By Bruce S. Crawford, MD, FACOG

Bladder control problems affect 37 million Americans, the majority of them women. The most common forms of this treatable condition include stress urinary incontinence (SUI) and over-active bladder (OAB).

The term stress urinary incontinence denotes leakage of urine associated with physical activity. Coughing, sneezing, laughing, walking up stairs, running and jumping are all common causes of leakage among women with SUI. Anything that causes a woman to use the abdominal muscles will result in an increase in abdominal pressure and stress or pressure on the bladder and urethra.

If the strong connective tissue that surrounds and supports the urethra and bladder becomes weak, the urethra loses its ability to maintain a seal, and leakage of urine occurs. Many factors contribute to weakening of these tissues. Vaginal childbirth, heavy lifting, chronic constipation and chronic lung disease are associated commonly with SUI. Genetic factors as well may contribute to this condition. It is not uncommon for patients with bladder control problems to report that mothers and sisters also experience these same symptoms.

Treatment for SUI has progressed substantially during the last 10 years. Although surgery for stress incontinence has improved, nonsurgical treatment options are adequate for the majority of patients. Pelvic floor muscle, or Kegel, exercises are an essential element of first-line treatment of SUI.

For patients unable to coordinate an adequate contraction of the pelvic floor muscles, a program of biofeedback and electrical stimulation can be of great value in rehabilitating the pelvic floor. In addition, topical estrogen in the form of a cream or suppository may provide significant improvement in stress incontinence.

The other very common form of urinary incontinence is over-active bladder. Patients with OAB complain of a sudden and strong urge to urinate that is difficult or impossible to put off. Two-thirds of women with OAB do not experience leakage of urine but are generally aware of "close calls," bothersome frequent urination and frequent nighttime voids.

Treatment of OAB may involve medications such as Ditropan, Detrol or Sanctura. These medications are called anticholinergics and work by quieting unwanted bladder contractions. Side effects such as dry mouth and eyes are fairly common but generally tolerated by patients with this distressing bladder condition.

Bruce S. Crawford, MD Gena Turner, APN/CNP

Medications used in OAB generally work better if combined with pelvic floor muscle exercises, fluid restriction and a program of timed voiding referred to as "bladder retraining."

Women living with urinary incontinence can take heart in the knowledge that in almost all cases symptoms can be significantly improved. Unfortunately, myths abound and keep many patients from seeking care for this very treatable condition. Rest assured that urinary incontinence is not an inevitable consequence of aging, effective treatment is available, and surgery is not the only option.

Your primary care physician will be able to address these issues with you and, if appropriate, direct you to the care of a specialist in the area of female incontinence.

Bruce S. Crawford, MD, is a gynecologist specializing in bladder control issues for women, including nonsurgical treatment approaches as well as pelvic reconstructive surgery. He is medical director, with nurse practitioner services provided by Gena Turner, APN/CNP, at the Women's Continence Center on the campus of Northern Nevada Medical Center in Suite 107, Vista Medical Terrace (up the hill from Northern Nevada Medical Center). For more information or an appointment, please call 356-8980.

Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000