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Non-Surgical Treatment Is Often Available For Women Who Suffer From Urinary Incontinence

17.02.2004

No matter how funny the joke, many women try not to laugh. They worry about coughing or sneezing unexpectedly, afraid the pressure on the bladder will cause a loss of control.

Regardless of how recently they’ve been to the ladies’ room, many women feel the need to go again, victims of an "overactive" bladder that tends to contract even when it isn’t full.

Unfortunately, many of these women - and those with other types of urinary incontinence - live in fear, frustration and shame because they believe their symptoms are beyond help. They may be too embarrassed to talk to their doctor.

Urinary incontinence, the loss of bladder control, is twice as common in women as in men, but most cases are far from untreatable. According to the recently appointed director of urogynecology and reconstructive surgery at Cedars-Sinai Medical Center, more than 80 percent of women who pursue treatment find relief.

"Many women incorrectly think that incontinence is a normal part of aging and that surgery is the only treatment. Actually, only about 20 to 30 percent need surgery," says Cynthia D. Hall, MD, a specialist in women’s pelvic health who focuses on the diagnosis and treatment of urinary incontinence, pelvic floor prolapse, pelvic pain and recurring urinary infections.

While aging may be one factor, urinary incontinence in women is often caused by an "interplay of factors," including a lack of estrogen, giving birth many times or giving birth to large babies, and genetics. "Genetics plays a huge part in predisposing a woman to urinary incontinence," Dr. Hall says. "Sometimes a woman who has given birth to 10 children won’t experience it, while another woman who has only one child or none at all, will."

The two most common types of incontinence are "stress" incontinence, caused by pressure placed on the bladder during such actions as coughing, exercising, lifting or laughing, and "urge" incontinence, caused by the bladder contracting when it isn’t full. About 40 percent of women with urinary incontinence experience more than one type, usually a combination of stress and urge incontinence.

Another type, "overflow" incontinence, uncommon in women, occurs more often in men with prostate gland problems. An inability to empty the bladder causes urine to overflow uncontrollably and leak. Nerve damage from diabetes also can lead to overflow incontinence, and some medications can cause or increase it.

"It’s extremely important to get a clear idea from the patient what her symptoms are and also to do a pelvic examination and perhaps bladder testing so we can treat them appropriately," says Dr. Hall, who works closely with - not in place of - her patients’ primary care and/or ob/gyn doctors. "Incontinence is rarely a dangerous medical condition; it’s more often a ’quality of life’ issue. I always stress to my patients that it’s their choice as to what type of treatment to pursue. There’s no one single treatment option; they have to choose what they want to do."

Among the choices are behavioral training such as timed voiding and dietary alterations, pelvic floor exercises (Kegels), perhaps with biofeedback or electrical stimulation of the pelvic floor, medication, pelvic support devices or surgery.

Urogynecology is described as a merging of two fields - urology and gynecology - into one medical specialty that focuses on women’s pelvic health. A urogynecologist completes medical school and a four-year residency in obstetrics and gynecology. The residency is followed by a two-year or three-year fellowship in urogynecology, during which the physician specializes in the evaluation and treatment of conditions that affect the pelvic organs and the muscles and connective tissue that support the organs.

Dr. Hall received her medical degree from the State University of New York and completed her residency at Long Island Jewish Medical Center. She then completed a fellowship in urogynecology and pelvic reconstructive surgery at Harbor/UCLA Medical Center. Before joining Cedars-Sinai, she was at North Shore University Hospital, a busy community hospital in Long Island NY.

Her research interests are in the mechanism and prevention of childbirth injury,of different graft materials in reconstructive surgery, and in the causes of mixed incontinence. "At Cedars-Sinai, we’re in the planning stages of studying different aspects of mixed incontinence (stress and urge). We want to know what the predictive factors or underlying problems are in a particular patient that make surgery work for both problems (usually urge incontinence is better treated by medicines or pelvic muscle exercises). Is it related to genetics, or anatomic (structural) differences or other factors?" she asks.

In addition to treating incontinence, Dr. Hall treats women who experience prolapse (an abnormal descent or bulging of the uterus, bladder, vagina or rectum), pelvic pain (bladder or urethral pain) and recurring urinary tract infections. For more information, please contact Cedars-Sinai’s Center for Women’s Continence and Pelvic Health at 310-423-9555.

Cedars-Sinai is one of the largest nonprofit academic medical centers in the Western United States. For the fifth straight two-year period, it has been named Southern California’s gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities.

Sandra Van | Cedars-Sinai Media Relations

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