Leak when you laugh? You don't want anyone to know.
Involuntarily pass gas or a stool sometimes? You REALLY don't want anyone to know.
Pelvic floor disorders (PFDs) like incontinence are still a taboo subject for many. But thanks to improved treatment options, more people are starting to talk about urinary and fecal incontinence, said Michael Feloney, M.D., FACS and double board-certified urologist and gynecologist.
Women also are asking about pelvic organ prolapse, said Sami Zeineddine, M.D., FACOG, OB/GYN. Pelvic organ prolapse happens when an organ in your pelvis – such as your bladder – drops and pushes against the walls of your vagina.
Here are some facts Alegent Creighton Clinic physicians who specialize in pelvic floor disorders want you to know:
- Pelvic floor disorders are more common than you think. It's estimated one-third of adult women are affected by at least one pelvic floor disorder. These include urinary and fecal incontinence, pelvic organ prolapse, chronic pelvic pain and sexual dysfunction. Known causes are obesity, pregnancy, weak connective tissue in the pelvis, even heredity.
- If you have "urge" incontinence or overactive bladder, the most common symptom is a sudden, desperate urge to urinate. "It happens with age and it happens with wear and tear on your bladder," Dr. Feloney said.
A second kind of urinary incontinence is "stress" incontinence, where the muscles that support the urethra are weakened. When the woman laughs, coughs, sneezes or works out, there's pressure on the urethra, causing a leak.
Pelvic organ prolapse also can cause problems. This is when the bladder drops, the rectum protrudes into the vagina, the vagina shifts after a hysterectomy or the uterus moves. According to Dr. Zeineddine, a woman who suffers from pelvic organ prolapse can experience embarrassment, lower self-confidence and pain. This can cause sexual dysfunction and affect intercourse.
- Pelvic floor disorders shouldn't be a condition that a woman feels she has to "manage," according to Dr. Feloney. "Many women think they have to live with it. That's not at all the case. It can be addressed and treated."
He said many women are unaware of options because the stigma of incontinence prevents conversations with friends, family members and even doctors. One study showed fewer than half of women with urinary incontinence discussed their symptoms with their physician. And on average, because of a woman's reluctance to bring up the subject, it's six-and-a-half years from time she first experiences symptoms to the time she receives a diagnosis.
"It becomes a topic we have to drag out of them sometimes," said Dr. Zeineddine. "Who wants to talk about their sexual life to a stranger? But lots of patients regret afterwards they didn't address the issue earlier."
- There are low-cost, accessible treatment options with experienced and trusted Alegent Creighton Clinic physicians who specialize in pelvic floor disorders. Dr. Feloney and Dr. Zeineddine both said options range from conservative to aggressive.
When Dr. Feloney first sees a patient, he performs a physical to determine if she has urge or stress incontinence, or both. Tests can include urodynamics, to see how well the bladder and urethra are working; cystoscopy, to visualize the bladder and urethra; and ultrasonography, to see the internal organs and to determine which organs actually are prolapsing out of the vagina
- Dr. Feloney then works with his patients on behavior modifications. A patient who's overweight or obese is more likely to have a PFD. "For so many, weight loss -- even a small number of pounds -- can lead to dramatic changes in incontinence," he said.
Giving up smoking can relieve the chronic cough that stresses the pelvic floor and improve the blood flow to the structures that support the pelvic floor. More fiber can slow fecal incontinence. Eliminating acidic foods that can cause irritation, such as tomatoes and chocolate, can make a big difference in helping urinary urgency and frequency symptoms. So can bladder training, where a patient urinates on a schedule then increases the interval between trips to the bathroom.
- Physical therapy can make a difference to some, according to Dr. Zeineddine. Alegent Creighton Health physical therapists who specialize in women's health and pelvic floor disorders can teach women to both strengthen and relax the muscles of the pelvic floor through Kegel exercises, which involve squeezing and relaxing.
- Medications also can help. Anticholinergic meds block the nerves that control muscle contractions and allow bladder muscles to relax, helping control urge incontinence. Topical creams and patches also are available.
- New procedures and surgeries are more effective and less invasive. For example, one procedure involves injecting bulking agents to thicken the urethra and help close the bladder opening. This can be especially helpful for stress incontinence.
Ten percent of the adult women who suffer some incontinence will undergo surgery. One of the most common surgeries involves the TOT (transobturator tape) sling. The sling holds the bladder in its normal position and is now considered the "gold standard" in the surgical treatment of stress incontinence. The TOT sling procedure is a quick 30-minute outpatient procedure with a high success rate of 90 percent. Complications are minimal and recovery is fast.
For women with urge incontinence, Interstim therapy is an option. It modulates the sacral nerves – which control the bladder and muscles related to urinary function – with electrical impulses. Dr. Feloney said it's like a pacemaker for the bladder; it helps the brain and the nerves better communicate so the bladder and related muscles can work properly. Interstim therapy also is an outpatient procedure.
There also are options for pelvic organ prolapse. Dr. Zeineddine said a special device called a pessary can be used to support the muscles that hold the pelvic organs. He described it as "a plug or a temporary fix for women who are not physically or sexually active." A more permanent "repair" involves surgery. "This restores the anatomy with minimally invasive outpatient procedures that bring fast recovery, cause minimal pain and offer a long-lasting solution," he explained.
- Don't wait to deal with your incontinence, advised Dr. Feloney. "The better you manage it early, the easier the problems are to fix." Symptoms can worsen and affect everything from relationships to your job and self-esteem. Research shows that women with incontinence have lower self-esteem and sexuality and more depression and social isolation.
"Their quality of life becomes much better," said Dr. Zeineddine. "One patient told me, ‘I feel like I am a woman again!'"
In 2010 an estimated 377,000 women underwent surgery to correct a bladder control problem or pelvic organ prolapse.That number is expected to increase sharply as the number of women with at least one PFD will nearly double to almost 44 million by 2050.
"You don't have to be a shut-in," Dr. Feloney said. "You don't have to be housebound and toilet-bound. You can dance at your daughter's wedding and go to your grandson's graduation. You don't have to be stuck at home. You can go shopping. You can take a road trip with your husband. Don't let incontinence control you and control your life."
You are not alone. One in three women is affected by a Pelvic Floor Disorder (PFD). While PFDs are common, they are not a normal or acceptable part of aging. They can often be reversed and effectively treated with painless, low-cost treatments options. We can help. Talk with a pelvic floor expert today.