Incontinence

By Ellen Dolgen

Are you afraid to cough, sneeze, laugh, or exercise, because you may leak urine?

Sadly, you can’t simply dial your plumber………. But if you educate yourself so that you can become your own best health advocate, you may be able to turn off that unwanted drip! Time to break open the conversation on incontinence.

Many women talk to their primary care physician about this issue and they basically are told that it’s common, and they must grin and bear it.  Nothing can be further from the truth.  There are specialists such as Female Pelvic Medicine and Reconstructive Surgery/Urogynecologist (FPMRS) and/or a Pelvic Floor Physical Therapist to help you.

According to Urology Care Foundation, there are three types of urinary incontinence that affect women:

1. Stress Urinary Incontinence (SUI) weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.
2. Overactive Bladder (OAB)- OAB is often called the “urgency” incontinence. It affects more women than men affecting one’s daily life and often restricting activities for fear that they will suddenly need to urinate and won’t be near a bathroom. Also, it can affect one’s sleep.
3. Mixed Incontinence – If you leak urine with activity (SUI) and feel the urge to urinate (OAB).

I reached out to Dr. Varuna Raizada, a Female Pelvic Medicine and Reconstructive Surgery/Urogynecologist at Scripps Health Clinic and Anuja Shah, a Pelvic Floor Physical Therapist to shed some light on this often very difficult and life changing issue.

Dr. Raizada first taught me what a pelvic floor is! She said, “Think of the pelvic floor like a large platter made of interlacing muscles, ligaments, and bones that bear the weight of your trunk and all the organs in the pelvis like the bladder, bowels and reproductive organs. It also supports lower limbs.”

Anuja Shah added, “Our pelvic floors help open and close the sphincter and aid in sexual performance by stabilizing the clitoris.”    Who knew????

Not sure what the difference is between a Female Pelvic Medicine and Reconstructive Surgery/Urogynecologist or a Pelvic PT and what their training is?

Dr. Raizada clarified, “An FPMRS physician completes medical schooling, a residency in Urology or Obstetrics & Gynecology and then complete an additional fellowship in the field of FPMRS. They consult with patients and come up with a treatment plan. This may either involve surgical or non-surgical therapies (medicine, physical therapy). When it comes to pelvic floor problems, pelvic surgeons work very closely with pelvic floor therapist.

Pelvic floor physical therapy: Physical therapists are typically required to have a bachelor’s degree before they are inducted into an accredited professional physical therapy program. In order to specialize in women’s health and pelvic floor diseases, they complete a clinical residency and clinical fellowship to advance their education. Typically, they are board certified in their specific field. Any physician can refer a patient to a physical therapist.”

Shah added, “It is always best to get a referral from a trusted source. This is important because there are so many approaches to treating pelvic floor conditions and some are contraindicated depending on the diagnosis.  For example, pelvic floor muscle (PFM) contractions, aka, Kegels are effective for patients with incontinence but could worsen symptoms for patients with pelvic pain.”

According to Raizada, some of the issues that can cause incontinence are genetic predisposition and pregnancy.  Shah added that history of constipation, decreased tissue integrity, diet, trauma, and lifestyle can contribute to this issue.

If you find that you are struggling with incontinence, first get evaluated by primary care provider (PCP) or your Gynecologist. However, it is good to note that some PCP’s may not be familiar with this issue.  You can ask your PCP to refer you to someone with this sub-specialist Remember- your healthcare professionals do not have a crystal ball – be open and honest about your issues!

Before we proceed, I just want to tip my pelvis to the wonderful Dr. Arnold H. Kegel for inventing the famous Kegel perineometer (an instrument for measuring the strength of voluntary contractions of the pelvic floor muscles) and Kegel exercises (squeezing of the muscles of the pelvic floor). He first published his ideas in 1948. Brilliant! I did those after delivering each of my children.  I sometimes did them to music in my car (nothing like a little Kegel rhythm)!

