By Andrew Broselow, MD, FACOG, TexomaCare
Female urinary incontinence is a problem faced by many. Incontinence is defined as uncontrolled loss of urine, and can affect young and old alike. Women often find themselves hesitant or embarrassed to bring it up with their doctor. It can be a minor nuisance or a source of physical and emotional suffering. There are several causes. Fortunately, most women can be cured or at least relieved to a large extent.
The two most common types of incontinence are “urge” and “stress”. Women sometimes have both which is called “mixed” incontinence. Urge incontinence is usually caused by an overactive bladder, while stress incontinence is generally caused by a physical defect. While the diagnosis is typically straightforward, specialized testing is occasionally needed. Your doctor will begin by asking you questions, such as how many times you have to get up at night to urinate, activities that worsen it, and so on. He may test you for a urinary tract infection, and order other tests to rule out medical conditions such as diabetes. He will do a thorough examination. On occasion, he may send you for testing called urodynamics, in which bladder pressures and other factors are measured.
Urge incontinence is more often than not treated with medication, but there are other things to try. Sometimes a change in diet is helpful. For instance, caffeine and chocolate can irritate the bladder. There are specialized clinics that may offer biofeedback, where you learn to control your symptoms through behavior modification. Getting up at night to urinate may simply be a symptom of drinking too many fluids before bedtime!
If those measures don’t work, medication is used. There are several on the market, and it can take a bit of trial and error to find one that works. The medications by and large are well tolerated. The main side effects can be a dry mouth and sleepiness. These medications cannot be taken if a person has certain medical conditions, such as glaucoma.
Stress incontinence is normally caused by an imperfection in anatomy. Most people have heard of a “falling bladder”, but this can mean various things. The symptoms are loss of urine with certain activities, such as running, coughing, sneezing, or bending over to do something like gardening. While the diagnosis is simple to make, the actual abnormality can be difficult to locate. Again, certain tests may be needed if the diagnosis is unclear.
There are effective treatments for stress incontinence. The treatments range from simple pelvic exercises called Kegels, up to major surgery. The treatment depends on the abnormality, the severity of the problem, whether someone can tolerate surgery, and most importantly, the patient’s wishes.
The goal of treatment is to make the woman completely dry. Unfortunately, this is sometimes hard to achieve, but most every woman can be helped to a certain degree. Despite advances in medical knowledge and technology, urinary incontinence treatment remains an inexact science. Sometimes repeat surgeries are needed, and sometimes medicines don’t work.
There are several types of physicians that can help incontinence. Start with your primary care physician, because he or she can often solve the problem. Other specialties include gynecologists, urologists, and a new specialty called urogynecology. Urogynecologists specialize in female incontinence, and may often deal with complicated cases.
In summary, urinary incontinence is common. Women should feel free to bring up the problem with their doctor. As is often the case, you may feel self-conscious, but remember that your doctor has seen many cases like yours and can’t help unless you initiate the discussion.
For more information or to schedule an appointment with Dr Andrew Broselow, please call 903-416-6272.