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WOMEN'S HEALTH
NOVEMBER IS NATIONAL BL
Gotta Go? SAFE AND EFFECTIVE TREATMENTS AVAILABLE FOR BLADDER CONTROL ISSUES Dr. Shane Sopp, Urogynecologist
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ou’re not alone. Up to 54 million women in America suffer from bladder urgency or leaking urine (Urinary Incontinence), including tens of thousands from the Syracuse area. I treat or have this discussion with over a dozen women a day. So why are so many of you suffering in silence? Is it an embarrassing topic to bring up ? It can’t be less embarrassing than buying those pads. Do you feel it is a negative rite of passage with age? I treat women from 16 to 90 (half of women over 50 have incontinence). Is no one asking you the question? I ask the following: ‘Do you: have frequency, urgency, get up at night, leak on the way to the bathroom, put the key in the door and fly over the furniture, leak with coughing, sneezing, laughing, lifting, running or sex?’ If this is resonating with you, keep reading. We’re just getting started. And it’s so easy to correct! There’s a tendency to lump all types of urinary incontinences into one problem, but there are many types with different cures. And I already know what you’re thinking: “I don’t want to take another pill” or “I don’t want that mesh surgery.” But I’m the messenger, so please indulge me. We can easily divide urinary urgency and incontinence into the three most common categories: Over Active Bladder Syndrome (OAB), Urge Urinary Incontinence (UUI), and Stress Urinary Incontinence (SUI). Continuing in ‘English,’ let’s do this visually. Imagine your bladder is a muscular balloon that relaxes and fill, and then contracts and empties. Also imagine that there is a straw emptying the balloon, and that’s your urethra. OAB is urinary urgency to go to the bathroom. UUI is leaking on the way to the bathroom. Normally, your bladder relaxes and fills with urine and then contracts and empties it. Both OAB and UUI happen when the bladder ‘relaxing cells’ and ‘contracting cells’ are out of sync. During the relaxing (the filling phase) the contractors
November 2020
misbehave and prematurely contract. Your brain and bladder connection aren’t ready for this, and thus the unexpected urge and “get outta my way.” SUI is a physical, or mechanical problem with the urethra. I wish we had named this ‘Strain Urinary lncontinence’... your urethra doesn’t need Xanax! Think of the urethra like a footbridge that’s suspended in place by bungy cords. When you step on that bridge, you don’t want it to drop or bounce.
The same goes for SUI. You have ‘ligaments’ that hold the urethra (straw exiting the bladder) in place so that when the force or pressure from coughing, etc pushes on it, it stays put. However, if the ligaments are stretched or torn (from forcefully pushing out those beautiful children or with aging, etc), the urethra drops and you leak. Now let’s work our way up the treatment ladder, remembering that we have
different problems that require different treatments, and it’s quite common for many women have all three problems. UUI + SUI = Mixed Incontinence.
The treatment algorithm for OAB/UUI has three levels of treatment Level 1: Behavioral modalities and pelvic floor physical therapy These can be tried for all incontinences. You may need frequent appointments, for weeks or months. Healing is not always predictable (FeMani Wellness2020). Level 2: Medication (covered by insurance) OAB and UUI are treated similarly. First, think about what we need to do: relax the bladder. This can be done by two different mechanisms of action (MOAs)...HCPs
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