Taking the Stress Out of Incontinence

You may have heard the term "almost wet myself laughing," but for Margaret it was an embarrassing fact of life. It happened frequently-during dinner parties, at restaurants and once in the middle of an important business meeting.
Margaret had urinary stress incontinence. While any type of urinary incontinence can cause significant emotional stress, the term, in this case, refers to the pressure placed on the bladder with laughing, coughing, sneezing, running, sexual activity or other movements that results in unwanted leakage of urine.
“Many women are embarrassed to discuss this common problem,” stated P.T. Nguyen, OB/GYN.  For many women, urinary stress incontinence is a distressing aftermath of pregnancy and childbirth.
Incontinence is defined as involuntary leaking. In practice, many women are too embarrassed to bring the matter up to a doctor-or anyone else-until the leakage or the fear of leakage is great enough to interfere with daily activities.
Stress incontinence is the most common type, accounting for more than half of all cases of incontinence. It affects mainly women, usually between the ages of 40 and 60, and the most common precipitating factors are pregnancy and childbirth-both of which place unusual strain on the supportive tissue, ligaments and muscles of the pelvic floor. About 30 percent of women develop some degree of stress incontinence about five years after their first vaginal birth.
Weakened Pelvic Floor -- When the structures that help support the bladder become weakened, the bladder tends to move downward, pushing out toward the vagina. The muscles that ordinarily force the urethra to shut tightly and stop the flow of urine become weakened and does not squeeze as tightly as they should, allowing urine to leak out during times of physical stress.
Decreased estrogen levels, even those that occur the week before a menstrual period, can also cause these muscles and those in the urinary sphincter to exert less force than usual.
Stress incontinence sometimes occurs in combination with the other main type, urge incontinence, caused by abnormal nerve signals controlling bladder muscles. If you have urge incontinence, you may feel the urgent need to urinate even though the bladder is not totally full. Hearing water running or even feeling water on your skin may bring on the urge, and leakage occurs as a result of this urgency rather than the squeezing, pressure reaction of stress incontinence. A sub-type of urge incontinence is overactive bladder, which results in frequent urination throughout the day.
In many cases, these types of urinary incontinence occur together, a condition known as mixed incontinence.
Treatment depends on what type of incontinence is involved-stress, urge, mixed, overactive bladder or another type. A doctor can usually determine this through a history and physical examination. One test that can be conducted in the doctor's office involves measuring the amount of leakage that occurs with activities such as jumping, climbing stairs, coughing, doing deep bends or washing hands.
Unlike other types of urinary incontinence that can be treated with medications that help relax bladder muscles, stress incontinence, by itself, generally does not respond well to drugs. The exception may be duloxetane, an antidepressant that has been found effective enough to be approved in Europe and is often used in the United States.
The problem usually occurs because of damage to ligaments, muscles and other structures that support the bladder. Women who have not yet completed their childbearing years should not have corrective surgery. And generally a surgical solution should be considered only after all non-invasive options have failed.
“Surgical solutions of long ago are no longer the gold standard,” said Dr. Nguyen. “Newer, more advanced procedures offer women treatment options.”
Sling procedures use a strip of tissue-taken from the patient's body or constructed from man-made materials-to cradle the bladder neck and lift it up.
A tension-free vaginal tape procedure has become increasingly popular since it was introduced in the mid-1990s. It's minimally invasive, using small incisions and specially designed needles to place a synthetic tape under the urethra that can then be adjusted to provide just the right amount of support.
“As with any surgery there are risks, but the newer minimally invasive procedures with new technology afford women a quicker recovery with long term success and fewer post-operative complications,” added Dr. Nguyen.
For more information, please call Dr. Nguyen at Massena Women’s Center at 315-514-1330.  Dr. Nguyen also treats patients for annual exams, pregnancy, and laparoscopic surgery for shorter recovery times, infertility, contraception, management of heavy or painful periods, pelvic pain, and gynecology consultation. Please call to schedule an appointment, new patients are welcome and the doctor is accepts most insurances.

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April 2014

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