Female incontinence affects millions of women throughout the United States. Although the problem is common, many women do not seek care because they are embarrassed or believe that incontinence is a normal part of aging. However, there are many ways to treat and even cure incontinence. The first steps are understanding the condition and knowing what can be done about it.
According to Eman Elkadry, M.D., Urogynecologist at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, incontinence can affect women of all ages. However, aging increases the risk for developing incontinence because the pelvic muscles may become weaker and the bladder may be increasingly overactive. “The incidence of urge incontinence increases with every decade of life,” says Dr. Elkadry.
Urge incontinence is one of the most common types. It is often referred to as overactive bladder and is most commonly associated with aging. It occurs when the bladder involuntarily and spontaneously contracts and causes urine leakage. Triggers that may cause accidents include running water, the act of unlocking the door to the house, or simply not making it to the bathroom on time.
Stress incontinence is another common type of incontinence and occurs when the urinary sphincter muscle is weakened or the pelvic-floor muscles are damaged. Childbirth is commonly associated with stress incontinence, especially in young women. Sneezing, laughing, coughing, exercising or other activities that place pressure on the bladder can induce leakage.
Women usually seek medical help when incontinence limits activity or decreases their quality of life. “When leakage becomes a bother in a woman’s life there are many options for treatment,” says Dr. Elkadry. Incontinence is often diagnosed based on medical history, symptoms and a physical exam. Other formal bladder testing may be required, such as urodynamic testing, which measures several areas of bladder function. Testing confirms whether the incontinence is caused by stress, urge or both (mixed incontinence). Dr. Elkadry says other tests may be needed to identify problems that could contribute to urinary incontinence.
Several non-surgical treatment options are available to women. Treatments differ depending on whether a woman is experiencing stress, urge or mixed incontinence. A pessary, which is similar to a diaphragm, is commonly used to treat stress incontinence. The device, which is custom fit for each woman in the office, can be easily managed at home. Pessaries support the bladder neck and prevent leakage caused by coughing, sneezing and other activities. “Many women have great success with a pessary and use it for many years,” says Dr. Elkadry. “Others use it to control symptoms until they are ready for surgery.”
Urge incontinence is often treated with behavior modifications (bladder retraining) alone or in conjunction with medication. Bladder retraining requires regulating fluid intake by spreading out fluids throughout the day instead of drinking large amounts at once. It also involves scheduled voiding starting at a gradually increasing, but comfortable interval. The bladder eventually relearns to delay urges. There are also various medications that can help quiet an overactive bladder.
Dr. Elkadry says women who aren’t responding well to more conservative methods may be treated with electrical stimulation, which stimulates and strengthens the pelvic floor muscles. “There are various types of electrical stimulation,” she says. “Some devices can be used at home and some in the office once a week.” There are also implantable devices that continuously stimulate the nerves to the bladder, called neuromodulation. Another alternative method and developing procedure for treating urge incontinence is Botox injections into the bladder.
Physical therapy is also an effective method for treating both stress and urge incontinence. Pelvic floor exercises, also known as Kegel exercises can help women increase function and strength of their pelvic muscles. Dr. Elkadry says many women can do the exercises on their own. However, some women have difficulty isolating and contracting the pelvic floor because the muscles are too weak or too tight. In these cases, Kegel exercises are ineffective. “I prefer to have those patients work with a physical therapist initially to make sure the pelvic floor is optimally rehabilitated,” says Dr. Elkadry.
Quitting smoking, losing weight and avoiding chronic coughing and constipation are ways to reduce the risk of developing incontinence. According to Dr. Elkadry, women who have a vaginal delivery and those with high-impact jobs can also reduce their risk by practicing Kegel exercises. Qualified physical therapists are available to teach those exercises.
At Mount Auburn Hospital, specialists can successfully screen and treat incontinence. “Women don’t have to suffer with incontinence,” says Dr. Elkadry. “For many women, there is a cure and if it isn’t cured we can at least significantly improve their quality of life.” Surgery also remains an option that woman can choose. Many of these surgical procedures are now minimally invasive and don’t require a hospital stay.
For a free breast self-exam shower card, please call us at 617-499-5094.