Innovative Urinary Incontinence Treatments for Women - Beyond Pelvic Floor Physical Therapy
WHAT IS URINARY INCONTINENCE?
Urinary incontinence is the involuntary leakage of urine and is often underdiagnosed and undertreated. In one survey, only 60 percent of patients seeking care for leakage (at least once weekly) reported receiving any treatment for their incontinence. Additionally, nearly 50 percent of those who did receive treatment reported that results were only moderate and temporary.
WHAT IS THE MAIN CAUSE OF INCONTINENCE?
There are a multitude of potential causes or risk factors for urinary incontinence, including:
Aging
Pregnancy
Childbirth (vaginal delivery brings a higher risk)
Menopause (i.e. vaginal mucosal atrophy and loss of hormones)
High impact exercise
Obesity
Lifestyle choices (smoking, caffeine intake)
Family history
Urobiome (i.e. unhealthy bacteria in the bladder)
Obstruction (tumors, urinary stones)
Neurological disorders (MS, Parkinson's disease, stroke, brain tumor or spinal injury)
THE FOUR TYPES OF URINARY INCONTINENCE
While many women experience intermittent, minor leaks of urine, others may lose small to moderate amounts of urine more frequently. There are several types of UI:
Stress incontinence - the leakage of urine when pressure is exerted on the bladder by sneezing, coughing, exercising, or laughing. Common contributors to stress incontinence include parity (pregnancy), obesity, high-impact exercise, family history, and age. This is the most common type of incontinence.
Urge incontinence - a sudden, intense urge to urinate followed by an involuntary loss of urine. The urge to urinate may become more frequent, including throughout the night. Urge incontinence may be caused by a minor condition such as infection, or a more severe condition such as a neurological disorder or diabetes.
Overflow incontinence - the experience of frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
Functional incontinence - a mental or physical impairment that makes it difficult to get to the toilet in time.
DR. KATE KASS’S APPROACH TO URINARY INCONTINENCE TREATMENT
ADJUNCTIVE TREATMENTS TO PELVIC FLOOR PHYSICAL THERAPY
Dr. Kass takes a comprehensive approach to treating urinary incontinence, evaluating possible contributory factors such as medications and medical conditions before recommending specific treatment. With these risks and side effects taken into account, there are several treatment options to consider.
Lifestyle modifications:
Weight loss – Obesity is a known risk factor for urinary incontinence, and weight loss in obese women appears to improve symptoms of urinary incontinence. Studies show greater benefits for stress incontinence than urgency incontinence.
Dietary changes – As some beverages may exacerbate symptoms of urinary incontinence, some patients may benefit from reducing their consumption of alcoholic, caffeinated, and carbonated beverages.
Constipation – Constipation can exacerbate urinary incontinence and increase the risks of urinary retention.
Smoking cessation – Smoking has been associated with an increased risk for urinary incontinence.
At-home pelvic floor strengthening - pelvic floor muscle (Kegel) exercises are especially effective for women with stress urinary incontinence but can be helpful for urge incontinence. Kegels strengthen the pelvic floor musculature so the urethra can more effectively compress and reflexively inhibit detrusor contractions. Generally, patients should perform a set of Kegels three times a day for 15-20 weeks to have effective results. For some patients, this approach may be impractical and difficult to sustain. Pelvic floor exercise can be supplemented by vaginal weighted cones (which can be purchased online).
Pelvic floor physical therapy - women who have challenges engaging the pelvic floor through at-home exercises may be referred to a health professional for clinical pelvic floor physical therapy. Physical therapists may help patients learn to engage their pelvic floor as well as incorporate biofeedback or electrical stimulation.
BTL Emsella - We specifically recommend BTL Emsella treatments, an FDA-approved treatment that tones your bladder and pelvic floor muscles, returning neuromuscular control to the pelvic floor. Emsella uses focused, high-intensity electromagnetic (HIFEM) technology to stimulate the deep muscles of the pelvic floor, causing them to contract. A single Emsella session produces thousands of pelvic floor muscle contractions - it’s the equivalent of doing 10,000 kegel exercises in a half hour. We call it the Kegel Throne. In our experience and according to several comparative studies, BTL Emsella treatments tend to produce faster, more significant results when compared to pelvic floor therapy. Read more here.
Topical vaginal estrogen/hormone replacement - vaginal estrogen therapy is recommended for peri- or postmenopausal women with either stress or urgency incontinence and vaginal atrophy. The loss of hormones can cause changes in vaginal anatomy, tissue plumpness, tone, pH, and vaginal flora, not to mention changes in lubrication and responsiveness during sex. Hormone replacement can be a key and necessary component in treating urinary incontinence and other genitourinary problems during and after menopause. Adequate estrogen therapy improves the health of the urinary tract and reduces urinary tract infections, stress urinary incontinence, and overactive bladder symptoms. You can read more here.
