Editor’s note: This is a two-part series. Next week, we’ll cover medications and surgical options to treating incontinence in women.

By Kristine Porter

kporter@tnonline.com

ncontinence is an issue that many women who suffer from it keep quiet to themselves. They don’t even tell their spouses.

Dr. Shawn Mendonca, a urologist with Lehigh Valley Heath Network. said some women who experience leaking during intercourse just stop being intimate and don’t tell their spouse why.

“They get embarrassed,” he said. “This can be fixed. And you can go and have a normal life after that.”

Mendonca said there are many different kinds of incontinence, but there are three that are predominate: stress incontinence, urge incontinence also known as overactive bladder, and overflow incontinence.

Stress incontinence occurs when a woman coughs, sneezes or exerts herself. It is caused by a weakened urethral resistance pressure.

“The purpose of the urethra and the sphincter around the urethra is to hold the urine in, but over time it gets weak,” Mendonca said.

Urge incontinence has to do with a malfunction of the normal physiology of the bladder. The bladder is supposed to expand and fill with urine, then contract later to expel it. In women with urge incontinence, the bladder may not expand properly, or it might contract at an inappropriate time. This type of urgency is sudden and unexpected.

The main risk factor for developing stress or urge incontinence is age.

“As we age, we use our bodies more. We use our pelvic muscles more and things get weaker,” Mendonca said.

A big risk factor for stress incontinence is the number of vaginal births a woman has experienced. Issues that can affect it include: the size of the baby at birth, forceps or vacuum suction delivery, and the length of labor. A prolonged labor increases the risk of incontinence.

“I just tell patients to live their lives and if it happens, we’ll deal with it,” he said.

The third type of incontinence is overflow incontinence. It is much less common and happens most often in people with spinal cord injuries, advanced stages of multiple sclerosis, or spinal surgery, Mendonca said.

In this type, the bladder doesn’t function at all. It keeps filling with urine and gets full, but never really contracts. As a result, the woman experiences leaking small amounts all the time.

Treatment for incontinence

As for treatment for incontinence, Mendonca said it really is a quality-of-life issue.

“For most patients as long as there’s no scary symptoms, there’s no downside,” he said. “It’s not a life-threatening issue to not get it treated.”

The downside though of not seeking treatment is really emotional. These people have to their lives always wearing some type of pad, and often feel embarrassed or worry that they might smell like urine.

“They don’t want to socialize with people,” Mendonca said.

There are medications and outpatient surgery procedures to treat incontinence. But there are also some simple ways to limit and even stop mild incontinence.

The first step is to stop drinking caffeine, Mendonca said. Caffeine is an irritant to the bladder. The higher the amount of caffeine content, the greater the risk of irritating the bladder.

“I’ve had patients who have gotten off of medications and not required further treatments because I told them to stop it. The biggest culprit is caffeine,” he said. “They are like, ‘Wow, I don’t miss it at all, because my urinary symptoms are so much better. I’m happier without the coffee.’”

For patients who have taken his advice, Mendonca said he asks them if they feel fewer urge episodes after stopping caffeine, and like a light bulb going on, they realize that indeed they do have fewer episodes.

In addition to caffeine, alcohol and spicy foods also irritate the bladder.

“I’m telling patients don’t drink alcohol, don’t drink their coffee, get rid of all the fun, don’t eat spicy food,” he said. “Telling them to stop doing all the fun things, but you know, it is what it is. They have to make that conscious decision. This is not going to kill you, but you control how miserable it’s going to make you.”

There are also behavior modifications that people can try.

Mendonca recommends going to the bathroom every few hours. It’s called time voiding. If the bladder is kept relatively empty, then the risk of leaking decreases.

Another method is Kegel exercises. These exercises involve tightening and loosening the pelvic muscles in order to strengthen them. It improves the sphincter function and helps to hold more urine, Mendonca said.

And a nonsurgical option is a pessary, which is a doughnut-shaped, plastic device that is inserted into the vagina. There is a knob on one side that pushes against the urethra to prevent it from leaking if a woman exerts herself.

Mendonca said that if the symptoms are mild or the woman is too elderly to undergo surgery, then nonsurgical options are the best first step in treatment.