If you have a problem controlling your bladder, you are not alone. Urinary incontinence is very common, affected up to half of all women at one time or another. In its early stages it is just an annoying inconvenience. Untreated, it progresses to a life altering problem restricts your activities, interferes with your work performance, even affects your sex life.
Everyone knows people who have had a bladder tack, yet still have problems. Many of those women had an inappropriate operation or were not properly evaluated or instructed prior to their surgery. Others have conditions that are not treatable with a bladder tack, instead medications or injections are more appropriate treatment.
The isles at Wal-Mart are stacked with adult diapers for those who are unable to find relief from their disabling incontinence problems. Urinary incontinence is one of the leading causes of women being placed in nursing homes. It is a personal tragedy for many women.
Dr. Holley can help you with your bladder control problems without major surgery, or, if surgery is necessary, prepare you for surgery with a proper evaluation.
Initial evaluation includes a general physical exam and review of your medical history, medications, and past surgical experiences. A urinalysis and urine culture are needed to evaluate and treat urinary tract infections and conditions. Measurements of your bladder position, capacity, bladder pressures, muscle tone, and neural reflexes are essential to make an appropriate diagnosis and plan treatment.
A pelvic examination measures the length and support of the vaginal walls supporting the bladder and identifies the location and extent of any pelvic support defects. Associated pelvic floor deficits can include vaginal prolapse, uterine procidentia, or rectocele.
A voiding diary helps us pinpoint the cause of incontinence episodes, relation to fluid intake, medications, and activities such as occupational duties and marital intimacy. Often a simple change such as taking your diuretic blood pressure in divided doses or first thing in the morning, rather than at night, is enough to control unwanted voiding activity at night.
Some patients are found to have a condition called “interstitial cystitis.” This is a painful chronic condition that results in disabling pain and urgency, symptoms much like a urinary tract infection, but with sterile urine. Antibiotics are not helpful with this condition; instead we treat it with solutions placed in the bladder to sooth the muscle wall and relieve chronic inflammation.
Bladder retraining exercises may include planned voiding exercises in which a small bladder is trained to accept larger volumes of urine before becoming uncomfortable.
Sometimes a simple office procedure to dilate your urethra and distend your bladder may be all that is necessary to restore normal bladder function. We can do this under local anesthesia and conscious sedation here in the office without major surgery.
We can also work with you to fit you with an appliance called a continence ring, a vaginal insert that you may wear in the vagina to support a sagging bladder. Specialized pessaries have been developed for incontinence that are very effective at reinforcing your vaginal tissue and improving continence. You cannot feel a properly fitted continence ring if it is in the right position. The newer inserts are made of silicon that does not absorb odors and does not cause infection.
Some types of incontinence are caused by bladder spasms, and can be treated with medications. Most of the available medications have side effects and must be monitored carefully. Some medications that were developed for other reasons are useful for the treatment of incontinence in some patients. For refractory cases in which bladder medications are ineffective, Dr. Holley can give you injections of Botox into the bladder muscle that can be effective in controlling bladder spasms.
A surgical bladder tack in years past was a difficult operation with a high failure rate. Almost half of women who had bladder tack operations 20 years ago continued to have incontinence. The operations done today are more effective, 80-90% 1 year success rates, but are also more risky. They involve the use of permanent mesh to support the bladder neck. The mesh can cause complications even many years after surgery, including erosions into the bladder or vagina, obstruction of the urethra, vaginal pain, vaginal bleeding, or pain with intercourse. Dr. Holley does not do these bladder tacks. If you really need one, she will refer you to a center of excellence to have this procedure, and she will evaluate and prepare you for the surgery.
Many women who have had incontinence surgery continue to leak urine even though their bladder tack was properly done and the bladder is in the proper position. Those women commonly have intrinsic urethral insufficiency, which can be diagnosed with bladder pressure studies. Dr. Holley does urethral injections of Dusasphere, a bulking agent, which helps hold the urethra closed so that leaking is reduced while bladder control is improved.
Most women with incontinence can be helped without major surgery and without the risks of artificial mesh. Even severe cases can be improved enough that these women can enjoy a normal life, occupational success, and marital intimacy without the threat of embarrassing urine leakage.