Imagine the Embarassment

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September 3, 2013 by Timothy E. Hughes, MD, FACOG, FACS

Imagine the embarrassment … you are standing in the check-out line at the store when suddenly it hits you: An unrelenting, powerful and insurmountable urge to empty your bladder. Desperately you think to yourself, “Quick, where’s the bathroom?” You then shudder as you feel the leak occur, right there as many others are standing right there. The scenarios are many, ranging from being at work, out to eat with family or friends, enjoying you favorite outdoor activity … the end result is the same; the uncontrollable loss of bladder control that often makes you just want to stay home and avoid the potential for embarrassment.
Incontinence is an incredibly common condition with which thousands of Americans suffer each year. While it can occur in both men and women, for a variety of reasons women comprise the overwhelming majority of urinary incontinence patients. Loss of bladder control can take one of several forms and can be caused by a number of different issues; each one of these is treated differently using measures ranging from biofeedback and medications, to minor and sometimes moderate surgical procedures. The pivotal and vital key to successful management is accurate assessment and diagnosis.
Stress Incontinence: Stress incontinence occurs when the supporting structures at the pelvic floor and neck of the bladder can no longer overcome the increased pressures that occur with coughing, sneezing, laughter or exercise. Sometimes leak will occur with simple position changes, such as going from a sitting to standing position.   This type of incontinence is the most common form seen in women. While it will sometimes be controlled with pelvic floor exercises or biofeedback, most cases require minor outpatient surgery to correct the anatomical defect.
Urge incontinence: Urge incontinence is just what the name implies: that is, urine loss associated with an uncontrollable urge (like the example above). Urge incontinence is often caused by uncontrolled contractions of the bladder muscle that results in leakage. This type of incontinence may respond to medication; sometimes requires specialized care in the form of InterStim therapy.
Intrinsic Sphincter Deficiency: With ISD, urine seems to “dribble” all of the time due to a failure of the circular muscle near the bladder neck. Surgical treatment is the preferred option in this type of disorder, but this can usually be done as outpatient.
Mixed Incontinence: This type is just what the name implies; “mixed,” or originating from more than one specific cause.   While sometimes more challenging to diagnose, successful treatment can be accomplished with adequate testing and evaluation.
If there is anything worse than urinary incontinence, it is probably fecal incontinence. It may be surprising, but this is not an uncommon problem, it just is not commonly discussed. Specialized care for patients with this history is available on referral from your Gastroenterologist (GI) physician. We have helped numerous women (and a few men) in overcoming this problem. A thorough evaluation is required by a GI specialist prior to consideration of this type of treatment.
At Springhill Center for Women’s Health, I am proud of the care that I am able to provide our patients suffering with incontinence problems. One of the biggest rewards of providing this type of specialized care is giving patients their independence and ability to live their lives and enjoy activities without the constant fear and embarrassment associated with urinary incontinence. As the only Board Certified Gyn specialist in Southwest Alabama offering this comprehensive type of care, including InterStim therapy for urge incontinence and urinary retention, it is an exciting time for our practice.
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