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Incontinence: You Don’t Have to Leak Forever!
By Damon L. Hoffmann, D.O.

Damon L. Hoffmann, D.O.

In the spirit of bladder awareness month I thought it would be helpful to write a piece on urinary incontinence in women. About one in three women experience incontinence after the age of 60. This can be a significant source of social embarrassment, and often women do not seek the help they need to fix the problem.

There are two major types of incontinence that must be differentiated, as their treatments are very different. Urge incontinence results from involuntary contraction of the bladder resulting in significant leakage with little prior notice to make it to the bathroom in time. The other major type of incontinence is called stress urinary incontinence characterized by leakage of urine with cough, sneeze, or positional change. This is most often a result of structural change to the pelvic floor and angle of the urethra usually secondary to childbirth.

All incontinence treatment begins with lifestyle and dietary modifications. Avoiding bladder irritants is an important first step in improving quality of life in these patients. Urge incontinence not related to infection is best treated with medicines that act to relax the bladder muscle and make it less responsive to these involuntary contractions. If medication is ineffective there are excellent surgical options that have shown success in those who fail medications. Botulinum toxin (Botox) has been approved by the FDA for treatment of overactive bladder. Another technology called a sacral neuromodulator, similar to a pacemaker for the bladder, can also have excellent results in patients not helped by the medication. This technology is becoming the standard of care for patients with refractory overactive bladder not responsive to medication. Whatever the modality, quality of life can most often be greatly improved with appropriate treatment.

Stress urinary incontinence can be managed conservatively with Kegel exercises and pelvic floor biofeedback, but it is controversial whether these techniques can fix the problem without further intervention. A pessary, which provides structural support to the vagina to prevent organ prolapse, can successfully treat select women with this problem. Surgical correction is often necessary to adequately treat this kind of leakage and is the gold standard of treatment. This can be accomplished by an outpatient procedure and may be tailored based on the surgeon’s comfort level and other urodynamic findings. One of a variety of slings on the market, for example, can provide approximately 85% cure rate with minimal side effects.

In conclusion, women with incontinence should feel confident that they can be dry with the appropriate management of their incontinence and should seek treatment for this disease that can cause significant impairment to quality of life.

Dr. Damon L. Hoffmann is with Washington Health System Urology Specialists. For more information, call (724) 222-8871 or visit www.whs.org.

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