A very common and yet embarrassing problem that we see every day is urinary incontinence. Although very common, it is often not discussed openly even with a woman’s physician unless directly inquired about. It is not, as many people think, a problem of elderly women alone. Many women are troubled with this even as early as their 20’s. A conservative estimate places expenditures on incontinence products in the billions of dollars per year in this country. Urinary incontinence impacts patients’ ability to function in the workplace, enjoy recreation, and even a normal sex life. Many secondary problems including frequent urinary tract infections, skin disorders, and depression to name a few, are seen quite often.
There are basically 3 types of urinary incontinence. First, stress incontinence which is responsible for the majority of diagnoses, is caused by loss of the supporting structures surrounding the lower urinary tract (bladder and urethra). This is exaggerated by vaginal deliveries of children, time, gravity, genetic predisposition, and chronic coughing like that seen in smokers. Second, urgency incontinence occurs secondary to uncontrollable bladder spasms that often lead the bladder to empty large volumes of urine with very little warning. A common scenario is the feeling of a full bladder and an inability to get to the bathroom before leaking occurs. Many contributing factors lead to this kind of incontinence including medications, infection, caffeine intake, neurologic disorders, and behavioral problems. The third type of incontinence is a combination of the first two and is termed “mixed” incontinence.
The good news is that there is treatment available for most cases of urinary incontinence. Stress incontinence is usually managed with restoring the normal anatomy either by surgery or the use of a pessary (a diaphragm type device placed within the vagina). Surgery for this problem used to be a major operation but now with modern, minimally invasive procedures, outpatient surgery is the norm. Most patients are back to work within a few days. Physical therapy/biofeedback has been shown to be helpful as well. Medication is the mainstay of therapy for urgency incontinence although behavioral modification plays a large role as well. Biofeedback is another avenue that may be explored. Mixed incontinence is a bit more of a challenge to manage and involves an individualized treatment plan often incorporating the treatment of both diagnoses.
In summary, urinary incontinence is a very common problem, not often discussed outside of a physician’s office but can be managed quite effectively in most cases. There is simply no excuse to allow this problem to modify one’s active lifestyle.
Mark P. Hyde, M.D., FACOG
Tags: bladder, health, M.D., Mark P. Hyde, richmond, urinary incontinence, Virginia Physicans for Women, virginia physicians for women, vpfw, women