Help For Incontinence
MADISON - Television commercials portray loss of bladder control and incontinence as problems suffered by elderly women, suggesting that the only answer is protective undergarments. In truth, incontinence affects women of all ages - even young, healthy women. And there are many options for women to improve bladder control, eliminate leakage and enjoy a normal lifestyle.
The most common bladder problems are stress incontinence and overactive bladder. Stress incontinence, leakage with coughing or vigorous activities, affects about 40 percent of women by age 40. Some experience only an occasional problem but in many the leakage is bad enough or frequent enough to be a real problem.
Overactive bladder, excessive urinary frequency and urgent urination affects an increasing number of women with age. About 15 percent of middle-aged women are affected; that incidence climbs to 30 percent as women approach their seventies.
With either disorder, the impact on a woman's quality of life is significant. Even minor incontinence can change a woman's body image and sexuality, as well as her sense of health and well-being.
According to Dr. Wade Bushman, a UW Health urologist who specializes in incontinence and bladder problems, "Bladder problems predispose to social isolation. Women give up going to the gym because they leak when they jog or work out. They feel uncomfortable in social situations where they can't get to a bathroom easily."
Despite this, women may not discuss it with their physician because they don't realize that it is a common problem for which good treatment options exist.
Giving women effective treatment options is the reason Bushman, who directed the Center for Bladder Health at Northwestern University from 1992-2002, has established a Bladder Clinic at UW Health.
"One of the obstacles women encounter in seeking treatment of bladder problems is having to shop around themselves for treatment options," he explains. "They may need an operation, but they go to someone who doesn't do it. They might benefit from exercises, but go to an office where exercises aren't discussed or offered." Offering patients the full array of diagnostic and treatment options in a single place is the mission of the UW Health Bladder Clinic.
According to Bushman, women whose bladder symptoms interfere with their lifestyle or require the use of a pad are most often the ones who seek treatment. When a patient comes in, her complaints are assessed in the context of her lifestyle and medical history. Once a working diagnosis is established, Bushman discusses the options with the patient.
"I talk with them about where they want to go - diagnostically, educationally and therapeutically," he says. "The major issues are how much does it bother you, is it going to get worse, and what are the options for evaluation and treatment."
Fortunately, there are effective therapies for most patients. For stress incontinence, medication and exercise can help a little, but surgery remains the most effective treatment. The problem in stress incontinence is not weak muscles but weakened ligaments that support the bladder. The ligaments are usually weakened by pregnancy, childbirth and aging, but can be surgically repaired.
Bushman favors the pubo-vaginal sling, a procedure in which a tissue graft from the patient's own body is used to replace the weakened and stretched ligaments. The procedure requires a two- to three- week recovery, but its proven long-term success rate tops other surgical options. "It keeps people durably dry," Bushman attests.
Women with overactive bladder are most bothered by the urgency of urination and the need to urinate at night. For some, pelvic floor muscle exercises or changes in fluid intake can help. For many, daily medication can control bladder muscle hyperactivity.
"They're like anti-arrhythmics a heart patient takes to suppress irregular heartbeats," Bushman explains. "They work well, but they need to be continued."
Fortunately, they are well tolerated, cause minimal side effects and are safe for long-term use. "Most patients who try them want to stay on them, because they feel like they've gotten control over their life again," Bushman says.
For more information about the Bladder Clinic, call 608-263-4757
Date Published: 06/15/2007