Leakage. There, we said it.

Also known as incontinence, the condition that afflicts more than 13 million people in the U.S. annually is hardly a taboo topic.

For those over the age of 65, incontinence occurs in 51 percent of the population, according to the Centers for Disease Control and Prevention. Women have a higher rate of incontinence than men. Incontinence encompasses leakages related to either or both the bowel and bladder.

Incontinence risk factors

For the aging, incontinence is associated with a number of factors, including chronic conditions such as diabetes and stroke, cognitive impairment and mobility impairment. Bladder incontinence can also be influenced by aging-related changes in the lower urinary tract, urinary tract infection and other health-related conditions to include mobility impairment.

Risk factors for bowel incontinence include chronic diarrhea, inadequate fiber and water intake and chronic constipation. Health factors include diabetes, stroke, neurologic and psychiatric conditions, cognitive impairment and mobility impairment.

In addition to the financial burden, people suffering from incontinence may carry an emotional burden of shame and embarrassment that adds to the physical discomfort and disruption of their lives.

Treating incontinence

Incontinence is not inevitable with age, however, and is a treatable and often curable condition. Tidewater Physical Therapy specializes in women’s health services, including the treatment of incontinence and pelvic pain. Tidewater Physical Therapy’s services are aimed at increasing a woman’s quality of life through self-management and using specific strategies to reduce symptoms and improve function.

People with incontinence suffer most commonly from stress incontinence or urge incontinence.

Stress incontinence stems from the increased abdominal pressure and weak muscles, resulting in the accidental release of urine— this happens, for example, when people laugh, cough, sneeze or jog.

Urge incontinence occurs when people must get to the bathroom right away from an immediate urge that there is no stopping.

But because people feel discomfort in talking about incontinence issues, many people fail to seek treatment. However, talking to a family doctor or gynecologist for a referral to see a physical therapist who specializes in women’s health, can truly help incontinence symptoms and ease feelings of shame, isolation and depression.

The role of physical therapy

Physical therapy helps incontinence patients gain control of their symptoms and will reduce the need for pads, special undergarments and medications.

In a private treatment room of the clinic, patients will have their pelvic floor muscles evaluated.

The pelvic floor is like a sling of muscles and it runs from the pubic bone in the front and goes all the way to the tailbone in the back. It’s one of the components that make up the core of the body.

Treatment includes heat to relax the muscles, electrical stimulation, ultrasound and manual therapy. The first day of therapy, 20 to 25 minutes is spent simply educating patients on what exactly the condition entails.

A therapist will help patients “find” the right muscles and use them correctly. The pelvic floor is one of the components that make up the core of the body, so it’s important to work on core exercises. Pelvic floor exercises, such as Kegel exercises, will work to strengthen the muscles that control your bladder, and put the patient in control of their urges again.

Finding a Physical Therapist

As part of your healthcare team, a physical therapist will make an assessment of your condition and create a plan to start you on the road to wellness. Our team will communicate with your physician of record and obtain a referral, if necessary, for your continued treatment. We will also work with your insurance carrier to make sure services are covered by your plan. To make your own appointment, find a clinic near you.

This article is sponsored by Tidewater Physical Therapy

In an earlier blog post, I reported that I was fortunate to be able to attend the American Urological Association annual meeting in early May. Attendees traveled to San Diego from around the globe to learn about the latest scientific breakthroughs for various urologic conditions. It was a stimulating conference with many new findings and reports. In this part two, I will present information on Botox for overactive bladder and the safety of slings done for stress urinary incontinence.

Botox is the most exciting new treatment for overactive bladder in years and data on its effectiveness was presented at the meeting by Dr. Victor Nitti. Patients who were part of an initial study on Botox could then enroll in an extension study. During this extension study, patients could receive repeat Botox injections over the course of a number of years, if needed. Analysis of large numbers of patients showed very positive results. Not only was Botox extremely effective in decreasing urgency, frequency and leakage, it also remained effective for a long time. Further, when repeat injections were done, the results were just as good and just as long lasting as when they were done for the very first time.

Botox injections can be performed right in our office in a few minutes. Numbing medicine is put into the bladder and there is very little discomfort. While the effects of Botox wear off over time, many patients see dramatic improvement for six to 18 months before noting a decline. At that time, the procedure may be repeated. Read patient testimonials from our own VWC patients who have had Botox for overactive bladder.

