WOMEN'S HEALTH

Gotta Go?

SAFE AND EFFECTIVE TREATMENTS AVAILABLE FOR BLADDER CONTROL ISSUES

Dr. Shane Sopp, Urogynecologist

You’re not alone. Up to 54 million women in America suffer from bladder urgency or leaking urine (Urinary Incontinence), including tens of thousands from the Syracuse area. I treat or have this discussion with over a dozen women a day.

So why are so many of you suffering in silence? Is it an embarrassing topic to bring up ? It can’t be less embarrassing than buying those pads. Do you feel it is a negative rite of passage with age? I treat women from 16 to 90 (half of women over 50 have incontinence). Is no one asking you the question? I ask the following: ‘Do you: have frequency, urgency, get up at night, leak on the way to the bathroom, put the key in the door and fly over the furniture, leak with coughing, sneezing, laughing, lifting, running or sex?’

If this is resonating with you, keep reading. We’re just getting started. And it’s so easy to correct!

There’s a tendency to lump all types of urinary incontinences into one problem, but there are many types with different cures. And I already know what you’re thinking: “I don’t want to take another pill” or “I don’t want that mesh surgery.” But I’m the messenger, so please indulge me.

We can easily divide urinary urgency and incontinence into the three most common categories: Over Active Bladder Syndrome (OAB), Urge Urinary Incontinence (UUI), and Stress Urinary Incontinence (SUI).

Continuing in ‘English,’ let’s do this visually. Imagine your bladder is a muscular balloon that relaxes and fill, and then contracts and empties. Also imagine that there is a straw emptying the balloon, and that’s your urethra.

OAB is urinary urgency to go to the bathroom.

UUI is leaking on the way to the bathroom.

Normally, your bladder relaxes and fills with urine and then contracts and empties it. Both OAB and UUI happen when the bladder ‘relaxing cells’ and ‘contracting cells’ are out of sync. During the relaxing (the filling phase) the contractors misbehave and prematurely contract. Your brain and bladder connection aren’t ready for this, and thus the unexpected urge and “get outta my way.” SUI is a physical, or mechanical problem with the urethra. I wish we had named this ‘Strain Urinary lncontinence’... your urethra doesn’t need Xanax! Think of the urethra like a footbridge that’s suspended in place by bungy cords. When you step on that bridge, you don’t want it to drop or bounce.

The same goes for SUI. You have ‘ligaments’ that hold the urethra (straw exiting the bladder) in place so that when the force or pressure from coughing, etc pushes on it, it stays put. However, if the ligaments are stretched or torn (from forcefully pushing out those beautiful children or with aging, etc), the urethra drops and you leak.

Now let’s work our way up the treatment ladder, remembering that we have

different problems that require different treatments, and it’s quite common for many women have all three problems. UUI + SUI = Mixed Incontinence.

The treatment algorithm for OAB/UUI has three levels of treatment

Level 1: Behavioral modalities and pelvic floor physical therapy

These can be tried for all incontinences. You may need frequent appointments, for weeks or months. Healing is not always predictable (FeMani Wellness2020).

Level 2: Medication (covered by insurance)

OAB and UUI are treated similarly. First, think about what we need to do: relax the bladder. This can be done by two different mechanisms of action (MOAs)...HCPs

love acronyms! One category of medicines ‘block’ the contracting receptors, and another ‘enhance’ the relaxing receptors. The most common side effects with the blockers are constipation and dry mouth, but about 85 to 90 percent of people don’t get them. In the enhancer (only one medication), only about 5 percent of people may get constipation.

There’s a rare incidence of increased blood pressure, and the risk is not increased if you’re on BP medication and stable.

There is a third medication or add-on treatment for OAB/UUI Local Estrogen with a vaginal cream or suppository. The bladder also has estrogen receptors, and when they no longer receive estrogen in perimenopause or menopause, the contracting receptors overpopulate. Some women actually get a three-fer: treatment of vaginal dryness, painful intercourse, and OAB/UUI. And by the way, estrogen does not cause breast cancer.

Level 3 Bladder Botox or Sacral Nerve Modulation (covered by insurance):

If medications don’t work, we have two additional treatments for OAB/UUI: Botox, which is painlessly injected into the bladder in 5 minutes and lasts about six months or Sacral Nerve Modulation. This sounds high tech, but it’s actually one of the simplest and most efficient procedures I do. It’s akin to a tiny pacemaker for the bladder; the battery/stim lasts 15+ years and is rechargeable. I doubt I’ll forever be able to say this, but our success rate with this has been 100 percent.

The treatment algorithm for SUI has two levels of treatment Level 1: Behavioral Modalities, Kegels and Pelvic Floor PT Level 2: Mid Urethral Sling

The Mid Urethral Sling goes under the urethra to support it from dropping. In order to understand the remarkable biotechnological advancements that got us to this procedure, you must understand that for decades before the evolution of slings (in the late 1990s), we had to perform a two to three hour, rather bloody procedure, through a C-Section-like incision to support the urethra.

While there are many different types, sizes, and placements of slings, and I’ve taught most, my personal preference is the single incision sling. It’s less than the length and width of a Bandaid, can be inserted through a one-inch incision inside and behind the vagina, in 15 minutes, under sedation, with no down time, no post pain (99 percent of time), and no intercourse pain (99 percent). Easy-peasy. Slings are FDA cleared and not related to previous ‘mesh’ issues. These should be done by experienced surgeons who routinely perform them.

Final thoughts: talk to a professional other than Dr. Google, and don’t become someone who says, “I wish I had done this years ago.” SWM

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