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by
Michael Goodman, M.D.
Today’s and next week’s
articles are devoted entirely to two subjects women
think about a lot but seldom comment on “in public”
(except maybe to their closest friends):
Incontinence, and vulvar aesthetics (what it
looks like and feels like “…down there…”.)
Urinary
incontinence, the loss of usually small amounts of urine
either secondary to urgency (“gotta go…gotta
go…”) or increased abdominal pressure (cough,
sneeze, laugh, exercise, lifting, etc.) is an
unfortunate fact of life for many women, especially
after childbirth and as they age.
This is a solvable
problem. You
do not have to be incontinent.
There are many solutions.
Arriving at the right one for you, however,
requires the service of an experienced and up-to-date
diagnostician and clinician.
As in much of medicine, one size does not fit
all; the perfect therapy for one woman may be
inappropriate for the next.
“Urge
incontinence” (the loss of small to moderate amounts
of urine on the way to the bathroom, especially with a
full bladder and the feeling of “having to go” all
the time) may be secondary to low estrogen levels,
bladder spasms or excessive intake of acidic foods.
For urgency
in women with lowered estrogen levels (as in menopause,
just after childbirth or in other women with lowered
estrogen levels) local vaginal estrogen therapy
frequently works wonders.
Tempering bladder irritants, including acidic
foods such as chocolate, coffee, tea, many fruits,
tomatoes, alcoholic beverages, chili/spicy foods, etc.,
helps. If these therapies are less than curative, adding in an
antispasmodic medication such as oxybutynin, Detrol®,
Vesicare®, etc. frequently helps.
A new electrical stimulating device (“Athena®”)
also helps and will be discussed in detail later.
“Genuine
stress incontinence”, the involuntary loss of usually
small amounts of urine with activities that increase
intra-abdominal pressure, is the most common type of
incontinence and is due to a laxity of the muscles of
the pelvic floor diaphragm, allowing the “neck” of
the bladder to slip down and straighten out when
intra-abdominal pressure increases.
Sometimes other things (uterus, apex of the
vagina, the rectum bulging into the vagina) slip down or
“prolapse” as well.
Why
does this occur? Genetics
certainly play a major role, as does the breakdown of
collagen and the muscular support with aging.
That said, however, undeniably the major
causative factor for the stretching and tearing of
fibromuscular pelvic support is childbirth, especially
long and difficult labors, and associated tearing of
vaginal tissues during delivery.
(In many
countries, women opt for “elective” cesarean
section, specifically to prevent the incontinence
associated with vaginal birth).
The therapy
of stress incontinence is aimed at strengthening the
muscles of the pelvic floor and in some way tightening,
repairing, or “suspending” the previously tough and
tightly woven fascial support that has been loosened
and/or torn by childbirth.
This can be done by exercise and biofeedback, the
new Athena® Pelvic Muscle Trainer, major bladder
suspension surgery and the new minimally invasive SURx®,
Radiofrequency Wave Pelvic Support Procedure (which can
also be used for the “vaginal tightening” in vaginal
rejuvenation–see next week’s column). Any physician treating urinary incontinence should be able to
offer you all of these alternatives.
Although
Kegel’s exercises, isometric contraction or
“squeezing” of the levator muscles of the vagina,
can increase muscular tone, this laxity is only part of
the problem; Kegel’s do not change/repair fascial
defect(s).
The Athena®
Pelvic Muscle Trainer is a new concept (access www.athenaft.com)
in muscle strengthening whereby a pelvic floor
electrical stimulator built into a wireless remote
controlled vaginal device gently stimulates the pelvic
floor muscles to strengthen and tighten with minimal
effort.
Pelvic
floor exercises via Kegels, biofeedback or the Athena®
device help some women with minimal incontinence.
For more moderate or severe situations and those
not corrected by exercises, especially when associated
with prolapse, surgery is the better option.
Surgical
procedures may be divided into two categories:
Major and minor.
If your incontinence is significant/severe,
especially with major prolapse, major surgery (abdominal
or vaginal) producing some sort of permanent suspension
and repair of the fascia is best.
“Burch” suspension, TVT (transvaginal tape)
and TOT (transobturator tape) are three of the most
common procedures performed.
All have excellent five-ten year success rates,
but all involve hospitalization, post-op catheter use,
and have the potential for significant complications.
For those
with mild/moderate incontinence, without or with only a
small degree of prolapse, the new SURx® procedure
offers a significantly easier recovery. SURx® uses radiofrequency thermal energy (“controlled
heat”) to increase the stability of the pelvic floor;
heating the tissue improves its stability because the
tissue contains collagen, and collagen reacts to heat by
shrinking and tightening.
A small incision is made in the anterior vagina
and the radiofrequency probe is applied to the fascia
underneath the bladder to shrink and stabilize it.
Any tears encountered can be repaired at the same
time. Although
patients must limit strenuous activities and intercourse
for approximately six weeks (as in other surgical
procedures), SURx® is an outpatient procedure (a total
of only three-four hours in the hospital), there is
virtually no pain involved, and recipients may return to
usual work activities in two-three days.
This is an
overview only of female urinary incontinence.
Remember, you do not have to suffer (either
vocally or in silence)!
Help is available.
Michael Goodman, M.D. is a gynecologist and
perimenopausal practitioner in Davis California with
special interest in pelvic floor problems and vulvo-vaginal
aesthetics. Visit
www.pelvicsupportaesthetics.com. |
