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Physicians Discuss Array of Treatment Options for Urinary Incontinence Among Females

Every day, Yoko Bean, MD, sees women whose lives have been impacted by a condition they don’t want to talk about and have waited years to seek help for: urinary incontinence.

Whether the woman is 20 or 80, their stories are often remarkably similar: They plan outings around available restrooms, carry extra clothes in their car, and curtail exercise and other activities that cause leakage. Many describe abandoning carts in the check-out line to find a bathroom or stopping a workout to change exercise clothes that are soaked in more than just sweat.

Dr. Bean, a board-certified OB/GYN who specializes in urinary incontinence and other pelvic floor disorders, says the silence surrounding a loss of bladder control doesn’t match a reality in which not only is incontinence common, but there have never been so many effective treatments from which to choose.

“Too many women assume it’s part of getting older or something they should just learn to live with,” explains Dr. Bean. “It’s not until they get tired of the embarrassment, loss of freedom and spending $200 a month on pads that they seek help—and then could kick themselves for waiting so long.”

With entire drugstore aisles dedicated to incontinence supplies, Melanie Santos, MD, Medical Director of the St. Jude Pelvic Health Center, says “no woman should feel alone.” “Childbirth and menopause often trigger bladder control issues, but we also routinely treat young women who have never had children and women who are 40 years beyond menopause,” explains the board-certified urogynecologist.

There are two major types of incontinence: Stress, the most common, is caused by lax pelvic floor muscles and occurs when you put pressure on the bladder. It’s the culprit behind “don’t make me laugh or I’ll pee my pants.” Urge incontinence is the result of the bladder contracting when it shouldn’t, causing overactive bladder syndrome or something Dr. Santos calls the key-and-pee syndrome. “If you’ve ever started to unlock your front door and suddenly desperately needed to pee, then you’re familiar with urge incontinence,” she explains.

Depending on your symptoms, pelvic floor rehabilitation—a specialized form of physical therapy that restores balance and strength to the pelvic floor—may be the first step or the entire solution. But for some, successful treatment will involve one of the growing number of outpatient or office procedures currently increasing cure rates.

  • Newer bulking agents, such as hydrogel, can plump up the tissues where urine is released from the bladder, preventing leakage. For urge incontinence or overactive bladder, Botox injections can relax the bladder and relieve symptoms.
  • Electrical nerve stimulation can be highly effective and may involve implanting a very small device just beneath the skin to stimulate the nerves controlling the pelvic floor. (New versions are MRI-compatible with batteries that can be recharged through the skin.) The least invasive version uses an acupuncture-like needle to stimulate the tibial nerve near your ankle, which in turn impacts the nerves that control your bladder.
  • Mini-sling procedures are the newest and least invasive surgical option for stress incontinence. This 30-minute outpatient procedure eliminates symptoms by placing a tape (called a sling) underneath the urethra to provide support and prevent leakage when you exercise or cough.

Regardless of which treatment you ultimately choose, candor is the first step. “Don’t wait for your doctor to ask,” says Dr. Bean. “Ask for a referral to pelvic floor rehabilitation or to a urogynecologist or expert in pelvic health. You’ll be glad you did.”

Melanie Santos, MD, FACOG, and Yoko Bean, MD, FACOG, specialize in the entire range of women's pelvic health issues, including incontinence, bladder infections, bowel dysfunction, prolapse and pelvic pain. For an appointment, please call (657) 376-6874.

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