Overactive Bladder

For some women, uncontrollable leaking or urges disrupt their everyday lives. Although these conditions are actually quite common, women frequently remain silent due to embarrassment or the belief that this is "something they just have to live with." The good news is a number of treatments including lifestyle changes, medications and minimally invasive surgeries can help improve the situation - all women have to do is come forward and talk to their doctors. When they do, they will find out they certainly are not alone.

"Urinary incontinence - the involuntary loss of urine - affects about 38 percent of all women," says Kimberly Gerten, MD, a urogynecologist with Park Nicollet Obstetrics and Gynecology. About 25 percent of women age 60 and older, and about half of all women who live in nursing homes, experience regular urinary incontinence. This condition also affects many younger, active women, especially those involved in running, aerobics and gymnastics.

At Park Nicollet, urogynecologists offer women a full range of treatment options with surgery being recommended only after more conservative approaches have been tried. Often treatment will also depend on whether a woman is healthy enough to undergo the procedure.

Treating "stress" incontinence

For most women, incontinence is one of two types. Stress incontinence occurs when muscles that support the bladder or urine flow are weakened by childbirth, surgery, or age, causing urine to leak when they laugh, sneeze, exercise or lift heavy objects. If the incontinence is not severe or a woman plans on having children, doctors usually treat it conservatively.

Kegel exercises strengthen the muscles that control the bladder and urine flow.

Estrogen cream strengthens the sphincter that controls urine flow.

A pessary, a small device placed in the vagina, that helps support muscles and hold the pelvic organs in place.

When these approaches are not successful or the incontinence is severe and women have completed their families, doctors may implant a mesh-like sling to support the urethra to help prevent leaking. "We perform this surgery through the vagina - there are no abdominal incisions," Dr. Gerten explains. "It is an outpatient procedure with a very easy recovery. It can greatly improve a woman's quality of life."

Treating "urge" incontinence

Urge incontinence, also known as overactive bladder, occurs when a woman feels she can't get to the bathroom fast enough or wakes frequently during the night to use the bathroom.

Like other types, urge incontinence also is initially treated with conservative approaches, such as Kegel exercises. Doctors may also recommend the following.

Lifestyle changes, such as decreasing fluid intake or avoiding beverages that irritate the bladder. Changing the timing of certain medications, such as diuretics, to help reduce the need to urinate at night.

Medications, such as DetrolR and DitropanR, to help calm the bladder muscle.

When these conservative approaches are ineffective, doctors may recommend implanting an InterStimR device. This device delivers mild electric pulses to nerves that control the muscles involved in urinary function. It works much like a pacemaker, which delivers impulses to the heart. InterStim is inserted through small skin incisions and comes with a control, so patients can adjust the strength of the impulses.

"Both surgical approaches - the sling and the InterStim device - are very easy ways to treat incontinence," Dr. Gerten says. "We want women to know about these options and to ask their doctors about them. There is no reason for women to live with incontinence."