Bladder training - Bladder training is most effective for women with urgency incontinence. Bladder training is usually taught by a healthcare professional specializing in urinary problems and involves timed voiding intervals and behavioral interventions.
FAQs
Q. HOW DO I FIND A URINARY INCONTINENCE DOCTOR IN SEATTLE?
A. We often recommend contacting your primary doctor or OBGYN first for evaluation. Your doctor or OBGYN may refer you to a pelvic floor physical therapist. However, patients may choose to seek out a more progressive approach such as Emsella, which is best found via an online search. If you are looking for an incontinence doctor in Seattle, we offer Emsella and HRT in our office.
Q. WHAT ARE MY URINARY INCONTINENCE TREATMENT OPTIONS IN SEATTLE?
A. Aside from at-home pelvic floor exercises, urinary incontinence treatment options in Seattle include pelvic floor physical therapists, nurses specializing in continence therapies, Emsella treatments, and doctors who provide vaginal estrogen therapies. In more complicated situations, patients may also seek out a urogynecologist.
Q. IS INCONTINENCE A NORMAL PART OF AGING?
A. Incontinence is a normal part of aging - with 28% of women reporting urinary incontinence symptoms between the ages of 30-39. Approximately 50% of women over 65 report having occasional leakage.
Q. WHAT HAPPENS AT A DOCTOR’S VISIT FOR URINARY INCONTINENCE?
A. During your doctor’s visit for urinary incontinence, a thorough verbal history will be taken and, depending on type of urinary incontinence and symptoms described, a physical exam and urinalysis may be conducted.
Q. WHO IS AN IDEAL CANDIDATE FOR URINARY INCONTINENCE TREATMENT?
A. Any woman at any age who is experiencing involuntary urinary leakage is a good candidate for UI treatment. The type of treatment may depend on the severity or type of incontinence a woman is experiencing.
Q. HOW DO YOU CURE INCONTINENCE?
A. Depending on the type of urinary incontinence, a significant reduction in symptoms or a cure may be possible. A cure may be as simple as behavior modifications or at-home exercises or, in more extreme cases, a bladder prolapse may involve bladder surgery. For most cases, pelvic floor strengthening is recommended, and we have found Emsella to be a great, non-invasive shortcut to restoring urinary control.
Q. WHAT HAPPENS IF INCONTINENCE IS LEFT UNTREATED?
A. If incontinence is left untreated, urinary incontinence can worsen with age and cause more inconvenient and unpleasant symptoms.
Q. IS TREATMENT FOR URINARY INCONTINENCE NON-INVASIVE?
A. For the vast majority of women struggling with stress or urge incontinence, treatments are considered minimally to non-invasive. At-home pelvic floor exercises are of course non-invasive - as are Emsella treatments. Work with a pelvic floor physical therapist often requires an internal examination and palpation, if agreed upon by the patient. This internal work is commonly necessary to help train a patient to effectively engage pelvic floor musculature and for the therapist to understand at which level pelvic floor dysfunction may be taking place.
Q. WHAT IS THE BEST HOME REMEDY FOR INCONTINENCE?
A. The best home remedies for incontinence are kegel exercises and the use of vaginal weights. If a patient is diligent and symptoms are mild, these may be effective. If a woman is around menopause or has more persistent symptoms - other interventions such as Emsella or hormone replacement therapy may be necessary.
Q. WHAT IS THE BEST EXERCISE FOR THE BLADDER?
A. Kegels are the best exercise for the bladder. The basic regimen consists of three sets of 8-12 contractions sustained for 8-10 seconds each, performed three times a day. Patients should try to do this every day and continue for at least 15-20 weeks.
Q. HOW MUCH DOES PELVIC FLOOR PHYSICAL THERAPY COST? IS IT COVERED BY INSURANCE?
A. Pelvic floor physical therapy can cost between $150-300 per session, depending on the geographic area and the therapist’s experience. Most insurance carriers will cover pelvic floor physical therapy or at least a portion of it - however, you must confer with your insurer for specific coverage questions.
Q. HOW MANY PELVIC FLOOR PHYSICAL THERAPY SESSIONS DO I NEED?
A. It is often recommended that a patient start with six to twelve weekly physical therapy sessions to appreciate demonstrable results.
PLEASE CONTACT US AT 425-657-3745 IF YOU ARE EXPERIENCING URINARY INCONTINENCE CHALLENGES AND WOULD LIKE MORE INFORMATION ABOUT POSSIBLE TREATMENT OPTIONS.
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