Another update from the AUA looked at the safety of slings done for stress incontinence. Stress incontinence is leakage related to exertion, such as a cough, sneeze or exercise. Dr. Anne Suskind and other investigators reviewed 6,698 mesh sling procedures done between 2006 and 2008, as well as 445 non-mesh procedures. They found that complications were extremely uncommon. Many other studies have confirmed the long-term safety and effectiveness of slings for treating urinary incontinence. This is in line with our experience here at Virginia Women’s Continence Center. The sling procedure – done as an outpatient – is minimally invasive. Patients are up and about and driving the very next day. The improvement in quality of live can be enormous – read what some of our own patients are saying.

There are many TV advertisements warning against the danger of vaginal mesh. It is important to understand that the sling procedure, done strictly for urinary incontinence, is not the same as the surgeries that were done with large pieces of mesh for “bladder tacking” or fixing pelvic prolapse. In fact, the sling does not sit under the bladder at all – it is completely under the urethra. In 2011, the FDA declared that manufacturers of the larger mesh kits had to do new studies and get new approval before being allowed to proceed. At the same time, the FDA said that companies did not have to do new studies on slings, with the exception of ongoing studies of the newest design modification of one of the slings. Further information on this can be found here.

These are just some of the new developments in the ongoing diagnosis and treatment of bladder problems. No matter the type of bladder problem you are experiencing, we are ready and willing to find a solution that will restore your quality of life. Make an appointment with Virginia Women’s Continence Center by calling 804.288.4084 and find out for yourself.

An estimated 17 to 53 million Americans are affected by overactive bladder. Frequent urination – the main symptom associated with overactive bladder – is defined as having to use the restroom more than eight times in 24 hours. Other symptoms may include waking up more than two times per night to urinate; urgency, or a sudden and strong desire to urinate; and urge incontinence, or accidentally wetting yourself due to not getting to a bathroom in time.

There are a variety of treatment options for patients who suffer from overactive bladder including exercises, diet and lifestyle modifications, medications, in-office procedures and the newest option: Botox injections.

Botox works by reducing bladder contractions and possibly decreasing the nerve signals that travel from the bladder to the brain, telling the brain that the bladder is full. The result is that the number of leakage episodes decreases and bladder capacity increases; thus increasing the amount of time between going to the bathroom.

Dr. Lonny Green

Dr. Lonny Green, urologist and director of Virginia Women’s Continence Center, was involved in the clinical trials that led to the FDA approval of Botox. Now, Dr. Green performs the injections in a couple of minutes at our John Rolfe Commons location. While some patients feel a slight pinch – the procedure is not considered to be painful.

In the clinical trials, most patients noted some improvement in their symptoms as soon as one to two weeks after the Botox treatment. The frequency of treatment varies from patient to patient, depending on how quickly symptoms return. Patients must wait at least three months between treatments, but most patients are re-treated between six and 18 months.

Just like any medical procedure, there are potential side effects from this treatment option. Some of the side effects that were reported during clinical trials include urinary tract infections, decreased bladder emptying (the inability to empty your bladder completely), blood in the urine, fatigue and insomnia.

Scheduling an appointment with Dr. Green is the first step in determining whether Botox is an appropriate treatment solution for your overactive bladder. If you’re interested in learning more about Botox or the other treatment options for incontinence, we recommend that you schedule an appointment with Dr. Green through our secure patient portal or by calling 804.288.4084.

Additional Resources:

To learn more about the types of urinary incontinence as well as other treatment options available, visit our Web site.

To read the recent article from the Richmond Times-Dispatch on Botox treatment for urinary incontinence, visit their Web site.

Virginia Women’s Center is an advertiser on Richmondmom.com

There are four types of urinary incontinence: stress, urge, mixed and overflow. Depending on the type of urinary incontinence you have, the treatment options can range from non-invasive therapies to minimally invasive surgical procedures. The InTone device is a new treatment option for women who suffer from stress, urge or mixed incontinence. By combining gentle muscle stimulation with pelvic floor training exercises, the InTone device can stop bladder leakage without medication or surgery. The InTone device is used on a regular basis in the comfort and privacy of your own home.

The InTone device helps strengthen your pelvic floor in two ways: gentle muscle stimulation and voice-guided pelvic floor exercises.Gentle muscle stimulation strengthens the pelvic floor by helping stop the spasms of the bladder muscle. If you have a strong pelvic floor, you can do things like cough, sneeze, laugh or run without leakage. Calming spasms of the bladder muscle allows you to “hold it” longer and avoid frequent trips to the bathroom.

The muscle stimulation will be customized under your physician’s supervision to ensure proper muscle activation. The muscle stimulation delivers a gentle electrical current directly to your pelvic floor muscles and has been proven to be an effective treatment for bladder leakage.

