Female Urinary Incontinence: The Secret You Don't Have to Live With

Urinary incontinence is more common than most people realize.

Some 12 to 17 million Americans suffer from the problem, more than half of whom are in nursing homes. But it's not something you have to live with. Although only one in five seeks medical help, about 80 percent who are treated can be cured or achieve substantial improvement.

Symptoms of incontinence differ, according to the type of incontinence you have:

Urge incontinence, usually experienced as a sudden, strong urge to urinate, may be due to an overactive bladder or waiting too long to go to the bathroom.


• Stress incontinence, involuntary loss of urine during activities such as coughing or straining, increases with age and number of vaginal deliveries.
  
  
• A person with both urge and stress incontinence is said to have mixed incontinence.
  
  
• Reflex incontinence, urine loss without warning, usually occurs in people who have suffered nerve damage.
  
  
• Overflow incontinence is often experienced as a frequent dribble.
  
  
• Nocturia, or bedwetting, occurs during sleep and is more prevalent in people with systemic diseases and those who have undergone previous pelvic or neurosurgical operations.

The type of incontinence you have will determine your treatment. Urge incontinence is usually treated with medications such as tolterodine or oxybutynin, and bladder retraining - having you plan your schedule so that you urinate regularly every three to four hours. Extended-release tolterodine and oxybutynin are now available, allowing once-a-day dosing. Anticholinergic drugs - drugs that block the passage of impulses through the parasympathetic nerves - may also be used and are also effective for nocturia and overactive bladder.

While it's normal to have an urge every three to four hours, some people ignore their body's signal, waiting until their bladders are too full.

"It depends at what volume a person gets an uncontrollable urge," says Dr. Lenaine Westney, assistant professor of urology at The University of Texas Medical School at Houston. "If it's every 30 minutes," she says, "a person needs medication."

Pelvic floor exercises may improve stress incontinence; however, surgical correction, usually a sling procedure, is still the most common treatment option. Estrogen therapy can be effective, but recent studies indicate that oral estrogen may not be as effective as estrogen applied vaginally

Some newer nonsurgical treatments are now available for incontinence. Devices that plug up the urethra do not appear to work well for active women. Vaginal-probe electrical stimulation can help to strengthen muscles. Chairs with electromagnetic fields stimulate pelvic muscle contraction. Pessaries designed especially for incontinence can reduce urine loss but are not totally effective. Weighted vaginal cones that achieve the same effect as pelvic floor exercises seem to work better in premenopausal women with stress incontinence.

A new self-contained microballoon system that can be implanted in the bladder neck to hold back urinary flow is currently under clinical investigation in the United States. Implantation of the microballoons is a minimally invasive outpatient procedure that takes about 20 to 30 minutes.

One of the most promising developments in treating urge incontinence, Dr. Westney says, may be a sacral nerve stimulator implanted in the spine at the third or fourth sacral nerve root. It overstimulates the nerve, overriding signals from the bladder and blunting bladder contraction. Patients undergo a three- to five-day test stimulation. If incontinence decreases 50 per cent to 70 percent, a permanent device is implanted. A lead is implanted into the lower back, with the device and battery above the right hip. Batteries last seven to ten years. Right now the device is large enough so that it is not the first line of treatment, but this may change with innovations during further product development.

"Some smaller devices are now in the investigational stage," says Dr. Westney. "When it is easier to implant, we will be willing to use it earlier."

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©2006 Texas Medical Center

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