Joining us for this week's Your Health segment is
Dr. Harry Johnson, associate professor of
obstetrics, gynecology and reproductive sciences at the
University of Maryland School of Medicine and
director of urogynecology and pelvic reconstruction at
the University of Maryland Medical Center.
Doctor, thank you for being with us.
My pleasure.
We want to focus on urinary incontinence.
More of an issue for women?
Well, the area that I work in primarily is women.
It's a problem that occurs somewhere between 30 and 80 percent
of women, will have urinary incontinence of some sort.
That's a huge range.
Does that mean it's hard to specifically define it?
Well, it's a problem that a lot of people don't like to discuss.
It's a problem that some people have been told
it's something that happens with aging
and it's something that you don't necessarily have to tell your doctor or report.
So, that's why we have such a wide range of incidence of this problem.
Is it a normal part of aging?
It's not a normal part of aging.
There are treatments available.
What are the causes?
Well, there are two main types of urinary incontinence, one is
stress incontinence which is a loss of urine with an urge,
I'm sorry, with laughs, coughs, sneeze and then there's
urge incontinence, which is the loss of urine
with the urge to go to the bathroom, which means you can't make it there and
there's different treatments for each one.
Are there different causes for each one?
Well, urge can be more associated with neurologic injury with aging,
whereas stress incontinence can be more associated with childbirth injuries
that injure support structures to the bladder.
Where do you start when somebody brings in this issue?
Well the first thing you do is take a careful history
and you talk to the patient about what type of symptoms they have,
are they having urge symptoms, are they having stress-type symptoms
or do they have a combination of both,
because you can have mixed incontinence.
And where do you go from there?
Well, after you have a careful history, you do a physical
examination, look for injuries that may have occurred from childbirth.
We do testing on the bladder and the urethra to see how the
bladder muscle work and how the urethra works
and try to figure out what the cause of the
incontinence is to direct our treatments.
Is there anything you can do for prevention
or exercises or is there something, you know, in the
childbirth process to look out for?
Well, actually there are exercises that you can do
and you do after childbirth and you can do it for the rest of your life
but it's called pelvic floor physical therapy.
One of the more common exercises is something
called Kegel exercises, which helps strengthen the pelvic floor muscles.
How effective is that?
Well it depends. It's probably around 50%,
depending on the problem that you have and why you've developed the
incontinence, but it is the first-line treatment choice for treatment of
incontinence. Both urge and stress.
What's the the second line treatment?
Well, for urge incontinence we have medications that we try.
There's several different medications that affect the muscles of the bladder.
After that, we have a new treatment, relatively new,
which is Botox injections to the bladder which affect the muscle.
We have neurologic treatments where we actually implant a neuro-
stimulator that stimulates nerves of the pelvic floor that affect the bladder.
For stress incontinence primarily, after pelvic floor exercises,
it's a surgical treatment.
What is the surgery consist of?
Well, the most common surgery that we do
for stress incontinence today is a sling.
Which is to put a support underneath the urethra.
Talk about, the difficulty, the range of difficulty of any of these
alternatives. If women are reluctant to bring this forward,
in part maybe there's some embarrassment,
but maybe in part it's fear of and uncertainty about how
the treatment options are going to work out.
Yeah, for urge incontinence, the treatment options
sometimes you have to try different medications and you see
how they work before you know whether they're going to be effective, or not.
So, some will work and some won't.
And you approach the problem in a step-wise fashion.
So, when one treatment fails, you move to the next treatment.
As far as surgery goes, there are complications from surgery
which are relatively rare, but they are real.
So, anytime I think somebody contemplates
a surgical procedure, they're worried about complications from that.
How difficult a procedure? Are we're talking a hospital stay?
The surgical procedure that we do for incontinence is a sling,
which is a same-day surgical procedure.
Generally, it takes 15 to 20 minutes to perform.
You're able to go home the same day.
Recovery is usually a couple of weeks, but you recover relatively quickly.
Among people who don't have this issue, do they have anything in common?
Somebody who makes it through,
and I should ask to what degree having kids affects this, but
the people who don't suffer from it, do you find anything in there that
might be useful for for other folks?
Well, what we've really found is
problems that can lead to an increased risk of incontinence.
We don't know necessarily why people that don't have incontinence,
didn't develop it, but there are lifestyle things that can affect
this problem, besides childbearing.
One of the big things is aging, lack of estrogen, smoking, obesity, heavy jobs
which involve heavy lifting, physical-type things
can all lead to incontinence over time.
And is there a direct correlation between number of kids, childbirth?
Well, the more kids you have by a vaginal delivery, the more
likely you are to have a problem.
So, it has been associated with the increased number of vaginal births.
Is there any relationship to infections in that part
of the, you know, urinary tract? Does that correlate at all?
Not really. That's really a different problem.
That can be associated with aging and lack of
estrogen, but it really has not been shown to lead to incontinence.
What's the first step for somebody who
thinks they may have a problem with this?
Well, I think the first thing you need to do is talk to your physician.
Whether you come to a specialist in urinary incontinence
or you talk to your primary physician.
It's a problem that you should talk to your doctor about.
It's a problem that does have some simple treatments that can be handled by
a primary care physician before you're referred to a specialist.
But the biggest thing is just get started on a treatment.
And is there any harm in waiting?
There's not really harm in waiting, but the biggest problem
that I see is people that have fairly severe incontinence will avoid social
activities and tend to stay in the house,
avoid going out in public, seeing their friends, things like that.
So, it can be very socially debilitating.
Dr. Harry Johnson, the University of Maryland. Sir, thank you for your time.
Thank you.
Your Health segments are a co-production of Maryland Public Television and
the University of Maryland Medical System.