Laughing And Leaking Is No Joke

DANBURY – Two physicians from Yale University School of Medicine joined two doctors associated with Danbury Hospital to discuss the causes and treatment of incontinence in a recent Medical Town Meeting, “Laughing and Leaking: New Directions in Treating Female Urinary Incontinence.”

The meeting, sponsored by Danbury Hospital for the community, drew a big crowd, illustrating the pervasiveness of the problem.  It included Eddie Sze, MD, and Kathleen Connell, MD, from the Yale University School of Medicine; and Jeffrey Gorelick, MD, and Edward Beck, MD, from Urology Associates of Danbury.

Urinary incontinence affects 12 million people, according to Dr Gorelick, who discussed the types, causes and treatments of the problem. “The drugstores are full of tools to manage urinary incontinence.” It’s a major quality of life issue, that doesn’t have to be part of the natural aging process, he added.

The causes of loss of bladder control are many, including increased pressure on the pelvic muscles, menopause, and a prolapsed bladder, vagina or uterus. It can also be caused by prostate surgery, hormonal problems, stroke, spinal cord injuries and diabetes.

Eddie Sze, MD, of Yale, discussed incontinence caused by pelvic organ prolapse, where a bladder, uterus or vagina falls down, mostly due to stretching or tearing during childbirth. This puts pressure on the pelvic floor.

While a prolapsed organ isn’t caused by any underlying serious medical condition, it is often very uncomfortable.

Some women, he said, chose treatment, while others decide to live with the discomfort and inconvenience. “No treatment,” he said, “is the option chosen by a vast majority of women. It’s a safe option. The condition can make you uncomfortable, but won’t affect your health and well-being.”

Other women, he said choose surgery or a pessary, a device to support a fallen organ.

There are two types of urinary incontinence – stress and urge.

Stress incontinence is leakage of small amounts of urine from increased pressure on pelvic muscles, and can occur during sneezing, coughing or laughing. This is mostly caused by weakened muscles that support the bladder.

Urge incontinence is the strong desire to void, often compounded by the inability to have enough time to get to the bathroom. An overactive or unstable bladder usually causes this type of incontinence. Incontinence is treated by encouraging a woman to do Kegel exercises, biofeedback, medications and hormones. Surgery, including the vaginal sling procedure, may also be done. Some of the newer medications have fewer side effects, minimizing dry mouth and constipation, according to Dr Gorelick.

Dr Connell discussed menopause and incontinence, saying that doctors don’t have a lot of information about this relationship. Menopause, she said, causes pelvic muscles to weaken, as well as general sagging of organs with aging. Estrogen helps keep organs healthy, and as the hormone drops during menopause, problems can occur.

Some of the symptoms relating to menopause can include vaginal dryness, pain with intercourse, urinary frequency, nighttime frequency, urinary urgency, incontinence and prolapses.     

Whatever the cause or the symptoms, doctors can help. If you’re suffering from incontinence, check with your doctor to see what type of treatment might be best for you.  If you need a doctor, call the Danbury Hospital Physician Referral service at 797-7322.