Wide range of treatments can help with urinary incontinence


Nearly one in three women experience urinary incontinence, including 50 percent of older women, but the condition doesn’t have to be a normal part of life. From lifestyle changes and medication to physical therapy and minimally invasive surgery, a range of successful treatment options are available.

First, though, you have to get over your embarrassment and discuss the problem with your doctor, usually a gynecologist.

According to Mayo Clinic, there are three kinds of urinary incontinence (UI).

Stress incontinence occurs when urine leaks during sudden exertion such as coughing, bending, lifting, exercising or stepping on uneven surfaces.

Urge incontinence is when you have a sudden, strong urge to go – even if you’ve recently peed. This can lead to accidents if a bathroom is not around.

A mixed urinary continence can also occur, with a combination of urge and stress incontinence.

While a range of causes may be behind the condition, Dr. Humberto Lamoutte, an obstetrician/gynecologist at Physicians to Women in Vero Beach, singles out obesity as the most important risk factor for daily urinary incontinence.

Obesity results in increased intra-abdominal pressure. The excess fat around the belly places extra pressure on the bladder and urethra while the intra-abdominal pressure also leads to chronic stretching and strain on the pelvic floor, weakening muscles and nerves, which leads to loss of control of the bladder.

Studies going back decades support Dr. Lamoutte’s opinion, finding that an increase in body mass index (BMI) is associated with increased risk of urinary incontinence.

Dr. Lamoutte also cites excess coffee and alcohol consumption as exacerbating UI, as well as certain medications. “If you’ve been prescribed diuretics, speak to your PCP and see if there’s an alternative to the medication or the dosage,” he says.

Mayo Clinic adds age-related physical changes and menopause to the list of potential causes of UI. An aging bladder muscle can decrease the bladder’s capacity to store urine, and after menopause women produce less estrogen, which helps keep the lining of the bladder and urethra healthy.

Studies estimate that 61 percent of women with UI don’t seek treatment due to a variety of reasons.

Everyday Health, a newsletter published a by team of medical and wellness experts, lists reasons some women suffer in silence:

  • Thinking a leaky bladder Is a normal part of aging, partly because TV ads for pads and diapers make them think it’s normal.
  • Being too embarrassed to bring it up with friends or doctors.
  • Thinking the problem is loose muscles when it is actually tension caused by tight pelvic muscles that result from unprocessed emotions and similar stressful feelings.
  • Doing Kegel exercises incorrectly. Dr. Lamoutte recommends that virtually every woman suffering from UI do these easily executed exercises.
  • Fearing that surgery will be the only solution, when, in fact, lifestyle changes and nonsurgical medical interventions are often very effective.

Dr. Lamoutte advises that weight loss will help with incontinence, especially a loss of 8 percent or more of body weight. Other ways to treat UI include:

  • Dietary changes – in addition to reducing coffee and alcohol consumption, eliminate or cut back on carbonated drinks and acidic foods (apples and oranges).
  • Manage constipation.
  • Medications that may help are available. Examples are anticholinergics, which help relax your bladder, and Beta 3 agonists, which relax the bladder muscle and can increase the amount of urine your bladder can hold. The latter may also increase the amount you are able to urinate at one time instead of small amounts more frequently.
  • Botox – injections of Botox into the bladder muscle may be beneficial if you have an overactive bladder. Generally, this is prescribed only if medications or conservative treatments haven’t been successful.
  •  InterStim therapy – a small device the size of a pacemaker is placed under the skin in your hip area that sends electrical impulses to the sacral nerves, which control bladder contraction and function.
  • Percutaneous tibial nerve stimulation (PTNS) – designed to stimulate the nerves responsible for bladder control using the tibial nerve in your lower leg. During the procedure, a small, slim electrode is inserted near your tibial nerve and connected to a battery-powered stimulator. The impulses travel to the tibial nerve and then to the sacral nerve.

In addition, surgeries like midurethral sling and bladder neck sling procedures treat stress incontinence and are designed to help the sphincter close or to support the bladder neck. Gels or other materials may be injected into tissues around the upper part of the urethra to bulk it up.

A surgical procedure called colposuspension uses sutures joined to ligaments along the pubic bone. These sutures lift and support tissues near the bladder neck and upper part of the urethra. This surgery can be done through laparoscopic incisions, or by a larger cut in the abdomen.

The Harvard Medical School newsletter outlines behavior-modification exercises that often are effective in alleviating UI. In addition to Kegel or pelvic floor exercises, it emphasizes the importance of training your bladder, which involves spacing out your voids.

If you currently urinate every hour, make yourself wait one-and-a-half hours before your next trip to the bathroom. Once you can do that easily, make yourself wait two hours, and so on. Your goal should be three to four hours between urinating. This may take several months to achieve.

Although urinary incontinence is not a life-threatening medical condition, it can significantly affect quality of life. When UI becomes bothersome, people often stop activities they enjoy such as traveling, exercising, and visiting family and friends. A visit to a gynecologist will offer a host of options to help overcome this all-too-common condition.

Dr. Humberto Lamoutte, an obstetrician/gynecologist at Physicians to Women, earned his MD degree from Louisiana State University School of Medicine, where he also completed his residency. He is a fellow of the American College of Obstetrics and Gynecology and is board certified by the American Board of Obstetrics and Gynecology. Physicians to Women is located at 1000 37th Place, #105 in Vero Beach: 772-288-2992.

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