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Urinary Incontinence

FEMALE URINARY INCONTINENCE
“Gotta go, Gotta go, Gotta go”

Have you ever seen the commercial on television of a smiling woman in a sundress and sun hat, enjoying a romantic boat ride on the lake with her significant other, when suddenly a panicked thought crosses her mind: “Gotta go, Gotta go, Gotta go.” Her bladder overpowers her mind, she bites her lip, and she crosses her legs in an attempt to suppress the bladder urgency.  How can she control her daily bladder urgency and frequency symptoms, and what are her treatment options?

Female urinary incontinence is a common problem that affects up to 50% of the adult female population.  Many women who have bladder leakage put up with the constant discomfort and embarrassment of urinary leakage and avoid seeking treatment. But with the proper medical diagnosis and evaluation, urinary incontinence problems can be treated and significantly improved.  The two most common types of urinary incontinence are overactive bladder and stress urinary incontinence.

I. Overactive Bladder:   The common symptoms are bladder urgency, frequency, and nocturia (going to the bathroom multiple times a night). Sometimes the urgency is so strong that you have urge incontinence (involuntary leakage of urine with the desire to urinate). The first option is simple dietary changes, lifestyle improvements, and bladder retraining.  Her are some recommendations:

  1. Decrease your caffeine intake (e.g. coffee & tea):  Slowly taper your caffeine intake so that you are drinking one half to one third the number of cups of coffee a day.  Consider changing to decaffeinated coffee.   Keep a bladder diary to record the number of times you use the bathroom on a normal caffeine diet versus caffeine-less diet. Also, consider decreasing acidic fluids (e.g. lemonade) and spicy foods.  You will see a significant difference.
  2. Nocturia (going to the bathroom multiple times a night): A simple alternative is to decrease your fluid intake at night.  After dinnertime, drink half the amount of fluids you normally drink and you’ll notice that your visits to the bathroom will be less during the nighttime and you will get more continuous sleep.
  3. Bladder Re-training:  With overactive bladder, your bladder has spontaneous involuntary bladder spasms but you can retrain your mind to suppress your bladder urgency and frequency sensations.  For instance, once you feel the urgency to use the restroom; try to wait another 15 minutes before using the restroom.  With much practice, one can suppress the urge sensation from 15 minutes to 30 minutes and perhaps up to one hour. 

These various bladder treatment options will help to regain control of bladder function and improve one’s daily activities. If conservative measures fail, then your physician will recommend medications (e.g. Detrol, Ditropan, and others) to improve one’s bladder control.  These medications help relax the bladder muscles and suppress the bladder spasms, thereby decreasing the urge sensations.  And in the severe cases of refractory overactive bladder in which all medications and conservative bladder retraining methods have failed, then the other options are bladder electrical stimulation like Uroplasty and Interstim (by Medtronics).

II. Stress Urinary Incontinence.  Another type of incontinence is stress urinary incontinence. The most common symptoms are leakage of urine with coughing, laughing, or sneezing.  At other times, urinary leakage can occur from walking, running, jumping, or lifting things. The recommended first line of treatment is conservative Kegel exercises.  Kegel exercises are pelvic floor muscle exercises that strengthen the muscles around the bladder neck and improve the bladder support, thereby decreasing the amount of leakage.

  1. Kegel Exercises: Over one-third of women start out squeezing the wrong muscles. Therefore, it is helpful to work with a doctor or nurse who can teach you the correct technique. You need to build the pelvic floor muscles, specifically the muscles around your vaginal area. Try to keep everything relaxed except the muscles right around the vagina. At the same time, do not bear down or squeeze your thigh, back or abdominal muscles. Breathe slowly and deeply. At first you can do the exercises with your knees together (lying or sitting). We recommend doing the exercises for ten minutes, twice a day. You should squeeze the muscle for a count of four seconds and relax for a count of four seconds. At first, you may not be able to do the exercises for a whole ten minutes or hold the squeeze for a count of four. With practice it will become easier as the muscles get stronger. It takes from six to twelve weeks for most women to notice a change in urine loss. Remember, if you do the exercises with resistance regularly, you could see results sooner and prevent stress incontinence.

What happens if I have tried the Kegel exercises for a few months and I still have leaking?  The next option is surgical treatment with a TVT (Tension-free Vaginal Tape) sling or TOT (Transobturator Tape) sling. This procedure is a simple outpatient surgical option, with minimal postoperative discomfort, and a quick postoperative recovery (less than one week).  The success rate of this bladder sling is excellent with a cure rate of approximately 90-95%.

 

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