General News
If you’re a woman, especially one who has given birth, you may have had this experience: Your day is humming along just fine, and then out of nowhere comes a sudden, embarrassing bladder leak. It may have been precipitated by a hearty laugh, a strong cough, or a powerful sneeze, or it may have had no apparent cause at all. Many women hesitate to talk to their doctors about the issue until it’s been happening for some time. Because it can be embarrassing to talk about, some will simply soldier on, stocking up on absorbent pads and planning their days around easy bathroom access. “I am surprised at how many women will wear protective garments and bring extra clothes along with them in case they have an ‘accident’ before they seek help,” said David Schutzer, M.D., of Hoke OB/GYN. “When the incontinence affects their quality of life, then it is time to seek out advice.” There are two main causes of urinary incontinence Dr. Schutzer sees in his patients:
Stress incontinence is caused by a weakening or prolapse of the valve that usually keeps urine inside the bladder. Any increase in pressure in the pelvis (such as from a laugh or sneeze) can overwhelm that valve, resulting in a leak.
Urge incontinence, or overactive bladder, is caused by a sudden contraction of the muscle around the bladder. These contractions can come on with no warning, and the result is an urgent race to the restroom. Stress incontinence is more common, and typically begins during the childbearing years. The intense pressure of a growing fetus and the experience of giving birth (whether vaginally or by Cesarean section) can significantly weaken the pelvic floor and urinary sphincter. These effects can be compounded by multiple pregnancies, or particularly complicated ones.
“Therapies for stress incontinence have become much less invasive, with quicker recoveries and higher success rates."
“Many of these cases improve or resolve over time,” said Dr. Schutzer, “but stress incontinence may reappear as women age.” With or without childbirth, some conditions increase pressure in the abdomen, contributing to stress incontinence—especially chronic constipation, asthma, COPD, smoking and obesity. By retirement age, most women will have experienced urinary incontinence. According to a recent AARP poll, 43 percent of women aged 50 to 64 have been through it. For women aged 65 to 80, that number rises to 51 percent. “It is important that women understand how common this is,” said Dr. Schutzer. “It affects about 15 million women in this country.” Knowing they’re not alone helps put an embarrassed patient at ease, and Dr. Schutzer said a thorough explanation of the anatomy behind the leak also helps. Then it’s time to decide on a treatment. “If someone has contributing causes, then we discuss trying to control their associated medical problems or weight loss,” he said. “We might discuss enrolling in an exercise program with a physical therapist that has special training in pelvic floor therapy. Or we could discuss surgery for correction of any anatomic issues that may contribute to her incontinence.” Whether the solution comes from a lifestyle change, an exercise regimen or a surgical solution, Dr. Schutzer said the outcome can be a big sigh of relief. “I have had some patients who were avoiding social situations, or had stopped going to exercise classes they enjoyed, out of fear of having an episode,” he said. “But many have returned to their normal social lives after corrective actions. Several come to mind who were able to enjoy playing on the trampoline with their children.” Dr. Schutzer said it’s exciting to see outcomes that might not have been possible when his career began.“Over the almost 30 years since I started in gynecology,” he said, “the therapies for stress incontinence have become much less invasive, with quicker recoveries and higher success rates.”
