Incontinence is the involuntary loss of urine. Low estrogen levels can decrease muscle tone and result in decreased urinary control in the bladder and urethra. Many types of urinary incontinence are possible. The two most common types, genuine stress incontinence and urge incontinence, will be discussed here.
Stress incontinence is most likely to occur in women who have had one or more children. With childbirth the tissue of the vagina is stretched and the underlying elastic tissue is broken. Prior to menopause the muscles of the vagina can be exercised to increase the tone and decrease the amount of urine loss. After menopause, atrophy, or thinning of the estrogen sensitive tissues results in reduced sphincter control. Other changes with menopause include a decrease in the support of the pelvic organs. When stress is put on the bladder due to coughing, sneezing, laughing or jogging a momentary loss of control can result in a small amount of leakage.
Urge incontinence can also be a problem for some women. It is usually described by women as a feeling of a sudden and uncontrollable need to urinate. It often occurs within an hour of having emptied the bladder. Women often urinate frequently during both the day and night due to the irritability of the bladder.
Kegel exercises, named after the doctor who first described them, help to strengthen the pelvic floor. The exercises are often effective for those who perform them diligently. The exercises can be done anywhere, without anyone being aware that they are being performed. To perform Kegel exercises correctly, you must first relax your abdomen, thighs and buttocks. Then contract the muscles of the pelvic floor by squeezing them inward and upward as if trying to control a strong urge to urinate. Hold the contraction for up to ten seconds then release. Do ten long squeezes three times a day. It usually takes one to two months to notice an improvement. Do not do the Kegels while urinating. It's possible to figure out which muscles are the correct ones by stopping the urine flow but continued exercise this way can lead to problems with urinary retention and can also be frustrating.
If the Kegels do not improve bladder control significantly, surgery is another option. Many different procedures have been developed to control urinary stress incontinence. These may range from repair of weakened vaginal walls to urethral suspension.
Recently it has become standard to perform a urethral suspension. This can be performed abdominally or vaginally depending on the patients age, anatomy and tissue strength. Dr. Ebner is especially trained in Gynecological Urology and can determine the type of surgery most likely to be successful in correcting your problem. A patients age, anatomy and tissue strength may influence the type of corrective surgery necessary and the long-term cure rate. Most procedures approach an 85% cure rate at 5 years. Women who are obese, smoke, use the medication prednisone, lift heavy objects, or have chronic lung disease are more likely to have recurrent symptoms.
Urge incontinence does not improve with surgery. It most often is the result of bladder or detrusor muscle instability. Women should start retraining the bladder using a timed voiding schedule throughout their awake hours that is slightly more frequent than their normal voiding habits. Gradually increase the voiding interval by 15-30 minutes every 7-10 days in an attempt to suppress the urge incontinent episodes. Estrogen supplementation as well as medications can also help with bladder spasms. Most of the medications for bladder spasms can also cause a dry mouth which can be uncomfortable. Serial Heparin installations directly inserted into the bladder may often provide relief of the discomforts of urge incontinence and decrease urinary frequency.
A complete history and physical exam should be performed by Dr. Ebner. He may also ask for a diary of your urinary patterns which includes caffeine and alcohol consumption as well as medication usage. Further evaluation includes a urinalysis, urine culture and urodynamics. During cystometrics the bladder volume and function is completely evaluated. Cystoscopy and Urethoscopy, or looking inside the bladder and urethra, is also performed when appropriate. Estrogen is usually prescribed for post-menopausal women if it is appropriate to their situation.