By Michelle Germain, M.D.
Special to the Review
If you enjoy shopping, dining out or other activities, but worry about locating the restroom because you have to frequently go to the bathroom, you may have urinary incontinence. You’re not alone.
Urinary incontinence, the accidental loss of urine, is a medical condition that affects more than 15 million American men and women. Many people suffer in silence, wear protection pads and often forgo the activities they love for fear of urine leakage. But hope and help are available.
What causes urinary incontinence?
During urinary continence, the closure of the bladder neck is inadequate (also known as stress incontinence) or the bladder muscle is overactive and spasms (called urge incontinence or overactive bladder). There are many conditions that cause urinary incontinence, including:
· pregnancy and childbirth
· high blood pressure
· effects of medications
· diseases, such as multiple sclerosis, Parkinson’s and spinal cord injuries
Growing older can also be a factor in urinary incontinence. As we age, muscle weakness and loss occur, which can affect the urinary tract. Nerve damage and prior surgeries can also cause incontinence. Women going through menopause can suffer because of estrogen loss, too.
Stress vs. urgency
If you cough, laugh or sneeze and have urinary leakage, you may have stress incontinence. Overactive bladder symptoms include a strong, sudden urge to urinate and the need to find a restroom quickly. When you urinate frequently or “dribble,” you may also have problems with your bladder not emptying properly.
A physician with experience in urinary incontinence can diagnose the condition by taking a good medical history and performing a physical exam, asking questions about fluid intake and lifestyle. If further testing is needed, the physician may perform a cystoscopy or urodynamics study.
A cystoscopy is performed by placing a small scope or camera into the bladder. Urodynamics is a test where tiny tubes are placed into the bladder, and the bladder is filled with sterile fluid. Pressure changes in the bladder are recorded to help the physician determine the causes of incontinence.
Incontinence treatment depends not only on the cause of the leakage, but also whether a patient is male or female. Conservative treatment includes fluid management; bladder training or pelvic floor muscle exercises; elimination of caffeine and other bladder irritants, such as spicy foods and citrus; biofeedback; electrical stimulation of the pelvic muscles; and medications.
Surgical options include a suburethral sling, which acts like a hammock to provide support for the urethra. An exciting new procedure is Interstim, which is like a bladder pacemaker, where a small electrode is inserted into a patient’s back close to the nerve that controls bladder function. Electrodes work to decrease bladder overactivity and urge incontinence.
Getting your life back
Instead of racing to find the next bathroom or spending lots of money for pads, take a deep breath and know that help is available for urinary incontinence. There are many options to help you gain confidence and control to have a healthier, active lifestyle.
Michelle Germain, M.D., is Chief of Gynecology and Director of Female Pelvic Medicine at MedStar Good Samaritan Hospital. She sees patients at MedStar Good Samaritan and MedStar Union Memorial Hospital and can be reached at 443-444-4100.