It’s a topic many women don’t feel comfortable talking about. But there is nothing to be embarrassed about when it comes to discussing bladder control problems with your doctor. Urinary incontinence — the unintentional loss of urine — is a very common problem among women, especially as they age. It’s also a very treatable problem.
In this episode of San Diego Health, host Susan Taylor and guest Varuna Raizada, MD, a urogynecologist at Scripps Clinic, discuss pelvic floor disorders, urinary symptoms and surgical and non-surgical treatments.
“There are multiple treatment options,” says Dr. Raizada, who explains physical therapy, medication and minimally invasive surgery, including robotic surgery.
The pelvic floor is made up of muscles and ligaments that support pelvic organs, such as the uterus, bladder and vagina. “You don't see them, but they are there supporting the weight of your entire trunk, all the time,” Dr. Raizada says.
Urinary incontinence and other pelvic floor disorders occur when the muscles or connective tissues of the pelvic area weaken or are injured. One out of every four women in the United States has at least one pelvic floor disorder, according to the National Institutes of Health.
There are many risk factors, especially genetics. “Family history is huge,” Dr. Raizada says.
Weight gain and childbirth are risk factors. Both put a strain on the pelvic area. “Sometimes those muscles get injured during childbirth,” she says. The number of vaginal births is an additional risk factor.
The most common pelvic floor disorders are urinary incontinence, fecal incontinence and pelvic organ prolapse.
There are two main types of bladder or urinary incontinence.
Urge incontinence is marked by a sudden need to urinate and involuntary leakage. “It’s just like the name suggests. Your bladder is working overtime,” Dr. Raizada says. “When the urge hits you, it hits you very strongly. Often times you're running to the restroom and even before you get there, you're having accidents. That is an overactive bladder.”
Stress incontinence occurs when physical activity, such as lifting, walking, laughing, sneezing or coughing puts stress on the bladder and causes leakage. “When those muscles become weak, urine escapes,” she says.
A urinary tract infection also causes pain and a persistent urge to urinate.
Uterine organ prolapse, also known as pelvic organ prolapse, occurs when the bladder, uterus or other pelvic organs droop down into the vagina.
“It is essentially a weakness of the vaginal walls,” Dr. Raizada says. “As we age, the connective tissue of the vaginal walls does not work optimally.”
While age is a risk factor, women with pelvic floor problems can often improve or reverse their condition with lifestyle changes and/or medical treatments.
“You can't really change family history, but there are things that are modifiable, such as obesity and smoking,” Dr. Raizada says. Smoking is a risk factor for bladder cancer and urinary incontinence.
Treatment usually depends on the severity of the symptoms, the type of leakage and the underlying cause.
“People with mild symptoms that show up a few times a week and maybe only moderately affect quality of life could seek physical therapy,” she says.
A physical therapist may recommend pelvic floor exercises, also known as Kegel exercises, to strengthen and heal the pelvic area. “A physical therapist helps retrain your pelvic muscles,” Dr. Raizada says.
A vaginal pessary — a soft, removable silicone device that is inserted into the vagina, — may be used to help support pelvic organs and prevent stress incontinence.
“Think of it like a tampon or one of the menstrual cups that women often use. It gently compresses the neck of the bladder and prevents leakage of urine,” she says.
Posterior tibial nerve stimulation may be used to treat urge incontinence. A thin needle is inserted under the skin of the ankle near the tibial nerve. A stimulator sends electrical impulses through the needle to the nerve, and on to other nerves in the spine that control the bladder. “It's a very non-invasive treatment,” Dr. Raizada says.
Minimally invasive surgery is an option when physical therapy and medications fail to work. “When people fail with the first line of treatments, we talk about procedures,” she says.
For uterine prolapse, minimally invasive surgery can help restore the uterus to its proper position.
Minimally invasive surgery is less invasive or damaging to the body, compared to traditional surgery. “We do them through small incisions,” Dr. Raizada says.
“In most of these surgeries, you are able to leave the same day,” she adds. “The restrictions are not very harsh. You're told not to drive, give your pelvic area some rest and not do any heavy lifting.”
As a urogynecologist, who is trained to diagnose and treat women with pelvic floor disorders, Dr. Raizada says she sees her job as empowering women with pelvic problems by “giving them back control of their bodily activities.”