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Wednesday, Nov. 16, 2022

Bladder Incontinence

Treatment options are varied

Although Bladder Health Month is in November, focusing on helping women suffering from persistent urinary incontinence is a year-round duty.

Bladder incontinence is the loss of bladder control, affecting women more than men due to pregnancy, childbirth and menopause. Incontinence brings women many surprises, including bladder leaks, more likely if they have had deliveries, needing to rush to the bathroom if they get urinary infections, and ultimately having to know where every bathroom is in a public space or friend’s house.

This negatively affects women’s quality of life, especially when activities such as running, walking or simply leaving the house are impacted. Many women choose to “live with it” as it is often considered taboo to discuss. However, it is essential to discuss this with health-care providers as they may have an over-the-counter medication, pelvic exercise or surgical suggestion that may help improve one’s life.

The key to getting the proper treatment is first to verbalize the concern to the right provider, as the correct diagnosis is critical. Getting an accurate diagnosis is essential as women suffer from various types of incontinence, and the treatments may differ.

For example, leakage associated with coughing and laughing, also known as Stress Urinary Incontinence, is most often treated conservatively with pelvic floor physical therapy or surgically by having a short outpatient procedure such as urethral bulking injections or a sling implantation. However, leakage with rushing to the bathroom or needing to urinate very often, also known as Overactive Bladder, can be managed with behavioral changes such as fluid management and oral medications, which may help reduce symptoms.

In more advanced cases, a tiny pacemaker or injections into the bladder wall to promote relaxation may be needed for better relief. Although some treatments for the different types of incontinence may sound alike, they do markedly differ, and their effects will also vary. Some patients may have more than one type of leakage simultaneously, and identifying which form of leakage helps maximize the success rates of one’s treatment.

Additionally, having a pelvic exam by a fellowship-trained urogynecologist (a specialized ObGyn with an additional three years of training focused on prolapse and incontinence) or a female-specialized urologist can help identify if a structural irregularity may exist, such as a prolapsed bladder or uterus, as these may also need to be addressed to help relieve the symptoms.

As prolapse, when the bladder drops from its usual position in the pelvis and pushes on the vagina’s walls, it may affect the frequency of urination, the ability of the bladder to empty adequately, or the urethra to be tight enough to prevent leakage. At times, the leakage happens because the prolapse prevents normal bladder function, and the urine becomes mostly trapped.

This may be diagnosed by pelvic examination and addressed surgically or conservatively using select pessaries, prosthetic devices to support the bladder, which are fitted in the urogynecologist’s office.

For patients interested in addressing stress incontinence in a conservative manner, pelvic floor physical therapy (PT) may be ideal for helping reduce the leakage. In conjunction with a trained therapist, the patient is educated about the timely activation of the right pelvic floor musculature to help increase support for the urethra. This differs from commonly known Kegel exercises, as it is more directed. When initiating the treatment, a pelvic floor therapist physically helps the patient identify the muscles to activate. Pelvic floor PT may also be effective for some patients with overactive bladder.

Regarding surgery for stress incontinence, there are various options. Those can include but are not limited to sling placement, bladder neck suspension procedures and urethral bulking. Slings may be made of approved mesh material as well as non-synthetic tissue. Depending on the procedure, the incision size may vary from being minuscule and cosmetic to slightly larger but in the bikini area.

Similarly, bladder neck suspension procedures may involve varyingsized incisions and may be done open, laparoscopically or robotically. Urethral bulking involves injecting a small amount of liquid-based material into the urethra. Compared to the others, the advantage of this option is the lack of incisions or visible scars. The procedure selection should be based on an extensive discussion with the surgeon and the patient’s lifestyle and expectations.

For individuals with overactive bladder, various medications are available. As medications may have side effects, discussing these with one’s prescribing doctor is essential. For example, some may have dry mouth and constipation as common side effects, which may cause the patient to become dissatisfied or disinterested in the treatment. Alternatively, some may interact with blood pressure medications and reduce the control of hypertension. Also, some may require multiple daily dosing, whereas others only involve a daily dose. Thus, having a conversation with one’s health-care provider is essential. It is important to note that most of these medications will take weeks to demonstrate their effects.

Familiarity with risk factors and preventative factors associated with bladder incontinence is also important. Although prevention is ideal, it may be a little challenging regarding incontinence. For example, the increased number of deliveries and body weight may raise the risk of stress incontinence. For overactive bladder, advanced age, foreign objects in the bladder such as stones, recurrent urinary tract infections and chemical bladder irritants may increase the bothersome symptoms.

Thus, seeking care from a specialist trained in women’s pelvic health, such as a urogynecologist or female-specialized urologist, is essential to optimize the care and maximize a woman’s ability to regain a sense of normalcy when impacted by incontinence or prolapse. Bladder health is important and can affect one’s daily life. Don’t “just live with it;” see a health-care provider if you are experiencing bladder incontinence or other issues.

Dani Zoorob, MD, is chair of obstetrics and gynecology at LSU Health Shreveport.


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