Urogynecology — it’s a specialty you probably don’t recognize, but if you’re a woman who suffers from a pelvic floor issue, this specialty can help you find relief.
Also known as female pelvic medicine, urogynecology is a subspecialty within obstetrics and gynecology that focuses on treating disorders of the female pelvis. These disorders include pelvic organ prolapse, urinary and bowel leakage, pelvic pain, urinary tract infections and constipation. Another area of urogynecology that has had many promising advances is in treatment for overactive bladder.
At Sanford Health in Sioux Falls, South Dakota, female pelvic medicine experts like Kevin Benson, M.D., are helping patients find relief from an overactive bladder with advanced treatments that go beyond lifestyle modification and medication.
Learn more: How Sanford Health provides bladder health care
According to the U.S. Food & Drug Administration, up to 40% of women in the U.S. live with overactive bladder symptoms. It’s a bladder control condition that’s defined by its symptoms — urinary urgency and urinary frequency, either with or without leakage.
“It’s a quality of life diagnosis. Overactive bladder affects a patient’s ability to enjoy activities that are important to them,” Dr. Benson said. “Patients really become socially isolated, depressed and burdened.”
An overactive bladder can affect women of all ages, but it becomes more common as women get older.
Worried about sneezing or lifting
Christin Bartels is a mother of two and said she endured a leaky bladder for way too many years.
“I wish I would have done this years ago, instead of worrying about what would happen when I sneezed or lifted something heavy,” she said.
When Bartels was pregnant for the first time, she was warned about many changes that could potentially occur. Stress urinary incontinence (SUI), or a leaky bladder, is prompted by physical movement or activity — coughing, sneezing, running or heavy lifting — that puts pressure on the bladder. SUI was mentioned, but she didn’t think it would actually happen to her.
“But it did,” said the Sioux Falls woman. “When my first son was born, I didn’t think I’d actually have problems with a leaky bladder. I was wrong.”
And after her second son was born the problem escalated, causing Bartels to be very self-conscious.
“Just trying to run and play with my boys was difficult a lot of days,” she said. “This problem had a significant impact on my quality of life.”
Being fit and active was, and is, important to her. But with SUI, it was difficult to find activities that didn’t create uncomfortable situations.
“I signed up for a Zumba class with a friend, and was so excited to try it out,” she said. “I couldn’t even get through the class without having to run to the bathroom.”
Simple solution for leaky bladder
After speaking with a coworker, she realized there could be a better way to live. She made an appointment with Dr. Benson.
“The most common cause of stress urinary incontinence is child bearing,” said Dr. Benson. “There are a lot of women who suffer in silence, but shouldn’t. There is a relatively simple solution to this common problem.”
Sanford Health offers the mid-urethral sling procedure to treat leaky bladder. After a consultation, Bartels was deemed a good candidate for the procedure, which was done at Sanford Health’s Female Pelvic Medicine and Reconstructive Surgery Clinic.
The outpatient procedure is performed under local anesthetic and typically takes about five to 10 minutes. Dr. Benson stressed this procedure is an approved standard of care and is different from the controversial vaginal mesh therapy.
“The beauty of this procedure is that it’s 90% effective, quick, and nearly pain free,” said Dr. Benson. “The effects of the procedure are seen immediately and patients can return to normal activities the same day. Our patients come in leaky and leave dry.”
With little pain and little inconvenience, Bartel’s quality of life has improved greatly.
“My surgery was at 11, and I was home by 1:30 that afternoon,” she said. “I was doing housework that night and went back to work the next day, with no complications.”
The only restriction is excessive exercise or heavy lifting for the first few weeks after the procedure.
Bartels was again able to enjoy her Zumba class. She also enjoys being active with her sons again. There is no worry or stress when she sneezes or coughs.
“I encourage anyone who is having problems like mine to schedule a consultation at Sanford,” Bartels said. “The entire team gave me a tremendous amount of respect during a vulnerable time for me. I appreciate how they cared for me and gave me back what I’d been missing for so many years.”
First, lifestyle changes
The treatment for an overactive bladder often begins with lifestyle changes. Restricting fluids, avoiding caffeine and practicing good bathroom habits can often improve symptoms. Physical therapy can also be helpful in bladder re-training and urge suppression. It can also help to carefully managing chronic diseases such as diabetes, obesity and sleep apnea. About half of all patients experience relief from these conservative treatments.
For the half of overactive bladder patients whose symptoms aren’t helped by behavioral changes, there are an array of helpful medications.
“Overactive bladder medications decrease a chemical in the bladder that’s responsible for its overactivity,” Dr. Benson said. “We believe that overactive bladder is a condition of premature bladder contraction, which causes urgency — or, if the contracting gets strong enough, incontinence.”
Treatments for pelvic issues
But if medication doesn’t successfully control a patient’s symptoms, there are several advanced treatment options available.
- BOTOX injection: Botox is commonly used for many medical conditions beyond cosmetics. Injected into the bladder muscle, it helps to relax the bladder and allow it to more effectively hold urine. Botox is injected during a simple, safe office procedure that takes only a few minutes. The medication last for several months and may be reinjected when needed.
- Sacral neuromodulation (InterStim Therapy): This therapy is based on pacemaker technology that can help regulate nerve signals from the bladder that result in overactivity, as well as urinary retention and bowel leakage. The InterStim device is a long-lasting option for urinary control. A small battery is placed under the skin to allow the device to operate for several years.
- Posterior tibial nerve stimulation (PTNS): Similar to acupuncture, PTNS uses a fine needle to influence peripheral nerves that aid in bladder control. A nerve that extends to the ankle is stimulated on a weekly basis during a simple, comfortable office procedure.
“These advanced treatments help between 80 and 90% of patients,” Dr. Benson said. “They are rapidly replacing medicines for treatment of overactive bladder.”
But even with a high percentage of women experiencing overactive bladder, many don’t mention it to their physician.
“This is an intimate issue that people don’t often discuss,” Dr. Benson said. “On average, patients have this condition for a number of years before they seek treatment.”
Patients often don’t discuss their symptoms because they are embarrassed or they feel like there is nothing that can be done to help.
“The number of people that deal with this versus those who get effectively treated is really disproportionate,” Dr. Benson said. “Some studies estimate that at least 7 out of 10 patients with this condition don’t have it addressed or treated.”
Because of the isolation it can cause, many women with an overactive bladder experience higher rates of anxiety and depression as they try to cope with symptoms on their own.
“If there’s meaningful things that a patient doesn’t do because of fear or worry, there is something we can do to get them their freedom back,” said Dr. Benson. “We’re talking about the person who didn’t go on vacation, who never visited their grandchildren, who quit going to church or the movies. Patients don’t have to be stuck in neutral any longer. There is hope.”
With advanced treatments helping more patients every day, Dr. Benson feels confident that women who seek help will find some relief.
“We have a full array of offerings to help people, because not one solution fits everybody,” Dr. Benson said. “We have a number of options available so patients can get what works for them.”
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