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Managing incontinence

Overcoming incontinence with expert help


Urinary and fecal incontinence is more common than you might think. It is estimated that by 2050, 43.8 million American women will experience at least one pelvic floor disorder, according to a study in the journal Obstetrics & Gynecology.

Pelvic floor disorders vary in diagnosis, but are typically broken up into three groups: bladder, uterine and rectal. Pelvic health conditions include bladder prolapse, bladder incontinence, bladder retention, bed wetting, uterine bleeding, uterine fibroids, uterine prolapse, hemorrhoids, rectal prolapse, fecal incontinence and pelvic pain.

To help address the growing need, Novant Health has opened the Novant Health Carolinas Pelvic Health Center in Winston-Salem, the region’s first integrated, comprehensive, patient-centered approach to pelvic floor issues.

It’s common, but not normal

Although incontinence is very common, it’s also not normal, said urologist Dr. Jack Smith of Novant Health Urology Partners Winston-Salem, who now also sees patients at the new clinic. Smith said any demographic can be diagnosed with pelvic health disorders, not exclusively women.

“About 10 percent of women who have had a hysterectomy will develop prolapse that could require some treatment,” Smith said. “As for males, they are more likely to experience complications in the pelvis from chronic pain issues or post-colon surgeries, or post-prostate procedures.”

Research has shown that some athletes may also encounter pelvic health challenges. The International Urogynecology Journal published a 2002 study surveying 291 athletes, of which the average age of participants was 22.8 years old. Results showed that 52 percent had experienced urine loss while participating in their sport or in daily life.

“Track and field athletes or gymnasts often times have stress incontinence from repeat injury to the pelvic floor from pounding on a hard surface,” Smith said. “It’s a real phenomenon.”

Smith said he recommends that patients better manage fluid intake. Most cases do not involve surgery or medications, just lifestyle changes.

“Some folks require medications, and a minority of patients requires minimally invasive interventions,” Smith said. “The standard case for an overactive bladder would be fluid management with or without the use of medications for a two- or three-month period as a form of bladder retraining. Oftentimes, the medication is removed after that period of time.”

Smith said that treatments are driven by the patient. “Our job is to provide them with information about their condition, their physical state and what the options are,” he said. “Treatment should be decided by the patient and physician working together to help fit the patient’s life and goals.”

Living proof

Jean Ann Hudspeth, registered nurse at Novant Health WomanCare in Winston-Salem, North Carolina, is all too familiar with urinary incontinence and experienced it for many years of her adult life.

“I had urinary stress incontinence for years and it got worse as I got older and had children,” Hudspeth said. “I figured it was something I would always just live with. I would go out with my girlfriends and when we laughed, I would leak. It was a hassle to wear pads or bring an extra change of clothes in case I needed it.”

Hudpseth said she often wore a pessary when exercising because she experienced urinary incontinence when running or jumping or even lifting weights.

Hudspeth sought treatment from Dr. Douglas Miyazaki, an OB-GYN at Novant Health WomanCare in Winston-Salem, who will also serve at the new pelvic health center. Hudspeth had minimally invasive surgery that was performed vaginally without incision. “It was a quick recovery period with minimal pain,” she said.

Miyazaki said the Novant Health Carolinas Pelvic Health Center is distinctive because it brings together specialists from many different fields to focus expertise in one place. “The center is not just unique to our area, but it is innovation within our field as well,” he added. 

For other people experiencing incontinence, Hudspeth hopes that the facility will prompt people to receive treatment. “They will get the treatment they need with specialized doctors who have invested their life in this specialty,” she said. “I hope that people with this problem realize that the problem is important enough to have a whole center dedicated to it.”

Tips for management

Overactive bladder and incontinence may also be triggered by diet, Smith said. “In some individuals, certain foods can cause bladder irritation, or it can manifest itself as frequency or urgency incontinence,” Smith said. “Those things can include iced tea, dark sodas and strawberries, or excessive consumption of coffee, chocolate, too many acidic foods or vitamin C.”

Smith also warned that sipping a drink throughout the day can trigger multiple trips to the bathroom. “There’s a myth that you have to drink fluid all day long, but drinking in blocks of time can be much more beneficial.”

Another myth is that incontinence is normal when we get older, but that is not true, Smith said. He said that Kegel exercises – an exercise performed to strengthen pelvic floor muscles – are a good preventive pelvic health tool to help decrease the instance of incontinence or urgency, but must be adopted early.

“Social circles are constricted when facing incontinence and it’s usually self-imposed,” Smith said. “By taking the proactive steps to see a provider and follow the recommended lifestyle changes, you can remain as active as you’d like to be and completely reestablish your quality of life.”

Stress versus urge

Stress and urge incontinence are two large categories when it comes to incontinence. Stress incontinence is anatomic, meaning the valve can’t withhold the pressure of a cough, sneeze, exercise or laugh.

“Think of stress incontinence as a child’s balloon and the stem is the urethra, and that’s the valve,” he said. “When someone pushes on the top of the balloon, there’s enough pressure that makes the balloon leak air. Treatments are usually aimed at the valve to help this problem.”

Urge incontinence is a neurologic signal and could occur with or without warning, creating a strong, sudden need to urinate. The bladder leaks urine when the sudden urge occurs.

Smith added that the prevalence of pelvic health disorders is high, and there are treatments available. “You have to look at it as having quality in your life, and that’s just as important as having your cholesterol checked,” he said.

Hope for the future

In the past, patients needing treatment for pelvic conditions would typically visit a primary care provider and then would be recommended to a host of specialists to receive treatment. Novant Health Carolinas Pelvic Health Center provides patients with one-stop diagnosis, evaluation and treatment, staffed by urogynecologists, urologists, colorectal surgeons, physical therapists and gynecologists.

Having every provider under one roof will improve overall care, reduce wait times and improve the patient experience. The center is the first of its kind in the area that can diagnose, evaluate and treat a wide range of conditions to achieve the best outcomes for patients.

“Our specialists have dedicated entire professional careers to pelvic floor dysfunction problems and our approach will offer a patient centered focus on the management and treatment of these conditions,” Miyazaki said.

A referral from a primary care provider is not required to make an appointment. Novant Health Carolinas Pelvic Health Center is located at 770 Highland Oaks Drive in Winston-Salem, North Carolina.

If you live in Virginia, click here to find out about incontinence care services offered by Novant Health UVA Health System.





Published: 7/5/2016