A TAMC doctor is on a mission to inform the nearly one-third of all women who suffer from urinary incontinence that there are new treatment options available at TAMC and that they no longer have to simply accept the condition as a part of their lives. Rachel M. Swartz, M.D., F.A.C.O.G., says that urinary incontinence, the involuntary leakage of urine, affects an estimated one out of three women.
“That’s right – one in three!” she said about the staggering number of women who suffer, often silently, with the condition. “Most women are embarrassed about their condition. And most women do not volunteer information about incontinence to me. I think a lot of women believe there is nothing to be done, or surgery involves the harmful mesh warned about on television, or they have tried a treatment option in the past and it failed so they have given up, or they have convinced themselves that incontinence is an inevitable part of growing older.”
Beyond the embarrassment most women who have urinary incontinence feel, Dr. Swartz says the condition is, at best, disruptive, and at worst, it prohibits women from leading a healthy, active life.
“I have had women tell me they don’t travel anymore due to their incontinence. If they do travel they plan their trip around rest stops and bathroom breaks. They don’t play sports that might cause them to leak. They limit their sexual activity or stop having sex all together due to fear of leakage. Incontinence significantly affects quality of life for many women,” said Dr. Swartz.
Women may suffer from urinary incontinence for a variety of reasons, not the least of which are pregnancy and vaginal childbirth, but there are other risk factors as well, according to Dr. Swartz.
“Being overweight also is a risk factor. Certain foods and drinks seem to be bladder irritants and can cause or worsen incontinence. Previous pelvic surgery, such as hysterectomy, increases risk. Lastly, any conditions that damage the pelvic or sacral nerves increase the chance for urinary incontinence,” she said.
With so many risk factors, it may be unsurprising that the number of women who suffer from the condition is so high, but Swartz said it’s unnecessary for it to be that way. There are multiple options for treatment and she encourages anyone with the condition to seek consultation to learn about their options.
“Yes, incontinence is treatable,” she says. “The rate of success depends on the type and severity of urinary incontinence and the type of treatment.”
The most common types of urinary incontinence are stress incontinence and urge incontinence.
“Stress incontinence is caused by weakening of the pelvic floor muscles that hold the bladder and urethra (the tube that empties the bladder) in proper place,” explained Dr. Swartz. “Women with stress incontinence leak with coughing, sneezing, or any activity that increases intra-abdominal pressure. These are the women who ‘laugh so hard they pee their pants.’ This may sound funny but it isn’t.”
She continued, “Urge incontinence, or overactive bladder, is caused by involuntary contractions or spasms of the bladder. Remember the commercial about the woman who has “gotta go, gotta go” all the time? This is how women with urge incontinence feel. They have sudden onset of an incredible desire to void and don’t always make it to a bathroom in time.”
Dr. Swartz said there are also instances of mixed incontinence where women suffer from both types at the same time, and other, less common types as well – all have treatment options.
TAMC OB/GYN and Midwifery Services, located in the Millennium office building at TAMC’s A.R. Gould hospital in Presque Isle, offers many of those treatment options, as well as the ability to refer patients to pelvic floor specialists outside the Presque Isle area.
Treatments for urinary incontinence range from simple good bladder hygiene and Kegel exercises to medication and more complex surgical options, depending on the type of incontinence. Dr. Swartz says the doctors at TAMC OB/GYN and Midwifery Services will usually try the simpler, “first line treatments” before recommending surgery.
“Good bladder hygiene” includes frequent scheduled voiding, avoiding certain foods and drinks that are bladder irritants (such as citric food, spicy food, alcohol and caffeine), and avoiding both drinking and eating at least two to three hours before bedtime, explained Dr. Swartz.
Kegel exercises, or contracting the pelvic floor muscles, are a first line treatment for stress incontinence. Staff at TAMC OB/GYN and Midwifery Services teach patients how to properly perform the exercises, which can be enhanced by using vaginal weights or an electrical stimulator. Another option, which is available as close as Bangor, is pelvic physical therapy by a certified pelvic floor specialist.
Medication often improves urge urinary incontinence. “There are multiple different brands available. The older drugs typically have more side effects, most notably dry mouth, but they are also the least expensive. Most recently one of these medications, Oxybutynin, has become available over-the-counter as a skin patch that is changed every three days. I find this exciting and empowering that patients can initiate treatment on their own if they choose,” said Dr. Swartz.
When first line treatments fail to solve the problem, then doctors will explore more complex options.
“Surgery can be extremely helpful for women with stress urinary incontinence,” says Dr. Swartz.
Most of those surgeries are in the category of midurethral sling.
“Essentially, a small piece of mesh is placed beneath the urethra to act as a hammock and support the urethra during increased intra-abdominal pressure experienced with activities like coughing and sneezing,” explained Dr. Swartz. “I want to clarify that the mesh is not the mesh that has been associated with lawsuits and injury claims that are frequently advertised on television. Dr. Nguyen and I perform the Monarc transobturator tape (TOT) midurethral sling procedure as well as a variation of this procedure called the MiniArc. These procedures have an over 80 percent success rate in improving stress urinary incontinence. They are performed alone as a same-day surgery or can be combined with other gynecological surgery such as hysterectomy or tubal ligation.”
The most recent treatment option that the health care providers at TAMC OB/GYN and Midwifery Services can provide to patients is the InTone pelvic floor electrical stimulator and biofeedback system.
“I’m particularly excited about this device as it can treat both stress and urge incontinence and is virtually risk and side effect free,” said Dr. Swartz. “Patients are taught how to use the device in the privacy of their own home. It provides electrical stimulation to the pelvic floor muscles and actually talks the patient through a series of strengthening exercises. Many insurances cover the device although if a patient does have to pay out of pocket there is a 100 percent money-back guarantee if she does not get results.”
To learn more about the options available for treatment, Dr. Swartz invites women to call 768-5944 to make an appointment with her or any of the other providers at TAMC OB/GYN and Midwifery Services.