Monday Medical: Help for incontinence is easily treated in an outpatient setting
For Steamboat Pilot & Today
A medical malady that both women and men share as they age is urinary incontinence.
Many also share a reluctance to discuss it with their provider — men more than woman, although more women suffer from it (about 30 percent of older women compared to about 15 percent of men).
“This is a common part of aging,” said Dr. Clay Pendleton, a urologist in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “We use minimally invasive techniques with highly curable treatments. It’s a quality-of-life issue, so I would encourage patients to talk with their doctors.”
The two most common types of incontinence are stress and urge, but the causes and cures differ for males and females. Most of Pendleton’s referrals come from gynecologists for women and primary care physicians for men.
“Women used to think, ‘It happened to my mom and grandma, so it will happen to me.’ But, I am seeing younger women who are very busy, lead active lifestyles and reject that notion,” said Pendleton. “Men tend to be more shameful than woman, and they don’t talk about incontinence. But here in Steamboat, people are fit and spend a lot of their lives outdoors, and if they have a problem, they want to fix it.”
For women, stress incontinence is caused when pressure on the bladder causes urine to leak. While more common in women ages 50 and older, it can occur even during the 30s. It is most likely the result of having multiple pregnancies that have weakened the pelvic muscles. Activities that can cause urine leakage through stress incontinence include coughing, laughing, exercising or lifting heavy objects.
An initial non-surgical option for mild stress incontinence is pelvic floor therapy. This includes specific exercises to strengthen the muscles that support the bladder and other pelvic organs, with a patient working with a physical therapist. If this doesn’t provide relief, another option is a short, 20-minute outpatient surgical procedure in which a hammock-like sling is placed under the urethra. That procedure typically has a 92% cure rate.
Urge incontinence usually occurs in women in their 60s or 70s, when the bladder muscles contract at the wrong time causing urine to leak. Treatment includes everything from taking oral medication to calm the bladder, injecting Botox in the area or implanting a nerve stimulator into the spine to calm the bladder nerves.
For men, urge incontinence occurs when the bladder goes haywire and leaks, likely due to hyperactivity of the bladder and prostate obstruction. It can be effectively treated with medications about 40 percent of the time; alternatively, a simple, outpatient surgical laser procedure is about 95 percent effective, according to Pendleton.
Stress incontinence for males occurs after having the prostate removed because of cancer. Pendleton was a pioneer in Colorado using the ProAct procedure in which tiny silicone balloons are deployed into the skin where the prostate used to reside. The fluid-filled balloons apply pressure to and support the bladder while helping to prevent leaks. The procedure, which typically takes less than 30 minutes, has been successfully used in Europe for many years.
Making a change now for a better future
Patients with incontinent issues should discuss concerns with their provider, knowing that a range of options are available and that they don’t have to needlessly suffer from discomfort.
“Patients can be embarrassed about it, but we see it so often,” said Pendleton. “Both men and women are relieved once it is taken care of. Many patients wonder, ‘Why didn’t I get this done ages ago?’”
Mary Gay Broderick writes for UCHealth. She can be reached at email@example.com.
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