If you are experiencing incontinence, Dr. Raizada has some helpful treatment options that you can try at home:

Try not to over hydrate.  Usually, 40-50 ounces of all fluids (yes that cocktail is included) is good enough o maintain health.  Apparently, our bladders are not designed to handle extremely large quantities of fluid intake.

During your waking hours, empty your bladder regularly – every 2-3 hours.

Avoid drinking large quantities of fluid intake before bedtime.

Do your Kegel exercises regularly. 

Try to distract yourself if you constantly have the urge to urinate.

Other treatment options need to be tailored to your need and may involve the use of medications, office acupuncture, physical therapy with biofeedback, or surgical procedures.

Here is Susan’s story:

Over the last 5 years, I have had an awareness of infrequent urine leakage when coughing, laughing, exercising or sneezing.  Additionally, when I would have a full cup of a caffeinated beverage, I noted I had more than a little leakage; it could be a constant drip without the ability to stop the dribble.  Consequently, I quit drinking fully caffeinated beverages.  When I brought this to the attention of my Internist on more than one occasion, he did a urine analysis to rule out an infection which was always negative.

Later I went to a Nurse Practitioner that specializes in menopause and she noted that my internal and external vaginal tissues were so dry (even though I was using an estrogen patch) that it was her opinion that the dryness was impairing my ability to contract my muscles to prevent leakage. First on her agenda was to use external and internal estrogen creams to “plump” up the vaginal tissues.  I am now using a local estrogen therapy (LET) cream called Estrace for the outside and an estradiol vaginal insert called, Yuvafem for the inside.

Together with my specialists, we will evaluate if these are working.  If not, the next step would be to consider using a pessary, which is a removable device placed into the vagina that helps support areas of pelvic organ prolapse (POP) and incontinence.

My Menopause Specialist then referred me to a Pelvic Floor Surgeon.  The Surgeon told me I was not a candidate for surgery – my leakage was not severe enough and that I should try Pelvic Floor Physical Therapy, continue with the creams and later consider a pessary if I thought the leakage became more of a problem.  This specialist was very gentle, thorough and understanding.

I then saw a wonderful pelvic PT.  She immediately made me feel comfortable.  She put some electrodes on me to see if the Kegels I was doing were productive. The physical exam and therapy are not uncomfortable or painful in any way. In addition, I have seen her several times and I have exercises that I am doing at home.

Like many women, Susan did mention this issue to her regular internist on more than one occasion and he never mentioned how this leakage could be linked to vaginal estrogen nor did he suggest seeing a specialist.

It wasn’t until she finally went to her gynecologist who is a  Menopause Specialist and spoke openly about these problems, she was referred to both a Female Pelvic Medicine and Reconstructive Surgery/ Urogynecologist first for an evaluation – then to a Pelvic Floor Physical Therapist.

Dr. Raizada did tell me that incontinence is generally a chronic problem much like vaginal atrophy. Typically, it does get worse, however, with early intervention you can prevent the exacerbation of the disease. Of course, there are no one-size-fits all protocol as not all leakage diseases are the same. However, with the right experts on the case, you can get the help you need and deserve!

Remember:  Suffering in silence is OUT!  Reaching out is IN.

For more great tips on how to find a menopause specialist and deal with menopause download my free eBook: MENOPAUSE MONDAYS the Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause. 

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Ellen Dolgen, spurred by her own experience struggling with the symptoms of menopause, is devoted to helping women everywhere. Through EllenDolgen.com and her FREE eBook, MENOPAUSE MONDAYS The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause, she shares the expertise of numerous specialists to replace confusion and embarrassment with medically sound solutions, presented in an entertaining and informative way. From hot flashes, insomnia, mood swings, mental fogginess, loss of libido, heart health, and lots more in between, EllenDolgen.com provides empowerment for women to become their own best health advocates. Her motto is: Suffering in silence is OUT! Reaching out is IN!