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Stress Incontinence

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Sarah McAchran, MD, UW Health urologist discusses the very common problem of urinary incontinenceMADISON - It's an increasing problem as baby boomers age, but urinary incontinence is something women have trouble talking about with their doctors.

"It can be incredibly hard for women to talk about. Often, they are in my office in tears," says Sarah McAchran, MD, a UW Health urologist. "I tell them, 'Don't worry, it's really very common.'"

Is it ever. A study published in the the Journal of the American Medical Association (JAMA) in September found that nearly a quarter of women over age 20 have a pelvic-floor disorder, with urinary incontinence the most common symptom.

And since the incidence rises with age, it's becoming even more common. The JAMA article notes that by 2030, more than 20 percent of women in the United States will be 65 years or older.

"As the population of older women increases, the national burden related to pelvic-floor disorders in terms of health care costs, lost productivity and decreased quality of life will be substantial," the authors wrote.

While incontinence isn't fatal, it can limit women's lives.

"Some older women don't leave the house because they're afraid of having an accident," McAchran says. "And younger women may stop running or exercising because they're afraid of leaking. It's a vicious cycle, because that can lead to weight gain, which makes the problem worse."

Fortunately, there is plenty of help available.

McAchran, who came to UW Health in August after doing a fellowship in female pelvic medicine and reconstructive surgery at the Cleveland Clinic, says that there are a number of ways to treat stress incontinence, which can result from childbirth, aging or being overweight. The result is leaking when women cough, laugh, or jog.

McAchran says that younger women tend to experience stress incontinence after childbirth; women in their 40s and 50s often begin to experience the problem as a result of weight gain and/or aging.

The least invasive step to address stress incontinence is usually exercise – those good-old "kegels" ­– and more sophisticated physical therapy, in which therapists use biofeedback to help women learn to control their pelvic muscles.
"Physical therapy is always worth a shot, because it doesn't hurt anyone, and there are no side effects," McAchran says.

Specialists like McAchran generally see women who have tried these steps, and found unsatisfactory relief.

She specializes in minimally invasive surgeries that can correct stress incontinence. One such surgery is called tension-free vaginal tape (TVT) surgery, and another is called transobturator tape (TOT) surgery. In each, a mesh tape is inserted through small incisions in the vagina and either the pubic hair line or inner thigh, and supports the urethra like a hammock. The surgery is quick and can be done with minimal anesthesia. Patients usually return home the same day.

One of McAchran's urology colleagues, Wade Bushman, MD, PhD, specializes in the surgical techniques for more complicated forms of incontinence, such as the pubovaginal sling and other surgeries that require hospitalization.

The other type of incontinence, urge incontinence, involves the sudden need to urinate. Women report having trouble making it to the bathroom in time. The first line of treatment of urge incontinence is medication. For those who do not respond, there is a device called Interstim that can be surgically implanted.

"It's like a pacemaker for the bladder," McAchran explains. "It's implanted in the lower back and stimulates the nerves to the bladder."

McAchran and other urologists are also using Botox, which is injected into the bladder, to calm overactivity. However, this is still considered experimental.

"We have a wide variety of treatment options for female incontinence; it's not just Kegels anymore," she says. "Women really need to talk to their doctors because this is a quality of life issue."

Date Published: 10/28/2008

News tag(s):  urology

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