Living Well: Treating incontinence in women with urodynamics
November 13, 2018
Unless you or someone you know has urinary incontinence, you've probably never heard of the term urodynamics. It's a common phrase used by urologists and gynecologists, alike. Urodynamics simply refers to a series of tests that assess how well a person's bladder and urethra are working.
"I perform multichannel urodynamic tests to determine exactly what type of incontinence a woman has, because not all urinary incontinence is the same. Urodynamics give me an accurate diagnoses, which means I can tailor my treatment and get good results," said Dr. Scott Ellis, OB/GYN with Memorial Regional Health.
Women suffer from urinary incontinence more than men, partly due to giving birth. But it's a misperception that women have to simply accept leaking or loss of control.
"I refer to incontinence as the silent shame. Women don't like to reveal they have it, unless I ask. So, I make it a point to ask at every annual visit. Women who say they are incontinent often follow it with, 'I know there's nothing you can do about it.' That's simply not true," Ellis said.
You may assume the main solution to urinary incontinence is surgical, since the transvaginal sling for stress incontinence received a lot of attention in the past. Yet, treatment for urinary incontinence is rich and varied — with new options being developed regularly, including improved slings.
"Solutions may be surgical, but they may be medical and even sometimes physical, depending on the type and severity of urinary incontinence. While we might not be able to cure incontinence 100 percent, we can significantly improve a woman's quality of life," Ellis said.
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MRH offers advanced laparoscopic surgeries for incontinence. Ellis has been performing laparoscopic surgeries — which promise a smaller incision and faster healing time than traditional surgery — for many years. The hospital offers all types of surgeries for incontinence and only needs to refer particularly complicated cases to urogynecologists in Denver.
Surgical options include the transvaginal slings for stress incontinence, with newer types that are less invasive, such as the single-incision mini-sling or the suprapubic sling. Sometimes, a few, well-placed stitches makes all the difference.
Ellis performs pelvic floor biofeedback at the hospital, and has introduced a new technique called sacral neuro-modulation for urge incontinence.
"With sacral neuro-modulation, we place a small, pacemaker-like device near the sacral nerve that stimulates the nerve with mild electrical pulses. This improves continence, since the nerve helps control the bladder and surrounding muscles during urination. It has been well-studied and shows good results for both urinary and rectal incontinence," Ellis stated.
Another exciting treatment option is periurethral collagen injections to help strengthen the muscles, connective tissue, and ligaments at the base of the bladder.
"Without making an incision, I inject material in and around a woman's urethra to make it stronger and thicker so it can better hold the pressure of urine," Ellis said.
Sometimes, urinary incontinence can be controlled with medications that prevent bladder spasms or calm an overactive bladder. Other times, it can be treated with physical exercises that strengthen the pelvic floor.
"There is a fair amount of pelvic floor rehabilitation and special bladder retraining exercises that women can do to ease their symptoms," Ellis said.
Ellis likes to do a thorough workup with urodynamics when someone complains of incontinence, because sometimes, he finds a more serious underlying issue.
"Certain neurological disorders, such as multiple sclerosis, can cause incontinence. It's good to rule out more serious causes," he said.
Whether it is stress incontinence — that happens when you cough, sneeze, or laugh — or urge incontinence — a feeling that you have to go immediately due to spasms in your bladder — or another reason for incontinence, MRH can help.
"We have all the advanced equipment and training that we need to make a great impact here at MRH," Ellis said.
To explore treatment options, call MRH Women's Health & OB/GYN at 970-826-8230.