Many women reach that point in their lives where they have to cross their legs when they cough or sneeze — or they begin drinking less water — to avoid urinary leakage. They have accepted that this is just something that comes with age, and they suffer in silence.
Dr. Esther Han, a urologist at Orlando Health, disagrees.
“I have quite a passion when it comes to women’s health,” she said. “Women have been told for so long that these things are normal: ‘Your mom has it. … Go buy pads.’
“It’s not normal,” she said. “I just want to be able to make sure women know, ‘Yes, it’s common, and, yes, more than likely, your best girlfriend is going through the same thing. It’s not normal. You don’t have to leak.”
Han is one of a growing number of female urologists who aim to educate women on incontinence and give them options for a better quality of life. She said tens of millions of women are experiencing incontinence in some form.
There are two types of leakage — urge incontinence and stress incontinence.
“You’ve got your bladder, the pump; the urethra, the pipe; and the sphincter, which is the valve and controls any kind of leakage,” she said. “Women come in saying, ‘I wet myself.’ We have to break it down. Is it your pump, your pipe?”
If it’s urge incontinence, it’s a pump failure, she said. The pump is overactive, and it is no longer stable.
“Your bladder is meant to hold urine — it’s a storage facility — and what you have is extra instability which allows it to squeeze ... which tells you you have to go to the bathroom,” Han said. “It’s prank calling your brain telling you you have to go when you don’t have to.
“The more common term is ‘overactive bladder.’”
Stress incontinence occurs when there is an increase in abdominal pressures, such as jumping, coughing, laughing, sneezing or going from a sitting to standing position.
“That’s usually caused by a leaky valve,” Han said. “Over time, the muscle in your pelvis causes leaks. You had a strong pelvic floor before, but due to aging, estrogen levels, childbirth … that causes you to leak.”
Han said the average age of her patients with incontinence is 40s and 50s, although she does treat some women in their 20s and 30s.
Treatment varies according to which type of incontinence the patient is experiencing.
For stress incontinence, Han typically starts with physical therapy to strengthen the pelvic floor muscles. And it extends far beyond just doing oft-mentioned Kegel exercises, she said, although those are a good starting point.
“It is exercise, and if you do stop, you will go back to square one,” Han said.
If exercise isn’t working, or the patient doesn’t have the time to commit to it, there are two types of procedures that can help.
In the first procedure, bulking agents are injected into the walls of the urethra to help close the sphincter. The goal of a urethral bulking injection is to help patients gain control over their urine flow.
The other option is a sling, which can be made of mesh, cadaver tissue or the patient’s own tissue.
For urge incontinence, conservative measures include reducing or eliminating caffeine, which can irritate the bladder; cutting out liquids four hours before bedtime to avoid frequent nighttime urges to urinate; and physical therapy.
“Constipation will exacerbate your overactive bladder,” Han added. “Not the frequency of your stool but the consistency of your stool. … If you have bowel problems, you will probably have bladder problems; it’s the same nerves that affect both organs.”
If those suggestions don’t work, the second line of treatment is medications, Han said.
“All of their objectives are to calm your bladder down, increase time between bathroom trips,” she said.
A third option is surgery, of which there are three options: a monthly acupuncture-like procedure in which a thin needle is put in the ankle; twice-a-year Botox injections to partially paralyze the bladder; and a sacral neuromodulation, akin to a “pacemaker” for the bladder, in which an electric lead is implanted into one’s sacral nerves, which control the bladder.
Han has been a practicing urologist for more than two years. After her residency, she completed a fellowship in female pelvic medicine and reconstructive surgery.
She urges women to speak up even though the topic might be embarrassing for them.
“They should say, ‘Hey, I don’t want to live with this. Can you treat me or send me to someone who can?’” Han said. “Even if you don’t want to go through a surgical treatment, there are other options, and you can have a better quality of life.”