Treatment Provides Welcome Relief For Women With Urinary Incontinence

"As women get older, the urge problem becomes more prevalent and is much more unpredictable." — T. Fleming Mattox, M.D.

“A lot of women end up isolating themselves. Social isolation is a big part of incontinence,” said Dr. Fleming Mattox, an associate professor in the Department of Obstetrics and Gynecology’s Division of Urogynecology. Based in Greenville, South Carolina, Dr. Mattox travels to Columbia every Tuesday to treat patients at University Specialty Clinics.

Age Plays A Factor

Urinary incontinence is not uncommon; in fact, an estimated 20 million women in the United States suffer from some type of urine leakage. As women age, the incidence increases, affecting 40 percent of women by the time they are in their seventies. Incontinence ranks as one of the top four reasons women are placed in nursing homes. Yet women don’t have to accept that incontinence is an unavoidable affliction that accompanies aging. A number of treatment options are available, and 86 percent of patients who pursue treatment make significant improvement, including complete restoration of bladder control.

When women seek medical attention for incontinence, Dr. Mattox’s first step is to conduct a comprehensive physical exam. “You don’t want to miss anything. Incontinence is one of the great mimickers,” he said. He elaborated, “A patient can have heart disease and it can mask itself as urinary incontinence. Diabetes is another example. I find one patient a month who’s convinced she needs a pill for incontinence and turned out to be diabetic.”

Two Common Forms

A number of medical conditions and medications prescribed for other problems can cause incontinence, which is seen most frequently in two forms. Women with stress incontinence may leak urine when they engage in exercise or other strenuous activity, or simply when they cough, sneeze or laugh. Urge incontinence involves leakage that occurs before a woman can get to the bathroom in response to an urge to urinate. “As women get older, the urge problem becomes more prevalent and is much more unpredictable,” said Dr. Mattox. Some women experience both forms or mixed incontinence. The two problems may not be related and need to be addressed separately. “Typically you would treat them for the urge incontinence first and see how they improve,” he said.

Once a woman’s particular situation is evaluated through a thorough exam and any diagnostic testing that may be needed, treatment can include medication, Kegel exercises to strengthen the pelvic floor muscles that help control the bladder, bladder retraining to teach a patient to urinate on a timetable rather than on the urge to do so, and diet modification to eliminate foods that irritate the bladder. Dr. Mattox is referred many complex incontinence problems; about 40 percent of these patients eventually require surgical treatment.

Surgical Treatment

While surgery to treat incontinence has historically met with varying degrees of success, this has changed with the development of advanced procedures such as suburethral sling and retropubic urethropexy. One of the newest procedures available enables surgeons to place a suburethral sling on an outpatient basis. The sling is made from permanent material, and current evidence suggests that this has the best long-term success compared to other slings. “These procedures are considered to be the gold standard for treating incontinence. Ninety percent of patients are immediately dry after surgery,” Dr. Mattox said.

Reprinted from Connections newsletter, July 2002

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