Treatment options for women suffering from incontinence

By E. William Johnson, MD, MPH

Atlantic Urology Associates, Core Physicians

Female incontinence is a common problem among women of all ages and can be extremely debilitating. Some women find themselves having to get up several times during the night, while others find themselves using the bathroom every hour.

Others find themselves embarrassed by uncontrollable leaking when laughing, coughing or sneezing. This condition often becomes disruptive to their lives as women plan their days around bathroom locations. The sense or feeling of needing to go to the bathroom may be constantly in their mind.

Although this is upsetting, some women may feel unsure about speaking to their physician about the problem or worry that there is little more they can do than wear a protective undergarment. Others may feel that this is a normal thing to experience after having a baby, entering menopause or a part of aging they cannot control. Women may give up after the first medication they tried did not work.

While one medication may not work for every woman, there are a number of treatment options and lifestyle changes women can make to help decrease these episodes of incontinence.

Initially, you should speak with your primary care provider about your concerns related to incontinence. If appropriate, you will be referred to a urologist, a physician who specializes in the diagnosis and treatment of diseases of the urinary tract and urogenital system.

When you meet with a urologist, the urologist will begin to determine the type of urinary incontinence that you are experiencing. A urodynamics study that measures how the bladder and urethra are performing their job of storing and releasing urine may be employed in making a diagnosis. This study can help your urologist understand how well your bladder and sphincter muscles work.

As the urologist works to determine what is causing your incontinence, you may be asked to keep a journal of your diet and fluid intake to determine if your diet, drinking habits or medications may be partially responsible. For example, certain foods are known to irritate the bladder and avoiding or consuming them in moderation may help decrease symptoms. Some foods that are considered bladder irritants include: chocolate and spicy foods such as peppers, chili or curry powder and tomatoes. Drinks that may irritate your bladder include coffee, tea, soft drinks, chocolate milk, citrus juices and all alcoholic beverages. Certain medications may also affect bladder function such as painkillers, cold and allergy medications, stimulants and some prescriptions.

The urologist will approach your treatment plan based on the kind of incontinence you are experiencing. The first type is stress incontinence, which occurs when you have a "leak" when coughing, laughing or sneezing. Some women experience this during pregnancy or after childbirth. Another type of incontinence is urge incontinence, which is also known as overactive bladder. Women find they have to go all the time and often have a hard time making it to the bathroom. Many women have a mixed diagnosis with both urge incontinence and stress incontinence. Incontinence can be caused by nerve problems, bladder muscle wall problems or over stimulation of the bladder.

One thing a urologist might suggest in cases of stress incontinence is that you begin using Kegel exercises to strengthen the pelvic floor or work with a physical therapist who may offer other exercises to strengthen those muscles to help lessen these episodes. There are no medications for stress incontinence, but there are prescription medications that might help women with urge incontinence. Although some women may experience side effects such as dry mouth or constipation when taking these medications, many women have successfully decreased the symptoms of urge incontinence when using these medications.

Patients with stress incontinence who do not experience relief after physical therapy may be candidates for a urethral sling, which is placed inside the vagina and under the urethra during an outpatient procedure in the operating room.

A device that emits a constant low level stimulation to the nerves of the bladder may be an option for women with urge incontinence, whose symptoms have not improved after diet or lifestyle changes. By targeting the communication problem between the pelvic nerves and the bladder, the device is able to calm the bladder, which helps decrease the frequent urge to go. The device functions on its own, and can be adjusted using an external device, similar to how a pacemaker works. This minimally invasive procedure is done in an outpatient setting and it takes less than one hour to place the device in your body. Like medication, this treatment approach may not work for everyone.

One other new treatment that has yielded positive results in women employs acupuncture for the bladder by stimulating the ankle nerve. The treatment includes 30-minute treatments in the doctor's office or clinic every week for 12 weeks.

Women are twice as likely as men to experience urinary incontinence, but it does not have to be part of your life permanently. If you have been carrying the burden of living with urinary incontinence in silence, make an appointment to see your primary care provider or a urologist. Whether you need to simply modify your diet, try medication or eventually decide to try the new minimally invasive treatments for incontinence, there are many options available to help you live an active and healthy life free from incontinence.

E. William Johnson, MD, MPH, is a urologist with Atlantic Urology Associates, a Core Physicians' practice with locations in Exeter, Portsmouth and Plaistow. Dr. Johnson's philosophy is to treat each patient as if he were treating a family member by considering both the total pictures of their lives and their long term outcomes. His goal is to provide patients with the most up to date care and treatment options in a compassionate and personal manner. For information, call 658-1277 or visit www.corephysicians.org.