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Dr. Angela Alt, St. Luke's Hospital

Relief possible for women with urinary incontinence

Women experience urinary incontinence, or the involuntary loss of urine, twice as often as men, according to the National Kidney and Urologic Diseases Information Clearinghouse. Many times, however, it's very treatable, and the specific treatment may depend on the type of urinary incontinence one has.

The two most common types are stress and urge incontinence. Stress urinary incontinence—or SUI—occurs during an increase in abdominal pressure such as coughing, sneezing or lifting something heavy. Urge urinary incontinence—or UUI—involves an involuntary loss of urine preceded by a strong, sudden urge to urinate. Those with UUI often have an overactive bladder.

For both types, behavioral therapy is the first line of treatment, such as scheduled voiding (urinating every two hours while awake) and avoiding dietary irritants such as coffee, tea, carbonated beverages, citrus juices and chocolate. Weight loss and pelvic floor muscle training can also help.

When these treatment options do not lead to significant improvement, medical and surgical treatment options are available. For postmenopausal women with UUI, estrogen cream can help with bladder overactivity. Another option for those with UUI is an oral medication that inhibits bladder contraction. If medicines fail to work, minimally invasive treatments can be considered such as Botox injection into the bladder. This is usually effective for six months to a year. InterStim Therapy, which is a medical device similar to a pacemaker, can be implanted to help patients with overactive bladder and urge incontinence.

Surgical interventions are also available to treat SUI. Minimally invasive options consist of bulking agents injected into the urethra (the channel through which urine flows) which increase the resistance to leakage. This sometimes needs to be repeated after one to three years. The most common surgical treatment is a urethral sling. With this treatment, a strip of material is placed under the urethra like a hammock. About four out of five patients remain dry after four years with this treatment.

If urinary incontinence is affecting your quality of life, don't hesitate to talk about it with your healthcare provider.

Dr. Angela Alt is a urologist at St. Luke's Hospital. Call 314-434-3433.

This article was published in the St. Louis Post-Dispatch on November 29, 2012.

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