By Ganesh S. Rao, M.D.
It’s embarrassing and usually happens at the worst times. Technically, we call it female incontinence, but simply put it is the accidental release of urine. If you are a woman with this condition, you are not alone. Ten to thirty percent of adult women are affected, and at least 50% of elderly women have female incontinence. It causes women to avoid an active lifestyle, shy away from social situations, and constantly search for the nearest bathroom. Some women are even uncomfortable talking to their doctor about the condition.
Uncontrolled release of urine can occur when you laugh, sneeze, cough or exercise. Or, you may have a sudden need to run to the bathroom, but don’t make it in time. Sometimes incontinence is caused by a urinary tract infection, medications, or even constipation.
There are several types or classifications of incontinence; stress, urge, mixed and overflow.
Stress incontinence is urine loss during physical activity that increases abdominal pressure; like coughing, laughing, and sneezing. This is the most common type of incontinence in women. You may leak a small to medium amount of urine.
Urge incontinence is urine loss with the urgent need to void, accompanied by involuntary bladder contractions (also called overactive bladder). With this condition you may leak a larger amount of urine that can soak your clothes or even run down your leg.
Mixed incontinence is a combination of stress and urge incontinence. The most troubling type of incontinence is overflow, or the constant dribbling of urine where the bladder never completely empties.
Bladder control problems can be caused by weak muscles in the lower urinary tract, or problems or damage either in the urinary tract or in the nerves that control urination. Stress incontinence can be caused by several factors like childbirth, weight gain or other conditions that stretch the pelvic floor muscles. When these muscles cannot support the bladder properly, the bladder drops down and pushes against the vagina. Since the muscles that close off the urethra cannot be tightened, urine may leak because of the extra pressure on the bladder when you experience some physical activities. Urge incontinence is a bit more mysterious – and is caused by an overactive bladder that expels urine out of the bladder uncontrollably. It may be caused by irritation of the bladder, stress, or even some medical conditions not associated with the urinary system.
There are several surgical and non-surgical treatments for both stress and urge incontinence. One of the most promising procedures for the treatment of stress urinary incontinence (SUI) is referred to as ‘sling’ procedures.
One such product is the TVT Sling, where the doctor inserts a strip of PROLENE polypropylene mesh tape in a 30-minute, minimally invasive treatment performed in an outpatient setting. The tape-like strip of mesh is woven through the pelvic tissue and positioned underneath the urethra, creating a supportive sling. When pressure is exerted, the tape provides the support needed to allow the urethra to maintain its seal. It is a procedure that can be performed under local anesthesia while the patient is awake. The results can even be tested and the tape adjusted for maximum effectiveness during the procedure, improving success rates.
The sling is also advantageous since patients may be able to go home a few hours after the procedure, with a two to three week recovery period, experiencing very little interference with daily activities. The treatment has been performed on over one million women worldwide, and a recent study showed that even seven years after treatment, 81% of women treated remained dry, and an additional 16% experienced significant improvement. Since all medical procedures present risk, patients are encouraged to ask their doctor about rare, but potential complications associated with sling treatment.
Whatever type of incontinence you suspect you may have, consult your physician for advice and testing to determine the best path of treatment. With today’s treatment options, there is no reason to endure this embarrassing, uncomfortable condition. Take your life back!
Dr. Ganesh S. Rao, M.D., F.A.C.S, received his bachelor of medicine and surgery at Mysore Medical College, University of Mysore, India. He was a research associate in the Division of Urologic Surgery at Washington University School of Medicine in St. Louis, Missouri, from 1996 to 2001. Between 1997 and 2000, he completed his internship in surgery and his residency in urologic surgery. He is certified by the Educational Commission for Foreign Medical Graduates and is a member of the Indian Physicians Association of Kentucky. Dr. Rao is certified by the American Board of Urology and is a Fellow of the American College of Surgeons. He joined Metropolitan Urology in 2001.