Incontinence effects millions of Americans, particularly women. Often beginning during pregnancy or in the postpartum period, it can persist into perimenopause, menopause and beyond. The dramatic decline of a woman’s estrogen levels and the physical trauma associated with delivery are two major factors leading to this largely overlooked health crisis. Women often experience challenges with urinary incontinence as they transition through midlife. In reality, more than 60% of U.S. women say they have dealt with these problems from 2015 to 2018.
There are two main types of incontinence: stress incontinence, characterized by leakage during physical exertion, and urge incontinence, marked by a sudden and overwhelming need to urinate. Knowing the differences between these types is key to successful treatment.
Women don’t usually start perimenopause until age 47. Symptoms can reappear or become aggravated at this stage when estrogen levels further drop off. This article will discuss the treatment options for incontinence and the non-invasive treatments available, including medication, physical therapy, and surgery.
Understanding Incontinence Types
Incontinence presents primarily in two forms: stress and urge. Stress incontinence occurs when exertion such as coughing, sneezing, or lifting suddenly puts pressure on the bladder. This added pressure can lead to involuntary leakage. Urge incontinence attacks you with a strong, sudden compulsion to pee. It can be difficult and sometimes downright impossible to just ‘hold it in.’
Both kinds of incontinence are often associated with midlife estrogen decline which can worsen symptoms. In perimenopause and after menopause, women lose estrogen, which helps keep the pelvic floor strong, making it harder to keep bladder control issues at bay.
“It’s characterized by the sudden compelling desire to pass urine that is either difficult or impossible to defer.”
Dr. Larissa Rodríguez emphasizes that seeking help for these issues should not be stigmatized:
To manage incontinence, evidence-based treatment options are available, including medications, physical therapy and surgery. For those who have urge incontinence, there are two classes of medications proven to decrease the frequency and urgency of bladder contractions.
“There’s no reason why this should be taboo.”
Treatment Options Available
Anticholinergics, the most common category, work by blocking acetylcholine, a chemical messenger that causes bladder contractions. The second type, beta-3 agonists, works by relaxing the detrusor muscle of the bladder to increase capacity.
In fact, besides medication, pelvic floor physical therapy is the most suggested treatment. This type of physical therapy works the pelvic floor muscles that surround and support the bladder and urethra. Any new training program needs a minimum of three months for clear gains to manifest.
Dr. Rodríguez states her belief in the effectiveness of physical therapy:
“The more fat there is on the bladder and the urethral sphincter, the greater the pressure exerted on these structures, weakening their ability to maintain closure and increasing the likelihood of urinary leakage.”
Women with remaining symptoms or women wanting more than conservative treatment can achieve significant improvement through botulinum toxin injections. These injections function by paralyzing the bladder muscles.
Surgery is still a good option for patients who fail conservative treatment. Specifically, sling surgery is regarded as the gold standard for surgical care of stress incontinence. In this minimally invasive procedure, a mesh tape is inserted underneath the urethra to offer support.
“I am a strong believer in physical therapy, and pilates is also quite good in getting people to engage the pelvic floor.”
The post-surgical results prove to be worthwhile, with many studies indicating positive effects that last for a minimum of 10 years. Patients do need to know that results will vary on an individual basis depending on their own health and conditions.
Surgical Interventions
Surgery remains a viable option for those who do not respond to conservative treatments. In particular, sling surgery is considered the gold standard for treating stress incontinence. This procedure involves placing a mesh tape under the urethra to provide support.
Dr. Rodríguez explains the importance of approaching treatment methodically:
“We always want to start with the most conservative measures and up the ante as time goes on, with meds or surgery. But surgery doesn’t change the muscle function, so in many cases, even the surgeon will want their patient to undergo physical therapy.”
The results from surgical interventions can be promising, with studies suggesting that effects last at least a decade. However, patients should be aware that individual results may vary based on personal health conditions.