Ask the Experts: Is Incontinence Permanent and Does it Require Surgery?
Urinary incontinence is leakage of urine you cannot control. It is a problem that can keep you from enjoying life, because you are afraid to be too far from a bathroom.
Urinary incontinence is not just a normal part of getting older. It can be managed or treated. There are many types of incontinence. Two of the most common are associated with stress urinary incontinence (SUI) and overactive bladder (OAB).
Stress urinary incontinence is leaking that occurs with coughing, laughing, jumping or exercise.
Overactive bladder is a constant “got to go” feeling sometimes associated with leaking or peeing before you get to the bathroom.
For some people, lifestyle changes may help ease your symptoms. These changes may involve:
Weight loss and/or limiting caffeine and alcohol
Retraining your bladder. The goal is to retrain your bladder to hold urine for three to four hours, with less urgency and leaking.
Learning to do Kegel exercises. These can often help improve your bladder control. The trick is to learn how to do Kegels the right way. A physical therapist can offer tools, like biofeedback, to teach you how to use and strengthen the right muscles.
When lifestyle changes and Kegel exercises do not help enough, your doctor may ask you to try other treatments based on your type of incontinence.
For SUI, your doctor may ask you to try an anti-incontinence pessary or a disposable vaginal device. If those are not good options for you, surgery may help. The most common surgical treatment is mid-urethral sling. This treatment helps close the urethra when you cough, sneeze, bend, lift, jump or run. This is a simple and short outpatient procedure.
For OAB, your doctor may ask you to try prescription medications. If both lifestyle changes and medicine are not working, surgery may help. One surgical option is nerve stimulation to help control bladder function. It can be done through a pacemaker-like device that is placed through surgery under the skin in the lower back area. This treatment can last several years and can also be done in short 30-minute procedures in the doctor’s office once per week for 12 weeks.
Another office based option is bladder Botox® (onabotulinumtoxinA) treatment. With this treatment, the bladder wall muscles relax, which then limits or removes the urgency-related bladder spasms, the “got to go” feeling and leaking that occurs before reaching the bathroom. The treatment needs to be repeated about twice a year.
It is always best to talk with your doctor to find the best choices for your type of incontinence. These options will vary from person to person, and there may be a trial and error period before finding the best treatment for you. Stick with it!
Dr. Ekene Enemchukwu, a urologist at Stanford University Medical Center, focuses on management of male and female pelvic floor conditions, voiding function and urinary incontinence.
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