Purpose Statement

This blog is intended to educate women on issues that affect women. Although we are all healthcare professionals, we are not here to give medical advice. Rather we hope this will encourage women knowing that help is available and give them the courage to seek help.

Sunday, June 12, 2011

Tolerating Incontinence

“Oh my, please don’t make me laugh or I will seriously pee my pants”!  Or here’s one, you pull into the driveway and the urge to pee suddenly hits and you do the potty dance all the way into the house.  Do either of these sound familiar?  Did you know that you don’t have to live with incontinence?  That’s right I said you DON’T have to live with incontinence!   Leaking urine is common but it is not normal.  Unfortunately often women are too embarrassed to discuss their leaking issue. When they do get up the nerve to tell their provider, they are told that leaking urine is the normal part of the aging process or “You have had children, what do you expect”.   Neither of these is accurate.  Just living with incontinence or using sanitary pads are not the only available options.  There are treatment options available and you do not have to tolerate living with incontinence.
When determining treatment options we must first determine the type of incontinence.   There are 4 different types of incontinence.
Stress incontinence is leaking urine with exertion such as laughing, sneezing, coughing, jumping, running, ect…  This is usually caused by muscle weakness.
Urge incontinence is leaking urine with a sudden, strong urge to urinate, but unable to get to the bathroom on time.  This can occur with a stimulus such as pulling into the driveway, hearing running water or keys jingling.  This is usually caused by an abnormal bladder contraction or an abnormal sensation.
Functional incontinence is the inability to get to the bathroom because of physical or mental impairment.
Overflow incontinence is leaking urine when the bladder remains in a constant full state.   The bladder reaches a tipping point where it overflows and leaks urine. 
Urge and stress incontinence are the most common types of incontinence and where we will focus most of our attention today.  It is possible and very common to have more than one type of incontinence. Often urge and stress incontinence occurs together and is referred to as mixed incontinence.
So, now we know the types of incontinence, what do we do about it?
As explained in 2 previous blogs, breathing exercises and strengthening the pelvic floor muscles are excellent options that can help with all 4 types of incontinence.  
Behavioral Retraining is changing a person’s behavior to resolve incontinence.  For example, if you typically leak urine after not voiding for 4 hours, you would work on changing your voiding habits to void every 3 hours to prevent incontinence.  Or if you get up in the mornings and do other things before voiding, but then leak before you can get to the bathroom, you would then void as soon as you get out of bed.
Diet can also contribute to incontinence.  Often times we consume many foods that are known to irritate the bladder.  Foods such as soda, tea, coffee, alcohol, citrus products, and spicy foods are all known dietary irritants.  If you suspect diet may be contributing to your incontinence, keep a food diary noting what you eat and your symptoms.  Start eliminating items such as coffee for a week or two and note your symptoms.  Compare your weeks and determine if your symptoms have improved or stayed the same.
Pelvic floor physical therapy (PT) is another great option for treating all 4 types of incontinence.   PT is not only kegal exercises, but is a detailed approach to conditioning all of the muscles that work together to maintain continence.   
About now you are probably thinking, “I just want a pill” or “I thought surgery would fix my problem”.  Well let’s talk about both.
There are several different medications available for treating urge incontinence.    These medications are not effective in treating stress incontinence.   This is because the medication works to decrease the abnormal bladder sensations or to decrease the abnormal bladder contractions that cause the incontinence.
You may be familiar with most of the medications which include Detrol LA, Enablex, Vesicare, Toviaz, Sanctura, Ditropan, and Oxybutynin.  If you have tried one in the past and you did not see improvement in symptoms, consider trying a different medication.  Although all the medications are used to treat the same types of problems, many of them work differently and you may find that trying a different medication relieves your symptoms.  A prescription is required to start these medications, so if you believe you have urge incontinence, please see your provider to discuss your treatment options.
Stress incontinence is usually treated with conservative options, such as pelvic floor exercises or with surgery.  The surgery is often referred to as a “sling”.  The procedure involves placing a small strip of your body’s tissue or a synthetic material, also called mesh, under the bladder neck or the urethra to provide support. 
If you have mixed incontinence, correcting stress incontinence with a sling at times will also improve urgency and urge incontinence.  However surgical correction would not be indicated for urge incontinence only.
The last treatment option we will touch on today is Interstim Neuromodulator.  This is essentially a pace maker for the bladder and is placed around the low back or buttock area.  This is used to treat urgency, frequency, urge incontinence, and urinary retention (the inability to empty the bladder).  This is an excellent option to consider if you have failed other treatment options.
The Interstim process has 2 phases.  The first phase is simply a test phase to determine if the Interstim is a good option for you.  You wear the test stimulator for 3-7 days and if the urinary symptoms are significantly decreased or resolved, you then proceed to the second phase of having the permanent Interstim placed.  We will discuss Interstim in detail in a future blog. 
If you have incontinence and have just been living with it, as explained above, you do not have to live with it anymore.  Please see your provider to discuss treatment options.  If you are told there are no treatment options available, seek out a specialist.  You are not alone!  Help is available!