Wellness Q&A on Urinary Incontinence with Amy E. Rosenman, M.D.

Q. Is urinary incontinence a normal part of aging?

No. Although urinary incontinence affects 30 percent of women over the age of 60, it is not a normal part of the aging process. It is a treatable condition and anyone suffering from it should consult their physician to determine which treatment option is best for them.

Q. What causes urinary incontinence?

One of the most common causes is stress urinary incontinence, which occurs when the pelvic muscles are weakened. If the pelvic muscles are not strong enough to keep the opening from the bladder neck closed while you are under physical stress, such as laughing, coughing or exercising, it allows urine to escape.

In women, stress urinary incontinence is often caused by childbirth, pelvic surgery and hormonal changes, such as menopause or an estrogen deficiency.

Other types of incontinence are caused by overactive bladder muscles, a blockage in the urethra or medication side effects.

Q. Is surgery the only option to treat urinary incontinence?

Many patients are reluctant to discuss their problem with their physician because they are afraid of undergoing surgery. However, there are many treatments available that do not involve surgery. For women with stress urinary incontinence, your physician may recommend muscle therapy to control your bladder, such as learning Kegel exercises, which are used to strengthen the pelvic floor muscles. Other forms of therapy may include biofeedback and/or electrical stimulation. In some cases, stress urinary incontinence associated with estrogen deficiency may be treated with hormone replacement therapy.

Q. Are there any new medical advances in the treatment of incontinence?

Yes, there is a new, minimally invasive surgical procedure currently available to
treat incontinence. A variation of the tension-free vaginal tape (TVT) procedure
is now being performed at Saint John’s that is much less invasive than the traditional TVT procedure first developed in 1995.

The TVT procedure involves the insertion of a thin strip of supporting tape into the pelvic region to form a hammock under the urethra. The tape grips the surrounding tissues and holds itself in place without sutures.

Under the new procedure, the tape is inserted through a tiny opening in the thigh crease, instead of in the skin above the pubic bone, so the surgery is much less invasive and leaves no scarring. There are no stitches; the incisions are so small that the skin is glued together after the tape is inserted.

The surgery is done on an outpatient basis, with minimum discomfort and is performed under a local or epidural anesthetic.

Dr. Amy Rosenman is a Fellow of the American College of Obstetricians and Gynecologists and a co-author of “The Incontinence Solution,” published in 2002. For more information, please contact Dr. Rosenman at (310) 451-8144 or visit her website at www.RosenmanMD.com

For more information about Saint John’s Health Center visit http://www.stjohns.org