Many women with urinary incontinence believe they are alone, says Dr. Leslie M. Rickey, a urogynecologist at the University of Maryland Medical Center and an assistant professor of surgery at Maryland's School of Medicine. But it's more common than many people think, she said. And when it interferes with a woman's lifestyle, it's time to see a doctor. There are treatments, many of them nonsurgical. Rickey talks about them and answers a few of the most common questions below.
Question: How common is urinary incontinence?
Answer: Urinary incontinence, or bothersome urine leakage, affects about one in every three women. It is more prevalent among older age groups, but I work with many younger women who suffer from urinary incontinence, sometimes after childbirth. Incontinence can have a significant negative impact on a woman's quality of life and emotional well-being and limit her ability to engage in physical activity.
Q: Are there different types of incontinence?
A: We typically characterize urinary incontinence as either urge incontinence or stress incontinence. Urge incontinence is leakage associated with strong urgency — a woman feels she cannot make it to the bathroom and may leak on the way. Stress incontinence occurs with effort or exertion, and patients often describe leakage with coughing, sneezing and exercising. Many women actually have both. In addition, up to 80 percent of women with urinary symptoms will report another pelvic floor disorder such as pelvic organ prolapse or problems with bowel function. It is important to be evaluated by someone that has experience with evaluating and treating a wide range of pelvic floor disorders.
Q: What causes urinary incontinence?
A: Childbirth and the aging process are primary factors. Medical problems such as asthma and diabetes can play a role, as can modifiable factors like weight gain and smoking. In fact, it has been shown that a weight reduction of 5 percent to 10 percent can significantly improve urine leakage. There is also increasing evidence that genetic factors may also play a role.
Q: When should women seek treatment for incontinence?
A: This is a great question. It has been shown that 50 percent of women with daily or weekly leakage do not seek treatment for their condition. Barriers to seeking treatment can include embarrassment, the belief that there are no effective treatments or a fear of invasive procedures. Women should know that while urinary incontinence is common, it should not be considered a normal part of aging. There are many nonsurgical treatments available for women who prefer to avoid surgery. To answer the question, if a woman has stopped doing things she enjoys, like going out to lunch with friends, exercising or running around with her children, don't let your bladder control your life! In other words, women should seek treatment when their symptoms become bothersome and start to interfere with their activities. This is a very individual decision that is different for each patient.
Q: What are the treatments for urinary incontinence?
A: Treatment depends on the incontinence diagnosis. Urge incontinence is usually treated with medication and behavioral modifications. Patients with persistent symptoms despite first-line treatment may receive an injection of botulinum toxin (also known as Botox) into the bladder, or may get a "pacemaker" for the bladder, both of which can be performed on an outpatient basis for urge incontinence. Initial therapies for stress incontinence include pelvic floor muscle exercises, weight loss or use of an incontinence ring. An office-based procedure called "urethral bulking" involves injection of a material around the urethra to create a better seal against urine leakage. Finally, if surgery is necessary, the most common procedure is placement of a "sling" underneath the urethra which provides support to stop urine leakage. Certain types of surgical approaches can be done on an outpatient basis, and the minimally invasive procedures I perform usually result in faster return to normal activities. In summary, the type of intervention is based on a woman's symptoms, anatomy and prior therapies, but it is equally important to assess each individual patient's desires and goals for treatment.
A webcast interview with Dr. Rickey, can be found at umm.edu/podcasts