By Dr. Nina Bhatia, Princeton HealthCare System
Is your urge to go bringing your life to a stop?
Do you run to the bathroom instead of running around the track?
If incontinence is interfering with your daily activities, it’s time to seek help. With the right treatment approach, you can control incontinence rather than letting it control you.
Millions of Americans — the majority women — suffer from some form of incontinence, especially as they grow older.
Some women may hold back a laugh or a sneeze for fear of urine leakage.
Other women cannot be too far from a restroom for fear of not making it in time.
While there are several types of incontinence the most common are stress and urge or a combination of the two.
Stress incontinence occurs when pelvic muscles are weakened or damaged, causing the bladder to leak during exercise, coughing, sneezing, laughing or any body movement that puts pressure on the bladder.
Urge incontinence, the urgent need to pass urine and the inability to get to the toilet in time, occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously stopped. Urge incontinence is also referred to as overactive bladder.
Though many women are shy about discussing incontinence with their doctor, it is a common condition that should not be swept under the rug.
There are many factors that can contribute to incontinence with pregnancy, childbirth and menopause among the main causes.
Pregnancy and childbirth can weaken the pelvic floor muscles that support the urethra leading to urinary leakage and/or the urge to urinate.
After menopause, lack of estrogen can lead to the thinning and drying of the urethral tissue, contributing to incontinence.
Other causes include:
Overweight and obesity, which increase pressure on the bladder and muscles that control the bladder.
Certain medicines, especially diuretics used to treat heart failure, hypertension and kidney diseases.
Caffeine and alcohol. Caffeine can irritate the bladder, while alcohol can cause you to produce more urine. Both can contribute to urge incontinence.
Chronic cough. Coughing can increase pressure on the bladder and weaken pelvic muscles.
Constipation. The rectum and the bladder share many of the same nerves. When stool is impacted it can cause the nerves to be overactive, resulting in urinary frequency.
Infections. Urinary tract infections can cause temporary incontinence, which tends to improve when the infection is treated.
Neurological disorders such as multiple sclerosis, stroke, or a spinal injury. These can interfere with the nerves that control the bladder.
Family history. If members of your family suffer from incontinence, your chances of developing the condition increase.
Incontinence is so common that many women think it is normal and just avoid activities or adjust their lifestyles to deal with it. In most cases, however, it can be easily corrected. In fact, the American Urogynecologic Society estimates that 80 to 90 percent of women who seek treatment experience significant improvement.
Treatment for urge incontinence usually begins with conservative therapies, including:
Diet changes to eliminate food (like spicy foods and chocolate) and drinks (alcohol, coffee and tea) that irritate the bladder.
Bladder training to help relearn how to hold urine longer.
Medications to regulate bladder nerve and muscle activity.
If conservative measures aren’t enough, University Medical Center of Princeton offers advanced therapies, including neuromodulation, a simple outpatient procedure that places a small generator, about the size of a pacemaker, under the skin to regulate the bladder.
Other options include bladder Botox or tibial nerve stimulation, both of which can be performed in the office with little to no discomfort.
Treatment for stress incontinence involves re-establishing support for the ligaments and muscles that support the urethra through:
Conservative treatments, including weight loss, lifestyle changes and pelvic floor muscle training, including Kegel exercises.
Collagen injections to improve the support of the tissue around the urethra, so patients are less prone to leakage.
A pessary device, which is a removable device typically made of silicone. It is similar to a diaphragm that is fitted into the vagina to help hold the bladder, uterus and bowel in place.
A minimally invasive outpatient procedure that uses a sling made of synthetic material to support the urethra. The procedure, performed under sedation, typically takes less than 30 minutes and most women return to normal activities within 24 hours.
To learn more about taking control of incontinence, join me for a live web chat hosted by Princeton HealthCare System (PHCS) at 7 p.m. on Thursday, Sept. 17. I will answer your questions and discuss treatment options.
To participate, go to the Ustream Channel at www.ustream.tv/channel/princetonhealth on your computer, tablet or smartphone on the day of the seminar.
If you’d like to ask a question during the web chat you can log in using your Facebook or Ustream account or you can create a new account. Alternatively, you can also submit questions in advance by sending them to PrincetonHealth@gmail.com.
To find a physician with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org.
Nina Bhatia, M.D., F.A.C.O.G., F.P.M.R.S, is double board certified in both Female Pelvic Medicine and Reconstructive Surgery, and Obstetrics and Gynecology. She is a fellow of the American Congress of Obstetricians and Gynecologists, a member of The American Urogynecologic Society, and a member of the medical staff at University Medical Center of Princeton.
