Incontinence: America's Not-So-Secret Problem
“It immediately changed my life.” That’s how Sharon, age 60, describes the surgery she had to fix her incontinence.
Urinary incontinence, or loss of bladder control, is very common, but that doesn’t make it any less embarrassing.
Incontinence has stepped out from behind the curtain thanks to more open and frank advertising for products designed to help those who suffer. But on an individual basis, people are often still too embarrassed to talk to their health care provider – which is too bad, because help is available.
Loss of bladder control affects about 25 million people in the U.S. While the problem is more likely to occur as you age, it can happen at any age. Women are affected over three times more than men, both because of childbearing and due to the weakening of the pelvic muscles when estrogen levels drop after menopause. With men, prostate problems are usually the cause. Some medications can cause incontinence, or make it worse.
“If I had known the surgery to fix my incontinence was so easy, I would have done it years ago” says Sharon. “The best thing was that after surgery, it immediately changed my everyday life. I no longer have to worry about the annoyances of incontinence.”
Urinary incontinence can range from merely annoying to almost crippling in terms or quality of life. If you have incontinence, you may reduce your social interactions to avoid embarrassment. People with incontinence may feel increasing loneliness and depression, and a reduction in self-esteem. You may also stop healthy activities, like running and exercising, to avoid leaking.
Sleep can also be affected, as you may find you wet the bed, or have to get up several times a night to go to the bathroom. This can also increase the risk of falls, especially in the elderly.
Incontinence Treatment Options
There are many types of incontinence, but the two most common types are stress and urge. Stress incontinence occurs when you laugh, cough, sneeze, or strain. Urge incontinence is when you feel a constant need to go, or when things like drinking water or hearing the sound of running water cause a sudden urge to go.
Treatment options range, but may include:
- Lifestyle changes, such as reducing fluid intake; avoiding drinks containing caffeine, alcohol, citrus, or artificial sweeteners; emptying your bladder on a regular schedule; maintaining a healthy weight; and not smoking
- Medication – either to treat an infection or control abnormal bladder activity
- Vaginal hormone replacement
- Bladder retraining
- Exercises to strengthen the muscles around the bladder and urethra (Kegel exercises)
- Use of a pessary – a device similar to a tampon that puts pressure on your bladder to help prevent leaking
- Surgery to repair weakened bladder supports
After having incontinence issues for about 10 years, Sharon says, “I felt it was time I took care of myself. My gynecologist recommended I see urogynecologist Dr. Ellen Solomon, at Baystate Urogynecology, and I’m sure glad I did. The surgery was easy and the staff was fabulous. The pain was manageable; I only needed to take Tylenol, and within a week, the soreness started to subside.”
According to Dr. Ellen Solomon, treatment options vary depending on the type of incontinence and lifestyle factors.
“To treat urge incontinence, we usually start treatment with behavioral changes and use of medications,” she says. “Patients with urge incontinence who take medications will be around 50% drier.”
She says both types of incontinence can be treated with pelvic floor physical therapy, which is around 55-70% effective.
“For stress incontinence, pessaries may also be used,” says Solomon, “but their effectiveness is less than pelvic floor physical therapy.”
Pessaries are removable devices placed into the vagina to support areas of pelvic organ prolapse. There is a new type of device on the market that is similar to a tampon, and is designed to put pressure on the bladder neck to prevent leaking. Solomon says it’s too early to tell how effective the product is, and noted that that using a dry tampon-like product, especially for post-menopausal women, can be uncomfortable.”
In terms of surgery, Solomon says, “Mesh slings are the safest method to treat stress incontinence surgically that we have. We know that women will be over 90% dry after surgery and 85% dry 10 years after sling placement, which is a long time.”
Help is Available
The first step in addressing incontinence is an honest talk with your health care provider. There are several ways they can diagnose what type of incontinence you have and what is causing it. They will take a complete medical history, check your urine for signs of infection, and possibly have you keep a diary that includes how much you drink, how often and how much you pee, and when you have accidents. You may need other tests, like an ultrasound or MRI.
They can then work with you on a treatment plan that suits your specific circumstances, or refer you to a urogynecologist for women or a urologist for men.
Dr. Ellen Solomon and her colleagues at Baystate Urogynecology, Drs. Oz Harmanli and Keisha Jones, see patients at the Tolosky Center, 3300 Main Street, Springfield; the Baystate Health Outpatient Center, 325 King Street, Northampton; and Pioneer Women’s Health, 48 Sanderson Street, Greenfield. For an appointment at any location, call 413-794-7045.