URINARY INCONTINENCE (LEAKAGE)

What is Urinary Incontinence (Leakage)?

This is a condition where a woman loses urine beyond her control.

The most common types of urine leakage conditions are:

Stress Incontinence: Urine leakage that occurs with strenuous activities such as coughing, sneezing, lifting.

Urge Incontinence or Overactive bladder is the urine leakage that happens due to an intense urge to urinate that cannot be controlled.

Mixed Incontinence is a combination of stress and urge incontinence.

STRESS URINARY INCONTINENCE

  • SUI is very common and a lot more younger women are affected by this.
  • It prevents women from doing physical activities such as jumping on a trampoline, jumping jacks, exercising etc.
  •  We have not done a “bladder suspension” since the 1990’s!
  • Dr. Khandwala introduced a unique technique of doing the sling procedure known as the DISST technique that stands for Dynamic Interactive Standing Sling Technique.
  • This procedure is done with the patient completely awake.
  • The DISST technique essentially guarantees success as the patient is coughing and there is no leakage at all despite standing up with a full bladder.
  • Dr. Khandwala and  Dr. Baratono have studied the success of the sling in their patients and have published their 3-year results
  • The published success rate is over 95% cure with <1% risk of complications.
  • Our single incision sling success of > 95% success is far greater than that reported by other surgeons at 55%.
  • After the DISST procedure, patients can return to all activities by the next day!
  • One of our patients surmised: “This is like a drive-through sling procedure!”
  • Another lamented: “I wish I had known about this procedure 10 years back when all this started. I have just been dealing with this and lost out on a decade of my life”.
  • Another patient wondered: “With a success rate of almost 100%, almost 0% complication rate, with return to all activities by the next day,and with minimal to no pain, why would ANY woman continue to suffer in silence and keep wearing pads? Get the DISST, diss urine leakage and get your life back!”

OVERACTIVE BLADDER (OAB) OR URINARY URGENCY INCONTINENCE (UUI)

Urinary urgency incontinence (UUI) is defined as the involuntary leakage of urine, associated with a sudden compelling desire to void. It is very common with 15% to 35% women affected by it.

Women with overactive bladder get a sudden urgency feeling and before they can take another step, urine is gushing down their legs and the bladder completely empties!

Management of OAB

The main principles are:

  • Lifestyle modifications such as fluid management and timed voiding. Avoiding caffeinated beverages, drinking proper amount of fluids and going to the bathroom on a timely basis, can improve OAB
  • Pelvic floor therapy done using a special machine by our in-house certified physical therapists is a very good adjunct for OAB management. 
  • Medications: Taking into consideration the patient’s age, medical history and current medications, we carefully choose the correct OAB medication that is not only effective but avoids long term side-effects such as dementia. 
  • Advanced Therapies: If medications do not work then there are several procedures that are done either in the office or in an outpatient center that helps with OAB control.

SEVERE NEGATIVE IMPACT OF URINARY INCONTINENCE ON A WOMAN’S QUALITY OF LIFE

One of our patients poignantly said: “I know that urinary incontinence will not kill me but it has taken my life away.”

Not knowing when or where urine leakage will suddenly happen, is  anxiety provoking.  For some, such anxiety induces feelings of hopelessness that leads to social isolation and about 30% of patients have depression.

Women are on a constant look out for a bathroom and some will not even dare leave their homes due to fear of incontinence!

Nighttime frequency and urgency can lead to sleep deprivation that can cause daytime fatigue and exhaustion that may affect work productivity.

Incontinent women have a much higher prevalence of sexual dysfunction. Contributing factors include:

  • Vulvar skin irritation caused by urine leakage.
  • depression and a lower libido that may result from fear and embarrassment about experiencing leakage during sexual intercourse.
  • Partner fear of being “urinated upon” during sex can also lead to erectile dysfunction

Elderly women are even more impacted by urine leakage:

  • Feelings of regression as they become increasingly dependent on others.
  • Low self-esteem and loss of dignity and embarrassment
  • Belief that urine leakage is untreatable leads to secrecy about their condition, and they tend to get socially isolated.
  • inability to remain active as they become more home bound.
  • Worse depression than younger women

HOW DO WE EVALUATE URINARY INCONTINENCE AT OUR PRACTICE

  1. Comprehensive History: Patients complete the history form in our HIPAA compliant AUGM Portal.
  2. Patients then watch specific educational videos about the disease state and what to expect when they come to the office.
  3. During the visit, our doctor will review the history and perform a comprehensive urogynecologic examination and testing. This process that takes about 10-15’  helps the doctor come up with an accurate diagnosis, no guess work.
  4. The doctor then discusses the findings and next steps with the patient and her family members in the consultation room.
  5. Most patients are started on the correct treatment either the same day or within a few days, if some additional  testing such as urinary diaries are required.
  6. Almost all patients with urine leakage can be managed in the office or an outpatient surgery center without any need to get hospitalized.
  7. In most patients, urine leakage can be completely corrected with minimal risk of complication or downtime.
  8. Our doctors believe that Pads should NEVER be worn! Pads hide the condition, weaken the pelvic muscle, create hygiene issues, increase cost,  and affect a woman’s self-esteem. Moreover, ALL these bladder conditions can be swiftly managed and cured!

What complications can urine leakage cause?

  • Skin problems:  Constant wetness because of urine leakage can cause vulvar irritation, sores and vulvar rash. On a long-standing basis, it could also lead to breakdown in the vulvar skin and predispose to superimposed bacterial infections. Also constantly wearing a pad may affect vaginal hygiene.
  • Changes in physical and social activities: Urinary incontinence may keep a woman from participating in normal activities. She may stop exercising and quit attending social functions. She may stop traveling or venturing out of familiar areas where the locations of toilets are unknown. Unfortunately, the diaper or pad became her best friend, something that should NEVER happen.
  • Changes in work life: Urinary incontinence may negatively affect a woman’s work life. The urgency and frequency could result in distraction from normal day-to-day activities and lack of concentration at meetings.  It becomes harder and harder to attend long meetings or conferences.  Nighttime urinary frequency may keep the woman up at night and therefore make her drowsy in the daytime and further worsen the already diminished concentration ability.  All in all, urinary incontinence may wreak havoc on a woman’s work life.
  • Changes in personal life: Perhaps most distressing is the impact incontinence can have on a woman’s personal life. Her family may not understand her behavior or may grow frustrated at how many times she goes to the toilet. 
  • Change in sex life:  Due to the fear of urine leakage during sex, a woman may start making excuses to avoid sex and this could create marital disharmony. Also, if there has been an episode of urine leakage during sex, the partner may be worried of being urinated upon and he too may not want to have sex. Urine leakage during sex has been known to cause erectile dysfunction. 
  • Change in mental health: Incontinence and all these above effects can lead to anxiety and depression and a feeling of loneliness.

Common Misperceptions of Urinary Incontinence

  • As I grow older, incontinence is going to happen. 
  • It affects older women more than younger women.
  • There is no treatment for urine leakage and pads are the ONLY solution.
  • If treatment is available, it leads to a lot of complications as seen in the “mesh ads.”
  • I would need a major surgery  to correct incontinence and it is not effective. 
  • I feel that I am the only one who has it and that too so bad.

HAPPY PATIENT TESTIMONIALS

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