Some women shrug off incontinence, thinking the involuntary leaking of urine is just a normal part of aging. Others give up dancing, exercising or going to the movies because the leakage, coupled with a frequent or urgent need to go to the bathroom, is just too embarrassing.
But help is available to improve symptoms and get you back to doing what you love, medical experts say.
“Often women delay getting treatment, because of embarrassment or they are afraid nothing will help,” said Dr. Rafael Perez, gynecologic surgeon and medical director of the Fibroid Center at South Miami Hospital’s Center for Women & Infants. “While it lengthens the time you have to deal with it, the good news is that most times, delaying treatment doesn't worsen the problem.”
There are two main types of incontinence. Stress incontinence is when you leak urine, often when you cough, laugh, jump or run. Urge incontinence is more about increased frequency and urgency.
Perez said he sees urge incontinence more in younger patients, while stress incontinence increases as you get older. “After menopause — the average age of menopause in the United States is 52 — over 50 percent of women have some sort of incontinence or bladder problem,’’ he said. “It's a humongous problem.’’
So what's normal? If you're going to the bathroom more than seven times a day, that may be a problem, Perez said. But it needs to be examined with a full workup, family history, physical examination, assessment of symptoms, and a diary of how much fluid you take in, and how much you're peeing out.
Therapy to help strengthen the pelvic floor is the first line of defense. This includes Kegel exercises (contracting the muscles that stop urine flow), biofeedback to help make sure you're doing the exercises right, and electrical stimulation, which contracts the muscles and helps strengthen the pelvic floor. “What that does is help the patient have a lot more control, and if the pelvic floor gets strong enough, they may not need anything else,” Perez said.
Dr. Eric Hurtado, a gynecologic surgeon at Cleveland Clinic in Weston, said if pelvic floor therapy doesn’t help, there are other options. One is a pessary, a ring inserted in the vagina that puts pressure on the urethra to prevent leakage. “It’s another route for people who want to avoid surgery,’’ he said.
Bulking agents, little beads injected around the urethra, also can help stop leakage. “They're very simple and they can be done in the office, but they're not the most effective treatment,’’ Hurtado said. Cleveland Clinic is involved in a research study that is using stem cells as an alternative to beads as a bulking agent, he said.
The most common surgical option for stress incontinence is the mid-urethral sling, a mesh sling that supports a sagging urethra.
“Urethral slings have become the go-to because of their ease, high success and low complication rates and because it is an out-patient surgery,” Hurtado said.
“We start with behavioral therapy and pelvic floor therapy, to see if they can get better,” said Dr. Yvonne Koch, a urologist at Mount Sinai Medical Center in Miami Beach. “We try lifestyle changes like avoiding bladder irritants like caffeine or alcohol.”
Bladder retraining, systematically trying to lengthen the time a patient waits before they go to the bathroom, also can help, Perez said.
The next step is oral medication for an overactive bladder. There are seven medications on the market. “The goal is to find something that works, is affordable, and has the fewest side effects,” Koch said.
If the medicine doesn't work or the side effects are too severe, there are other treatments. Botox injections can help relax the bladder. InsterStim, or sacral neuromodulation, acts like a pacemaker for the bladder to change its impulses.
Perez said one therapy, percutaneous tibial nerve stimulation, stimulates a nerve near the ankle that affects your bladder. The idea is to help reset the reflex to go, he said.
Hurtado said acupuncture may help in about 50 percent of cases, but there is not enough good research to say for sure.
Hormone cream such as vaginal estrogen cream may help post-menopausal women, he said. “If they have a lot of vaginal atrophy, it can help, along with the oral medication,” Hurtado said.
The overall improvement rate with treatment is about 90 percent, he said. For a complete cure, where you don't leak a drop, it's about 50 to 60 percent.
“Women think they're alone. They don't realize it's such a common problem,” Koch said. “Treatment improves quality of life, because when they get better, they go back to things they like to do.”