Urinary Incontinence Explained
As many as 25 million Americans are affected by bladder control problems. Many more suffer from pelvic disorders such as interstitial cystitis, vaginal prolapse, uterine prolapse, or "dropped" bladder. These disorders are a sensitive issue and many women suffer in silence, too embarrassed to tell anyone even their physician.
Because these disorders are not widely discussed, many people are reluctant to talk about them, believing that their situation is unique. I have found that many of my patients simply believe that as you get older leakage of urine in some amount is inevitable and needs to be tolerated. However clearly as the above numbers show you are not alone- these conditions are quite common.
More importantly these conditions are quite treatable. However proper treatment starts with proper diagnosis.
Pelvic relaxation is the loss of support to pelvic organs such as the bladder, vagina, uterus or rectum. May be caused by injuries from childbirth, aging, muscle weakness, or nerve injury due to surgery. Symptoms often worsen with standing or other vigorous activity.
Symptoms may include:
- Bulge outside the vagina
- pressure or discomfort in the vagina
- pain or discomfort with intercourse
- feeling the bladder is not completely empty after voiding
- severe chronic constipation and or straining with bowel movements
- frequent urination
Urinary Incontinence (leakage of urine) may be caused by a number of conditions such as previous childbirth (especialy when traumatic), degenerative changes associated with aging, muscle weakness, infections, medications, neurologic disorders, and possibly hormonal deficiencies (although this last cause is now controversial). Symptoms may include:
- leaking with urine when coughing, sneezing, lifting or exercise
- frequent urination
- increased urge to urinate
- leaking of urine associated with a strong urge
- the need to wake up at night and rush to get to the bathroom
Effective treatments totally depend on the source of the problem. Whereas in years gone by the only approach was surgical - and some people improved and some didn't - the approach to urinary leakage is quite different and often complex. Although symptoms may seem similar to patients, the underlying problem may represent an irritable bladder, a problem with the urethral sphincter, or increased mobility of the urethra. Treatments range from surgery to medication to bladder retraining and pelvic floor exercises including electrical stimulation and biofeedback. Proper diagnosis can now be made with a simple test called multichannel urodynamics. We have a special continence nurse who comes several days per month and performs these test on our patients. A patient arrives with a full bladder and will void into a special apparatus that measures rate and volume of voiding. A small catheter is then placed into the bladder as well as vagina. This is a fraction of the size of a catheter used when one has a baby or some sort of surgical procedure. It is absolutely painless. The catheters have a transducer on their ends so as the bladder is filled with sterile saline pressures can be measured. This pressure profile enables proper diagnosis of bladder and urethral function. The procedure is covered by Medicare and virtually all other private insurances.
If you suffer any loss of urine virtually at any time please feel free to discuss this with Dr. Goldstein and or his staff. This is not inevitable. Proper diagnosis and appropriate therapies are available.
©2004 Steven R. Goldstein, M.D.
