DR. SOHAIL A. SIDDIQUE: Urinary dysfunction is common in women age 40 and older and billions of dollars are spent each year on pads, panty liners, diapers, etc., to help with urinary leakage. Many women will avoid social activities for fear of incontinence or will have to map bathroom locations when out of their homes. Some may avoid important events including vacations, weddings or graduations because of fear of urinary dysfunction. Some women avoid sexual relations because of urinary dysfunction.
The symptoms of urinary dysfunction include urinary frequency, incontinence or leakage, urgency and nocturia, which is urinating at night. These increase with age and often start in the premenopausal years and may worsen after menopause. A major risk factor is vaginal childbirth though women who have cesarean section births or who do not have a child are not protected. Cesarean delivery may delay the onset of symptoms. Urinary dysfunction is commonly associated with pelvic prolapse, which is the descent of the uterus or vagina sometimes to outside the body. Women can see this or feel something coming out when they strain for bowel movements or when they wipe after urinating.
Any symptoms of urinary dysfunction are not normal and women should seek medical evaluation and treatment. Sometimes symptoms occur because of illness such as untreated undiagnosed diabetes. Some medications such as diuretics or "water pills" may worsen symptoms though this effect usually goes away with time.
The range of treatments for urinary dysfunction vary and can include weight loss, dietary modification, behavioral modification, pelvic floor exercises such as kegel exercises, physical therapy, a pessary device, medications and surgery. The appropriate therapy is tailored to the patient's symptoms. Frequently a combination of treatments is successful, while for some women only one type of treatment is needed.
For urge Incontinence, medications and physical therapy are the mainstays of treatment. Not all types of urinary dysfunction are amenable to surgery and some types of dysfunction can get worse with surgery. A physician's recommendations can only be made after a careful history and physical exam are performed.
Many times women with mild symptoms can improve their quality of life with early physical therapy such as doing kegel exercises to strengthen the muscles of the pelvic floor. Up to 50 percent of women do not perform these exercises correctly as many strain instead of squeezing and make their incontinence worse. Proper kegels involve contraction of just the pelvic floor or vaginal muscles and not contraction of muscles of the butt or legs or stomach.
Women should seek help from their primary care physicians, gynecologists, urogynecologists or urologists. Many times urinary problems are accompanied by prolapse and bowel problems and a team of doctors working together can provide the best care.
Take control of your life - don't let bladder problems control you. Seek help today.
Dr. Sohail A. Siddique is an assistant professor of Obstetrics and Gynecology and chief of the Urogynecology division, Southern Illinois University School of Medicine.
