Q&A Topic: Incontinence In Women
Warren Bromberg, MD, FACS
Q. If I think I might have urinary incontinence, when do you advise seeking treatment?
A. First of all, I think it’s important to define urinary incontinence. It is considered to be the involuntary or accidental loss of urine control. There are several reasons why this condition should be evaluated:
• Because the uncontrollable loss of urine is bothersome and embarrassing, and
• Because the loss of urine control may be a symptom of an underlying medical condition that needs to be evaluated and addressed, such as a urinary tract infection, diabetes, or, for men, a large prostate.
Q. Are there different types of urinary incontinence that require different types of treatment?
A. Yes, the treatment recommended depends on the type of urinary incontinence you are experiencing. That’s why the first step in treating your condition is determining the specific type of incontinence:
• Stress incontinence, which affects more women than men, results from the failure of the control mechanism at the outlet of the bladder to stop urine from leaking out when pressure is applied to the bladder. This explains the loss of urinary control when you cough, sneeze, laugh, or exercise.
• Urge incontinence results from an overactive bladder that contracts involuntarily. A sense of a sudden strong urge to urinate often precedes the loss of urine.
• Overflow incontinence occurs when the bladder isn’t able to empty with normal urination . The urine leaks out under pressure either continuously or when pressure is applied to the bladder. This is more often diagnosed for men than women and is usually due to an enlarged, obstructing prostate.
• Functional incontinence occurs when one has normal urination, but difficulty getting to the bathroom in time. For instance, severe arthritis can make it difficult to move quickly when first feeling the urge to go to the bathroom.
• Incontinence from neurological disorders is associated with such conditions or diseases as a spinal cord injury, a stroke, Parkinson’s disease, multiple sclerosis, or dementia, for example.
Q. To determine whether I should pursue treatment, where do I start?
A. It’s best to first start with a visit to the pediatrician for a child or a primary care physician for an adult. They would be able to rule out any simple cause of the urinary incontinence and decide if it’s necessary to see a urology specialist. Either the pediatrician or the primary care physician could refer you to a urologist if the condition cannot be resolved with a simple treatment.
Q. If treatment is recommended, are there different types of treatment?
A. After a urologist determines the cause and type of incontinence you are experiencing, he or she will recommend the treatment that can best address your problem. Not every condition needs to be treated surgically. Sometimes, only simple behavioral modifications are needed. The range of non-surgical and surgical treatment options include:
• Stress incontinence most often requires a surgical procedure to improve the support system under the urethra or to place an artificial sphincter. A sling or hammock procedure—a 20-minute outpatient procedure with a very high success rate—is commonly performed and allows a return to normal activities in a week or two.
• Urge incontinence can often be addressed with an oral medication to reduce the urge or by injecting Botox into the bladder muscle with a special scope.
• Overflow incontinence due to an enlarged prostate requires medication to shrink the prostate or a relatively simple surgery with no more than an overnight stay.
• For functional incontinence, we teach people how to moderate their fluid intake or plan scheduled trips to the bathroom.
• Incontinence from neurological disorders can cause all types of incontinence and treatment ranges from non-surgical to surgical. It’s especially important to receive an early diagnosis in order to avoid further complications, such as urinary infections or loss of kidney function.
Q. How successful are treatments for urinary incontinence?
A. Urinary incontinence is a very common, but debilitating condition that can be highly embarrassing and can even affect intimacy. It shouldn’t be ignored or “kept in the bathroom.” And, although using pads or disposable briefs may seem like a simple solution, in the long run, they can lead to infections, skin breakdown, and can become very expensive.
The good news is that the available treatments are highly successful. Most people can be cured or significantly improved. All of the latest treatments for both women and men are offered at Northern Westchester Hospital. It’s also encouraging that there has been a significant increase in awareness and more people are willing to discuss urinary incontinence and its affect on them with their doctors. Primary care physicians also are now more inclined to ask questions about incontinence and recommend treatment.
Northern Westchester Hospital
Co-Director, Institute for Robotic & Minimally Invasive Surgery
Learn More About Dr. Bromberg
Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).