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Clinical Corner

Incontinence Q & A Janet Li, MD

Urinary Incontinence (UI) impacts millions of adults in the United States. Sadly, too many suffer in silence, not realizing it is a treatable condition. Dr. Janet Li, Section Head of Female Pelvic Medicine and Reconstructive Surgery at Beth Israel Deaconess Medical Center, answers common questions about the condition.

Q: How common is urinary incontinence?

Dr. Janet Li: Urinary incontinence is more common in women than men. Recent research found that one in four women over the age of 18 experience episodes of leaking urine involuntary. In addition, one in five adults over age 40 is affected by overactive bladder or recurrent symptoms of urgency and frequency. Older women are at greater risk for urinary incontinence, although incontinence is not-and should not be-considered a normal part of aging.

Muscles involved in urinary incontinence in women

Q: What causes it?

Dr. Janet Li: Urinary incontinence is a symptom of a larger bladder and/or pelvic disorder. A wide range of conditions and disorders can cause incontinence. These include birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. Excessive stretching of supportive tissues, muscles and nerves during pregnancy and a difficult vaginal delivery can also predispose women for urinary incontinence. Additional contributing factors include chronic cough, chronic constipation, excessive weight, repetitive heavy lifting, and pelvic tumors, as well as genetics.

Q: At what point should a woman seek medical help?

Dr. Janet Li: A woman should seek medical help if her symptoms affect her daily activities. These problems might be embarrassing but neglecting them can make the symptoms worse. If they are not treated, they can continue to have a negative affect on her quality of life and cause emotional distress. She should speak with her primary care provider about seeing a specialist who is trained to diagnose and treat female pelvic floor disorders. No woman should have to "just live with" symptoms of urinary incontinence.

Q: What options are available for treatment?

Dr. Janet Li: There are different types of urinary incontinence with different treatment options. Therefore, it is important that an accurate diagnosis be made. The diagnosis is made based on your symptoms, a thorough examination, and, in some cases, specialized testing. Once an accurate diagnosis is made, a decision about proper treatment can follow.
There are a wide-range of treatment options, both non-surgical and surgical, to treat urinary incontinence. Effective non-surgical options include pelvic floor muscle exercises, behavioral modifications, bladder retraining, incontinence devices, and medications. Pelvic floor muscle exercises, known as Kegel exercises, can help strengthen the pelvic floor muscles that hold the bladder in place and control urine flow. Behavioral modifications include weight loss, dietary changes, and voiding on a schedule. Bladder retraining can help reduce urinary urgency, frequency and leakage. Incontinence devices, such as pessaries or urethral inserts, are appropriate in some cases. There are several medications which can be beneficial, as well.

While many women have success with non-surgical treatments, there are some whose best option to relieve symptoms is a surgical treatment. There are different types of effective surgical procedures, and most are minimally invasive, allowing you to leave that same day. Examples of procedures that treat urinary incontinence and overactive bladder symptoms are: urethral injections, suburethral slings, nerve stimulators, and 'Botox' bladder injections. The type of procedure recommended will depend on your type of incontinence.

To make an appointment with a UI specialist, call 617-667-4070.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted March 2011

Contact Information

Female Pelvic Medicine and Reconstructive Surgery (Urogynecology)
Department of Obstetrics and Gynecology
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 8th Floor
330 Brookline Avenue
Boston, MA 02215
Phone: 617-667-4070
Fax: 617-667-2999
Appointments also available in our Needham and Chelsea locations; please call for more information.