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Incontinence: Don’t Suffer In Silence
Incontinence affects nearly half of all women at some point in their lives, but it is a problem that many suffer from in silence. Some women are afraid to talk to their health care providers about it, but there is a place where they can find support in a comfortable, sensitive environment. The UCSF Women's Continence Center has a team of experts specially trained in treating women with incontinence, and offers a range of medical, surgical and behavioral treatment options.
Types of Incontinence
Incontinence can affect women of all ages. The problem can be minor for some women, but for others it can have a strong effect by limiting exercise, travel and social activities.
"The most common type of incontinence is stress incontinence," says Dr. Sharon K. Knight, a gynecologist at UCSF Medical Center. "It happens when movements that put stress on the bladder, such as coughing, sneezing, exercising or laughing, causes your bladder to leak."
Urge incontinence, or overactive bladder (OAB), happens when you urinate excessively, or suddenly feel a strong need to urinate and can't make it to the bathroom.
"If you look at all incontinence patients that come into our center, about 95 percent of them have stress incontinence, urge incontinence or a combination of the two which is called a mixed incontinence," says Knight.
Less common cases of incontinence include overflow incontinence, in which the bladder does not empty properly, eventually spilling over. Functional incontinence can happen when someone has difficulty making it to the bathroom due to limited mobility. "If a patient has severe arthritis, they don't technically have anything wrong with their bladder, but they can't make it because it’s difficult for them to get to the bathroom in time," says Knight. Alzheimer's patients can also suffer from functional incontinence because they lose the ability to recognize the need to go to the bathroom.
Pregnancy, aging can play a factor
There are many possible causes of urinary incontinence, but a big factor is genetics. "We know that people who have had pregnancies and childbirth have higher rates of it," says Knight. "But after you get to a certain age, like age 50, for certain types of incontinence, the fact that you've been pregnant falls out of the risk factor."
Aging can also play a role in incontinence. "There may be some issue with hormonal changes, or it may be an issue with your nerves as they age," Knight explains. "It could be a combination of things. For example, urge incontinence is something that happens as you get older, but we still don't know the definite ideology of why it happens."
Risk Factors
There are other kinds of health issues associated with incontinence that people may not realize. "It appears that there's a higher rate of falling and fracturing a hip if you have urge incontinence," says Knight. "It's more than just the inconvenience and social issues of being incontinent. If you have a risk that you are going to fall and break a hip, it's an even bigger reason to get treatment."
Other risk factors include smoking and obesity. "If an overweight patient loses just 5 percent of their body weight, they can significantly decrease their incontinence," says Knight. "That's just one more reason to keep in shape and keep your weight down."
Range of Therapies
The UCSF Women's Continence Center offers a range of therapies to treat incontinence problems. This could include behavioral changes such as changing your diet and fluid intake, or even changing the clothing you wear.
"We try to tailor it based on the individual and have other behavioral therapies as well," says Knight. "There's something called bladder retraining which helps a patient train their bladder so they can wait longer and have more time to get to the bathroom." She says the patient decides what therapies they want to try, depending on the success they have.
One of the more familiar therapies is Kegel exercises, which help strengthen pelvic floor muscles. Urine leakage can happen when those muscles are weak. Physical therapists at the center will use biofeedback to make sure patients are doing the exercises correctly. "It gives them the visual cues that they are moving the right muscles," says Knight.
Electrical stimulation is also used to help strengthen pelvic muscles. "It's not painful," explains Knight. "A probe goes into the vagina and sends out a tiny current that stimulates the nerves. The muscles contract without the patient doing anything." She says this treatment can work for both stress and urge incontinence.
Medicines are also used to help treat incontinence. Most of the drugs relax the bladder muscle. "With urge incontinence, the bladder is constantly contracting and pushing urine out before the patient gets to the bathroom," says Knight. "This helps inhibit those kinds of contractions." Some of the medicines can have side effects including dry mouth and constipation. The center works with patients to determine which medicines will work best for their treatment, and have the fewest side effects.
Although there are no medicines for stress incontinence, there are other treatment options, including a device called a pessary. It's a rubber device that presses against the urethra, leading to less leakage. "For about 50 percent of people, it will help with stress incontinence," says Knight. The device is fitted to a patient's body, and it is not noticeable when in place.
Another device, called a semsoft, can be placed in the urethra like a catheter. "It literally plugs the urethra," says Knight. "It's particularly good for someone that says they have problems when they go running or hiking."
Surgery is another treatment option, used primarily for stress incontinence. The most common surgery is a type of sling procedure called a TVT, or tension-free vaginal tape. It's minimally invasive, with two tiny incisions made in the vagina above the pubic bone. Collagen implants can also be used to treat a very specific type of stress incontinence.
Talk to your doctor
In the United Stations alone it's estimated that about 13 million people suffer from some form of incontinence. In fact, incontinence is a common reason why people get put in nursing homes.
Knight says the first step toward any treatment is to talk to your doctor and find out what can be done to help you. "Sometimes women don't come in because they think that we're going to say they need surgery," says Knight. "I think it's important to let people know there are all kinds of treatment options. It's really the patient's choice what they do."