Almost one in five women in general population, and nearly 3 out of 4 women living in nursing homes suffer from urinary incontinence, but only 1 in 4 women seek treatment for this issue which has profound effect on quality of life.
Wide range of therapies are available and almost there is some treatment option for all women suffering from this issue says a review of therapies published online in JAMA.
Stress urinary incontinence is the commonest problem in women and often caused by weak pelvic muscles because of physical changes from pregnancy, childbirth, and menopause.
Urge incontinence does not have a specific cause, it is often termed as ‘overactive bladder’ and the leakage follows a strong urge to urinated. It is associated with other medical disorders like diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
The two types of incontinence sometimes coexist.
Women are mostly shy of discussing this problem with the healthcare provider and continue coping with the problem instead of seeking treatment and cure.
The physician should initiate the treatment with understanding the women’s goal for seeking the consultation, how it’s affecting her quality of life, and any previous treatment. A concomitant physical examination should follow to rule out pelvic organ prolapse, cancer or neurological disease.
Urinary Tract Infection and hematuria should also be ruled out.
The therapy should begin with advising about pelvic muscle exercise and life style modifications. If the patient is obese she should be advised to reduce weight, adequate hydration, limiting the caffeine intake and timed voiding at regular intervals to reduce the urgency of episodes.
For stress urinary incontinence, options include estrogen vaginal cream, transurethral and periurethral injection techniques bulking procedures. Common agents used for bulking are autologous fat, glutaraldehyde cross-linked bovine collagen, calcium hydroxylapatite, pyrolytic carbon-coated beads, polydimethylsiloxane, and ethylene vinyl alcohol copolymer.
Botox and stem cell therapy may be useful in some cases.
Urethral inserts are also in use, along with pessary or stiff vaginal ring to support prolapsed bladder or vagina.
Other surgical options include bladder neck suspension, mid-urethral sling, and Transobturator vaginal tape (TVT-O) is widely used for stress incontinence in women.
For treating the urge incontinence, medications are prescribed to relax the bladder and that includes Antimuscarinics, Tricyclic antidepressants and Beta-3 agonists.
Botox (onabotulinumtoxinA) and electric nerve stimulation are the other options.
Non-ablative
vaginal Er:YAG laser (VEL) has been reported to improve SUI in small
pilot studies. Large randomized studies are needed to compare its efficacy with
other treatments and evaluate the duration of therapeutic effects.
Urinary incontinence is a common problem of aging, and physicians should initiate the conversation about it, as women are too embarrassed to talk about it. Treatment should be initiated by life style modification, medicines and surgery if conservative measures fails.
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