Thrive/ Sheila Helmberger
Certain medications, diet, and childbirth are all things that can contribute to incontinence. Statistics show over 13 million Americans suffer from the sometimes embarrassing condition, which occurs with a regular involuntary release of urine. Incontinence can happen at any age, and while men can experience it as well, women make up 85 percent of the cases.
If you spend your life looking for the bathroom everywhere you go and declining invitations to events you'd like to go to because you're too embarrassed or nervous you might have an accident, there are several options for treatment, and most of them are non-invasive and can give you peace of mind and change your life.
The Urology staff at Essentia Health is located at the Brainerd Clinic and includes Dr. Eric Chapman, Dr. Bradley Qualey, Dr. Scott Wheeler, and Physician Assistant Jessica Brandl. The group works with patients to find a solution for the condition, which includes urge incontinence, the need to go to the bathroom immediately, with little warning, and stress incontinence, which is leaking urine whenever you do things like cough or sneeze, run or jump. Incontinence can affect all areas of your life from social activities to how well you sleep, or do your job. "A lot of people come to us and say they thought it was something they just had to live with. It's more common as you get older, but you don't have to live with it," says Brandl.
Dr. Qualey says incontinence is a lot more acceptable than it used to be, "It's getting easier for people to talk about. The first step when a patient comes is to get an accurate history, determine what type of incontinence the patient has, identify what the patient's goals are and work with them to come up with the best option for treatment. There's a wide gamut of things that can contribute to incontinence and it's our job to figure that out. It can something simple, like dietary, relating to irritants such as coffee or foods that are high in acid or it can be medications they are on." Sometimes a functional assessment is done to see what's happening.
The Urology staff says there three steps they often take when working with a patient. General behavior modifications are often suggested as the first step in looking for a solution. Caffeine or other irritants may be eliminated first as well as having the patient begin Kegel exercises or other physical therapy that can help strengthen the pelvic floor. As a second step, the medical staff will talk to the patient about medicines that are available to help relax the bladder and make the condition more manageable. Surgical solutions are the final step in treating incontinence, and there are many options.
For urge incontinence one procedure that can be done uses acupuncture needles in the ankle. It stimulates the nerve that goes from the spine to your bladder and fatigues the nerve and calms it down.
Dr. Wheeler and Dr. Chapman also do a procedure called InterStim® or Sacral Neuromodulation. A
pacemaker-type device is inserted that manipulates the pelvic nerve that goes to the bladder. The device is monitored once it's inserted and will need to be replaced every four to six years. "The nice thing about that procedure is we have a test evaluation that is done in the office first for that," says Brandl, "If that doesn't work we can rule that out right away before we go any further."
Dr. Qualey does another procedure that injects Botox into the bladder. Twenty injections are given in different parts of the bladder while the patient is asleep. It just takes a few minutes, he says, and the patient can go home right after. It's easy on the patient but needs to be repeated about every six months. "These are two recent exciting developments that can really change a patient's quality of life," he says.
For stress incontinence non-surgical procedures also include pelvic muscle exercises, and certain medications. One surgical solution is a sling procedure that places a strip of material beneath the urethra. It offers support to the urethra and prevents leakage during exercises or some of those bodily functions (like coughing) that might occur otherwise. Synthetic slings are made from polypropylene mesh. "It is safe and FDA approved," says Dr. Wheeler. "There is some concern about types that were found unsafe in years past but have since been pulled off of the market."
A life changing procedure
Thirty-seven-year-old Elisha had her first procedure after she had two children and was just 21 years old and living in Mississippi. She was told it would last about eight years. Over time she slowly started having problem with incontinence again and after three more children it worsened to the point where she was wearing diapers. she knew it was time to have something else done.
"It's a little awkward when you laugh or you cough or you sneeze and you feel like you're going to pee yourself. It shuts out a lot of things you want to do because you don't want to be out doing things and feel like you're going to wet your pants all the time. I just keep thinking am I going to make it to a bathroom? I have to make it to a bathroom."
It took me five years to get back to the doctor after I started having problems whenever I'd cough and sneeze. At first it only happened once in a while or if I was sick, and then it started happening all of the time.
Elisha says having the surgery has changed her life. "I enjoyed working with everyone," she says of Dr. Chapman and the staff at Essentia Health. They sat down and explained things.