The InTone device also features voice-guided pelvic floor training exercises. The InTone device will talk you through your entire 12 minute session. The pelvic floor exercises are performed by contracting your muscles as directed. The InTone device uses an illuminated bar graph so that you know the strength of your contractions. The bar graph will also help guide you toward doing your exercises correctly.

Dr. Lonny Green, urologist and director of Virginia Women’s Continence Center, specializes in treatment for urinary incontinence and he is also a Certified InTone Specialist. Scheduling an appointment with Dr. Green is the first step in determining whether the InTone device is an appropriate treatment solution for your incontinence. If you’re interested in learning more about the InTone device or the other treatment options for incontinence, we recommend that you schedule an appointment with Dr. Green through our secure patient portal or by calling 804.288.4084.

Virginia Women’s Center is an advertiser on Richmondmom.com

This summer I flew to New Zealand to visit my best friend and her new baby.  Having a two-year old myself, I thought that the greatest gift I could give was the comfort of an old friend to help with the cooking, cleaning, diapering, and simply talking about motherhood.  I personally experienced a difficult time during the postpartum period and wanted to be there for my friend as much as possible. 

As soon as she picked me up at the airport, I realized she was adjusting to motherhood just fine!  While we chatted and caught up, I realized the differences between her postpartum experiences and my own were more than two women handling the introduction to motherhood differently.  It reflected a cultural difference. 

In New Zealand women learn about pregnancy, childbirth, childcare, and postpartum rehabilitation.   A midwife visits the new mother and child at their home regularly, often multiple times every week, for the first six weeks after birth, checking on the baby’s progress as well as the new mother’s physical and mental well being. The new mothers are screened for postpartum depression and the level of support given by family and friends is evaluated. 

Further, the new mothers are physically monitored and are referred to a women’s health physical therapist on a regular basis.  The physical therapist specializing in women’s health and postpartum rehabilitation checks for musculoskeletal concerns, which include diastasis (abdominal separation), posture, and pelvic floor strength and suggests appropriate exercises.  These interventions often result in reduced incontinence, back pain and diastasis, and provide a faster return to normal posture and body mechanics, including sexual intercourse. New Zealand’s culture embraces the notion of supporting and nurturing the mother’s mental and physical well-being as well as the infant’s.   

In the United States, pregnancy and childbirth overshadow the postpartum needs of the mother.  Women learn about childbirth and childcare, but ignore the importance of postpartum rehabilitation.  Instead, the nurse gives the mother a quick bit of postpartum instruction at check out, often buried in a packet of other information. The mother’s six-week check-up does not usually address the musculoskeletal components so carefully checked in other cultures. 

There are no medical postpartum supervised exercises offered, and prevention, or at least alleviation, of incontinence, back pain, diastasis and poor abdominal function is rarely discussed.  Additionally, there is rarely any advice given regarding normal posture and body mechanics.  Often new mothers return to normal activities too soon, despite a nagging feeling (call it women’s intuition) that their bodies just are not right.  Our bodies are not the same after childbirth, yet we are not being taught how to regain our lost musculoskeletal function. 

In fact, the United States is significantly behind many developed countries in its care for women and postpartum rehabilitation. Canada, Australia, France, Germany, and the Netherlands all have postpartum programs developed to improve the musculoskeletal health of women during their child bearing years.  

Thankfully, with education we can change our culture to value the mother’s health as much as the health of her baby.  There is a small but growing group of healthcare providers who understand this and embrace the importance of postpartum rehabilitation.  Women’s Health Physical Therapists have unique musculoskeletal knowledge.  Working with them and your physician on postpartum education and assessments can improve your physical health, and your joy of life.

In Richmond, Women’s Health Physical Therapy offers a musculoskeletal check of your abdominal muscles, pelvic floor, posture, and the biomechanics you use in taking care of your baby.  Most insurance companies will cover postpartum care under the category of disuse muscle atrophy.

If you are expecting, I encourage you to continue to read up on the issues discussed above. If you are lucky enough to have already joined the ranks of new mothers, I urge you to request postpartum physical therapy.  Learn about musculoskeletal postpartum rehabilitation, and share what you learn.  Together we can change our culture, one mother at a time.    

–This article written by Jane Ireland Broadbent and was sponsored by Women’s Health Physical Therapy. www.obgyn-physicaltherapy.com    For more information about their services including treatment prenatal and postpartum services, incontinence, pelvic pain, orthopedic, breast cancer, osteoperosis, constipation, fetal incontinence, fibromyalgia, balance, lymphedema, pelvic pain, and headaches.  804-379-3002