Jeannine Miranne, MD, MS, Division of Urogynecology at Brigham and Women’s Hospital, discusses urinary incontinence. Urinary incontinence in women is a very common problem. It affects 17 percent of all American women, and its prevalence increases with age. More than one in five women ages 50 and older are affected. The risk factors for urinary incontinence include older age, childbirth, obesity, and menopausal status.
Urinary incontinence is defined as the involuntary loss of urine or a loss of urine beyond one's control and it can be divided into three main subtypes. Urgency incontinence is urine loss with a sudden urge or uncontrollable desire to void. Stress incontinence is urine loss with sneezing, coughing, laughing, and other physical activities that increase the pressure in the belly. And mixed incontinence occurs when a woman has symptoms of both urgency and stress incontinence.
Urinary incontinence significantly impacts patients' lives. Many patients base their life around their bladder. Women know where every single restroom is. They know where the restrooms are in the mall, along the freeway. It really can hinder one's quality of life. Many women think that urinary incontinence is a normal part of aging and they're unaware that there are available treatment options for this problem.
First line treatments for all types of urinary incontinence are behavioral and dietary modifications. I usually recommend that women limit their fluid intake to 64 ounces of total fluid in a day and that they cut down on foods and drinks that are irritating to the bladder, such as coffee, tea, soda, artificial sweeteners.
In addition to behavioral and dietary modifications, there are other treatment options. Pelvic floor physical therapy can be recommended for women with urinary incontinence. This is particularly helpful in women who have difficulty identifying their pelvic floor muscles or in contracting them effectively.
For stress incontinence, additional options for treatment include using a pessary, which is an intervaginal support device. The pessary helps to provide support to the bladder, neck, and urethra to help prevent urine loss with activities that increase the pressure in the belly. Other additional treatment options for stress incontinence include peri-urethral bulking agent injection, which involves injecting a filler in the urethra to bulk it up and help prevent urine loss, and surgery. Sling procedures can be done using your own tissue or with mesh. The most minimally invasive surgical procedure is a mesh sling.
The mainstay of treatment for urgency incontinence is medications. Medications can help to relax the bladder muscle so that it doesn't squeeze as often. And this can help prevent sudden urgency and leakage associated with urgency. Additional options for treatment of urgency incontinence include Botox injections in the bladder muscle and a procedure called InterStim, which involves placement of a device similar to a cardiac pacemaker.
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