Urinary Incontinence - You Don't Have to Live with it Anymore

Vol. 13, No. 3
Fall 2003

  • Revolutionary New Device Helps Patients Living with Chronic Stomach Disorder

  • Long Island Can Breathe Easier Thanks to Winthrop's Pulmonary Hypertension Center

  • New Catheterless pH Monitoring System elps Diagnos Reflux Disease More Accurately, Less Invasively

  • Urinary Incontinence - You Don't Have to Live with it Anymore

  • Fay J. Lindner Foundation Awards Grant for Renovation, Expansion of Emergency Department

  • Multiple Sclerosis Treatment Center at Winthrop Looks Towards Future of Research, Treatment Options

  • Winthrop's Institute for Neurosciences offers Comprehensive Care for Stroke Patients

  • Don't Wait - Vaccinate! Flu Season is Quickly Approaching

  • Healing Comes in the Form of Giving

  • $10,000 Donation from Jay's World Childhood Cancer Foundation Helps Fund High-Tech Microscope at Cancer Center for Kids

  • TWIGS to Honor its Founders at Golden Goose Gala Roaring 20s Party

  • A Celebration of Life... Patient gives back to those who helped him in his time of need

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  • Alan Garely, MD, Chief of the Division of Urogynecology and Pelvic Reconstructive Surgery at Winthrop (right) with Andrea McCrink, NP (center), discuss treatment options with a patient.
    If you look up the term urogynecology in the dictionary, you're not likely to find it. That's because it's a relatively new field of medicine. This specialty was created to meet the specific needs of women with disorders of the pelvis including pelvic prolapse, overactive bladder and urinary incontinence. Urogynecology combines the practices of urology and gynecology to address health problems that many women are either too embarrassed to ask their healthcare provider about or just accept as a normal process of aging.

    "Pelvic disorders and urinary incontinence affect millions of women," explained Alan Garely, MD, Chief of the Division of Urogynecology and Pelvic Reconstructive Surgery at Winthrop and one of only four fellowship-trained urogynecologists on Long Island. "That is why it is important for women to know their options and receive treatment from a specially trained physician who will address their unique needs."

    Signs & Symptoms of Urinary Incontinence

    Urgency, frequency and incomplete emptying of the bladder are signs that there may be a problem. There are several types of incontinence including:

    Stress Incontinence
    Many people first notice signs of incontinence when they leak a small amount of urine during exercise or when they laugh, cough or sneeze. This is known as stress incontinence and is the most common type.

    Urge Incontinence
    A sudden and strong urge to urinate followed by spasms in the bladder that cause urine to leak is another type of incontinence known as urge incontinence or overactive bladder. This type of problem affects approximately 17 percent of women. Many patients experience frequency and urgency, but do not actually leak urine.

    Mixed Incontinence
    A combination of overactive bladder and stress incontinence can also occur and is known as mixed incontinence.

    Overflow Incontinence
    Those experiencing a feeling as if the bladder is never completely empty may have what is known as overflow incontinence.

    According to Andrea McCrink, Nurse Practitioner in the Division of Urogynecology at Winthrop, pregnancy, labor and delivery, menopause and the structure of the female pelvic floor can cause urinary incontinence. The muscles of the pelvic floor stretch in a "hammock-like" fashion from the pubic bone to tailbone. These muscles support the pelvic organs (uterus, bladder) and help to close off the urethra and rectum to prevent urinary and fecal incontinence. When these muscles are stretched (in pregnancy) or put under stress and strain, they weaken, leading to incontinence.

    "Any amount of urinary incontinence is a symptom of some form of dysfunction that should be addressed and checked out by a urogynecologist," stated Ms. McCrink.

    A Solution to the Problem

    Urinary incontinence is curable and treatment is tailored to the specific needs and symptoms of the patient. The Division of Urogynecology works closely with Winthrop urologists, colorectal surgeons and gastroenterologists to ensure the best treatment and outcome. Patient, Heidi Brody, knows all too well about life with incontinence. "Every time I laughed, sneezed, coughed or lifted something, I leaked urine," she said. "It was a real problem for me. I was constantly in the bathroom but never felt like my bladder was completely empty."

    There are many effective non-surgical treatments including oral medications, pelvic floor therapy and biofeedback. Pelvic floor therapy includes kegel exercises and electrical stimulation to strengthen the muscles. Biofeedback is often used in conjunction with these exercises to help patients gain control over their muscles by helping them become more aware of how their body and the pelvic floor muscles are supposed to work.

    In addition, a pessary, a small support device inserted into the pelvic floor, can be effective in controlling symptoms of pelvic organ prolapse without surgery.

    When Surgery May be the Best Option

    For more serious cases of stress incontinence or when other non-surgical approaches fail, surgery may be a viable option. One of the most common and minimally invasive procedures performed is Tension-Free Vaginal Tape (TVT). A meshlike tape is placed under the urethra to return it to its normal position and stop leakage. Dr. Garely was the first physician in New York to perform this procedure over four years ago.

    Ms. Brody was one of the many to benefit from surgery. "Within 36 hours of my procedure, I felt like I was cured. It was wonderful," she said. Ms. Brody received a urethral sling, which is placed around the urethra and attached to the abdominal wall to lift the urethra back into a normal position. The placement of the sling exerts pressure on the urethra during stress events to alleviate leakage of urine.

    "Treatment has allowed me to be more active and to travel without worry," added Ms. Brody. "I now realize that incontinence is not a normal part of aging. I always thought it was just something I had to deal with, and now I know that it's not. The problem is easily correctable and today I feel just great."

    For many women, incontinence is not only a physical concern but also affects the emotional and personal state-of-mind. That is why Winthrop's Division of Urogynecology delivers expert medical treatment combined with compassion and understanding.

    "People today lead very active and social lives and don't want a problem such as incontinence to get in their way," said Dr. Garely. "We restore our patients' quality of life."

    "Many women think they are alone with this problem," added Ms. McCrink. "But, once they come to us and open up about their problems, they learn that there is help out there, and that incontinence is not just another part of the aging process."

    For more information on incontinence and pelvic floor disorders contact Winthrop-University Hospital's Division of Urogynecology and Pelvic Reconstructive Surgery at (516) 663-3010 or call 1-866-WINTHROP.

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