Women's Care : Services : Continence/Pelvic Relaxation Program

Incontinence of either urine and stool or gas is a socially disabling condition that becomes more common as women age. It affects upwards of 16 million American adults and is 5 times more common in women. The exact causes of incontinence are not always known but it is felt that a combination of damage to the muscles and connective tissue of the pelvic floor that can occur with childbirth and the natural consequences of aging lead to the majority of incontinence women experience.

In the past women with incontinence were often reluctant to seek medical care and even when they did seek out therapy they were often told this is a normal part of aging and they should learn to accept it. This attitude of acceptance of incontinence should be a thing of the past. There is a currently push toward many new therapies to treat incontinence that now allow for the physician and patient to tailor make a treatment plan based on the patients wishes.

Forms of Incontinence

Stress incontinence
Stress incontinence is urine loss that occurs with activity (abdominal stress) such as coughing, sneezing, lifting or laughing. The name “stress incontinence” can be confusing as most people associate the term stress with emotional stress, but this type of incontinence has nothing to do with emotions. It is usually the result of a weakening of the muscles that hold the urethra or bladder neck closed. Not surprisingly it is treated with techniques that strengthen or support the urethra or bladder neck. These techniques can take many forms from surgery to “elevate or tack the bladder neck” to exercises that strengthen the pelvic floor to medications that improve the tone of the urethral sphincter mechanism. This area of treatment is undergoing a rapid expansion. There are newer and minimally invasive surgeries being developed. In addition, for the first time there are medications that are being tested to specifically treat stress incontinence.

Urge incontinence
Urge incontinence is exactly what it sounds like – the loss of urine before reaching the commode when you first have the urge to void. The incontinence occurs when the bladder contracts and the individual can’t control it. Most individuals have a “grace period” after they first sense the urge to void. Patients with urge incontinence get the urge to void rush to the bathroom and leak urine before they get there. In essence they have lost their “grace period”. Currently, there is no known cause for urge incontinence; it is probably due to any one of a hundred subtle changes in the central nervous system that interrupts the individual’s ability to consciously control their bladder contractions. This is another area where treatment options are varied and several new therapies are always emerging. Generally urge incontinence therapy is aimed at restoring bladder control or the “grace period”. This can be done with medications that relax the bladder muscles or by retraining the bladder through drills.

Mixed incontinence
Some patients will have both stress and urge incontinence and this is termed mixed incontinence. Treatments will be based on which symptom is worse.

Fecal Incontinence 
Fecal incontinence is a very socially disabling and embarrassing condition.  It is the uncontrolled loss of gas, liquid or formed stool from the rectum.  Fortunately, it is a fairly uncommon condition affecting only 1-2% of the population.  It is difficult to determine the exact cause of fecal incontinence, but pregnancy and vaginal delivery with large obstetrical lacerations are most frequently implicated.  Fecal incontinence has not undergone the intense evaluation that urinary incontinence and pelvic organ prolapse have, therefore, the treatment options are somewhat limited.  The most important treatment option for fecal incontinence is increasing dietary fiber.  In the patients who are not cured by dietary fiber, surgical correction is often recommended.  

Pelvic Organ Prolaspe

Pelvic organ prolapse is a condition in which the walls of the vagina or the cervix of the uterus bulge out beyond the opening to the vagina.  Patients often present with the symptom of a vaginal bulge that can be seen or felt, particularly when cleaning themselves after using the commode or in the shower.  It is a fairly common condition and it is thought that over $1 billion US healthcare dollars are spent each year treating this condition.  We don’t know all the causes of pelvic organ prolapse, but it is more common in women who have had at least one vaginal birth, and it increases with age.  There are also some studies to suggest that it may be due to a lot of heavy lifting either through work or recreational activities.  It may also be more prevalent in patients with chronic conditions such as constipation or chronic cough.  Finally, there are some investigators who feel that it is more common after a hysterectomy. 

The treatment options for pelvic organ prolapse are basically three. 

• The first treatment option is no therapy whatsoever. 
• The second option is non-surgical management in the form of a pessary.
• The final option is surgical correction.  

If you think you may have problems with prolapse and would like to speak with somebody, please feel free to contact Dr. Swift’s office at 792-5300 and ask to come in for an initial consultation.

» MUSC Bladder and Pelvic Health Program

Treatment Option Tools for Female Urinary Incontinence:

» Nexcura Treatment Option Tools for Women's Health