedback to identify and isolate the right muscles to strengthen the pelvic floor, have all shown improved outcomes.
Vaginal estrogen supplementation (creams/rings/suppositories) can help improve blood flow to the pelvic floor muscles and vaginal tissue. When used together with vaginal exercise, estrogen supplementation can drastically improve bladder control.
Continence devices, such as pessaries, can help restore normal vaginal anatomy and help with incontinence episodes. These range in size and shape and need to be fitted by a gynecologist or incontinence specialist. Patients can be taught to insert and remove these devices on a daily basis, or they can be removed and cleaned by a health professional every two to three months.
Lastly, surgical options have been the mainstay for treatment of stress incontinence. There has been some negative press in the past few years about vaginal mesh, which is used in many of these procedures. However, in the right hands (experienced pelvic surgeon) and in the right patient (medically stable and able to heal well), these procedures are most effective. Prior to surgery, the surgeon will test the bladder by doing urodynamics to make sure the right approach is taken.
Eve A. Ashby, DO, FACOOG, is a board-certified gynecologist with Beaufort Memorial Lowcountry Medical Group. A graduate of the University of Medicine and Dentistry of New Jersey, Dr. Ashby is also an Assistant Professor and Regional Director of Medical Education for A.T. Still University School of Osteopathic Medicine. She can be reached at 843-770-0404.
Gregory Glover, MD, FACOG, FPMRS
Werner & Glover Women’s Health and Beaufort Memorial Hospital
Incontinence isn’t just for urine.
Fecal incontinence is the loss of stool or gas at unwanted times. Although it affects about 18 percent of women, it is not often discussed due to its nature. It may be incapacitating in that it may cause those experiencing symptoms to minimize social contact to avoid embarrassing situations.
The most common causes are from injury often related to pregnancy and childbirth, which may not cause problems until years after the injury. Surgery, radiation and trauma may also cause similar injuries. Infections, tumors, neurologic diseases, congenital problems and dietary intolerance are among the other causes of fecal incontinence.
The first treatment step is to adjust and optimize your diet, as formed stools are easier to control than loose ones. Medications and pelvic muscle exercises can help, as well.
For patients who are not improved with initial treatment, stimulation of the nerves that control bowel movements (neuromodulation) usually results in over 90 percent improvement of symptoms. Surgery to repair trauma may be indicated for certain individuals.
Gregory Glover, MD, FACOG, FPMRS, is a board-certified gynecologist with Werner & Glover Women’s Health in Beaufort. A member of the Beaufort Memorial medical staff, Dr. Glover specializes in female pelvic medicine and reconstructive surgery.
Eric S. Gwynn, M.D. - New River Urology & Hilton Head Regional Healthcare
Is urinary incontinence inevitable as you age?
Approximately 25 million American adults experience loss of bladder control, but they often don’t have to. According to the National Association for Continence, 80 percent of those affected by urinary incontinence can be treated. For some people, this involuntary release of urine can affect their quality of life.
Incontinence is a symptom, not a disease. On a temporary basis, it can be caused by urinary tract infections, constipation or certain medications. Persistent urinary incontinence may be caused by weakness of the bladder, or the muscles supporting it, overactive bladder muscles, or urinary tract blockage.
Certain foods, medications and drinks can activate
the muscle that pushes urine out, including:
> Caffeine or alcohol
> Soda or any other carbonated drink
> Sugary, acidic, spicy foods and fruits
> Blood pressure medications or muscle relaxants
Not All Incontinence is the Same
Types of urinary incontinence include:
> Stress incontinence happens when certain activities such as coughing, sneezing or laughing increase abdominal pressure on the bladder.
> Urge incontinence occurs when the need to urinate happens unexpectedly.
> Overflow incontinence involves small amounts of leakage due to a full bladder.
> Functional incontinence affects people with normal bladder control, but who cannot get to the bathroom quickly due to physical limitations or mental disease.
Once the cause of urinary incontinence has been identified, treatment options usually fall into three main categories.
> Behavioral techniques require making certain lifestyle changes. For example, setting up a schedule to go to the bathroom every few hours or retraining the bladder to gradually extend the time between bathroom trips. Pelvic floor muscle exercises, also called Kegel exercises, are recommended to strengthen the muscles below the bladder that control urination.
> Medications can be prescribed to treat an overactive bladder, or urge incontinence. These drugs block nerve impulses to the bladder, decreasing the urgency and frequency of urination.
> Medical devices or surgery are also available to treat incontinence. More than 200 variations of surgical procedures can be performed to treat causes of urinary incontinence. These include placement of an artificial urinary sphincter to control urine flow, injection of a bulking agent (such as collagen) into the urethra to create resistance against urine flow, or implantation of a sacral nerve stimulator to help control the bladder. A bladder neck suspension, or sling procedure, can be done to help hold up the bladder and narrow the urethra to prevent leakage.
> Urinary incontinence should not be suffered in silence. Hiding incontinence can lead to rashes, sores and skin or urinary tract infections. Talk to your doctor about your signs and symptoms, as well as your options. For more information visit the National Association for Continence website at www.nafc.org.
With more than 10 years of experience in urology, Dr. Gwynn offers a range of services to address conditions such as incontinence and female pelvic floor prolapse. He is board certified by the American Board of Urology. New River Urology and Hilton Head Regional Healthcare. Call for more information: Bluffton/Savannah 843-706-2255 or Hilton Head Island 843-342-7607.
Katherine Coley, M.D. - Advanced Women's Care of the Lowcountry
Can feminine rejuvenation help with incontinence?
The answer is YES! Feminine rejuvenation stimulates collagen production in the vaginal walls, helping to bring back support and elasticity to the vaginal tissue. The upper vaginal wall sits right beneath the bladder and plays a big part in supporting the bladder and the urethra. Stress incontinence is caused when there is a weakening of the supportive tissue holding the urine back when force is applied such as a cough, laugh, sneeze or jump. Feminine rejuvenation also helps with overactive bladder or urge incontinence. As the tissue becomes healthier, there is less spasming as the bladder fills, leading to less frequency and urgency. The tissue around the opening to the urethra is also improved with feminine rejuvenation and helps prevent urinary tract infections. The end result is overall better urinary control throughout the day and better sleep through the night because getting up many times to void can be minimized.
Dr. Katherine Coley is a board certified Ob/GYN at Advanced Women’s Care with 13 years of experience. She graduated residency from New York Presbyterian hospital/Weill-Cornell program. Call for more information: 843-341-9700.