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Leaks – Let's Talk About It

Posted November 11, 2014 by Bogdan Orasanu, M.D. and Osasumwen Asemota

As I sit across the table from the middle-aged woman nodding in agreement with the symptoms of the little "leaks" when she coughs or runs, and the feeling of having to "go" all the time with nothing really "coming out", she exclaims "yes!" in astonishment . "I have been having these things happen to me for quite some time now. I was always too scared to really speak about it until now…it's so embarrassing".

This story is not uncommon. She is not alone. In fact, millions of women in the U.S have dealt with some form of urinary incontinence (UI). UI is often a stigmatized and unreported condition that affects almost one third of men and women in the U.S between the ages of 30 and 70 as of 2008, according to the National Association of Continence.

In fact, women are twice as likely to experience urinary incontinence as men. Additionally, on average, women wait 6.5 years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problem. Urinary incontinence is often seen a part of "growing old" or as part of the aging process rather than as a medical condition. It is not uncommon to feel embarrassed by this, like the woman mentioned earlier in this blog post. They often feel like it's "their fault" and that it would be a sign that they cannot take care of themselves or they are losing their independence. However, this is not the case at all.

Urinary incontinence is defined as the involuntary loss of bladder control. It is not a disease, but rather a symptom caused by a number of factors and leading to an overall decreased quality of life.

It is often associated with vaginal child births (causing pelvic support problems), but can also be related to urinary tract infections, side effects of certain medications, abnormal growths (polyps, bladder stones, or less commonly bladder cancer), urinary tract abnormalities, or neuromuscular problems (such as multiple sclerosis, spinal disorders etc.).

There are two main types of urinary incontinence: stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Women with SUI leak urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, runs, or exercise. It is caused by a weakening of the tissue that support the bladder or the muscles of the urethra. In contrast, in people with UUI, leakage of urine is triggered by an overactive bladder muscle (the detrusor muscle) that contracts too often or by a bladder nerve disorder. It is not uncommon for some women to have a combination of both stress and urgency incontinence symptoms.

To diagnose these disorders, your physician will take a detailed history and perform a thorough physical examination. Lab tests may also be done to detect a urinary tract infection. Other tests that assess how your bladder functions may be necessary: urodynamic tests (to check the function of the urethra and bladder), postvoid residual volume test (this test measures the amount of the urine that is left in the bladder after urinating), and/or cystoscopy (a thin lighted tube with a lens at the end is used to look inside your bladder and urethra).

The good news is you don't HAVE to just "deal with it". There are several treatments available to lessen the severity of the urinary incontinence so that you can go about your life more comfortably.

The treatment options can be less or more invasive. Lifestyle changes and physical therapy should be tried at the beginning of the treatment.

Lifestyle changes involve losing weight in overweight women, avoiding constipation, drinking less fluids and limiting caffeine intake (which is a diuretic and bladder irritant), seeking treatment for chronic constipation and stop smoking.

The physical therapy helps strengthen the pelvic floor muscles. Biofeedback is a training technique useful in patients with problems locating the correct muscles. Devices inserted into the vagina to help support the pelvic structures (pessaries) could sometimes be used. In selected patients with an overactive bladder muscle, medications can be useful to control muscle spasms or unwanted bladder contractions. They can help reduce frequency of urination and leakage associate with UUI. However, if conservative treatments fail, minimally invasive surgical procedures are available. They should be discussed with the physician. Choosing the right procedure depends on your age, lifestyle, and general health.

Don't be afraid to tell your doctor about your symptoms so you can receive further evaluation, explore different options and get the best treatment for YOU.

So, with that said — leaks. Let's talk about it.

Bogdan Orasanu, M.D.
Urogynecology and Reconstructive Pelvic Surgery
Summa Women's Health Institute
Summa Health System

Osasumwen Asemota, M3


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