Are you having trouble making it to the bathroom? Are you frequently forced to interrupt your exercise activities, or even a good movie, to make a special trip to the ladies' room? Isn't it time you looked into the causes of your - yes - incontinence?

ou are not alone in your problem. Urinary incontinence is experienced by many women over the age of 40, especially after childbirth. Women today are speaking more frankly with their gynecologists about urinary incontinence - a real "quality of life issue."

Valerie M. Cucco, DO, an experienced urogynecologist with Winthrop's Department of Obstetrics/Gynecology, says, "It is rare that a woman will present urinary incontinence as a chief complaint - perhaps because it is neither life-threatening, nor an emergency, or because the patient is too embarrassed. However, the more information the patient provides about her urinary incontinence symptoms, the more likely the physician is to get to the root of the problem, and tailor effective individualized therapies." Treatment options range from behavioral therapy to surgery.

Incontinence - Why?
Anatomical problems can cause "genuine stress incontinence" - incontinence of urine during sneezing, laughing, and coughing. The risk factors include obesity, constipation, smoking, and heavy lifting. Genuine stress incontinence can be relieved through surgery on the fallen bladder neck.

Incontinence related to positional causes occurs during aerobic exercise or when walking on a treadmill. Detrusor instability, or an unstable bladder, causes the plight of those who "cannot make it to the bathroom."

Urge incontinence is caused by inappropriate bladder contractions. Medications, such as Detrol®, can help by relaxing the bladder. Certain anti-depressant drugs may also curb urge incontinence, as the improvement of bladder response is one of their side effects.

Diagnosis and Urodynamics Testing
As symptoms can overlap, Dr. Cucco always recommends urodynamics testing as part of a complete gynecological examination, geared to identifying irregularities in the bladder, urinary tract, and pelvic floor, through a manual examination and visualization of the bladder with a urethrascope or cystoscope.

The Pessary, Prescribed for Genuine Stress Incontinence
The pessary is actually a revival of an older, very effective device, used since the turn of the 20th century, to assist with uterine prolapse. Incontinence pessaries help with pelvic support defects as well as genuine stress incontinence. Usually shaped like a ring, pessaries come in many different styles and sizes. Pessaries are also recommended for women whose bladder neck may have dropped due to vaginal childbirth.

Estring^TM
The Estring^TM - a ring worn vaginally, containing estrogen, released at a constant rate over three months - can be substituted in some patients for estrogen cream. It also helps to alleviate incontinence by strengthening the muscles of the pelvic floor.

Behavioral therapies
Behavioral therapies include the modification of urination patterns through bladder training.

Seven urinations per day are considered normal - but some people urinate twice an hour or more. A bladder retraining schedule can help. Patients are also instructed in Kegel exercises, which strengthen the pelvic floor musculature. "Women should do Kegel exercises at a young age, especially during pregnancy," says Dr. Cucco, who tells almost every patient to perform 25 Kegels, twice a day.

Others are prescribed vaginal cones. Larger than a tampon, cones come in five to six graded weights, and aid in Kegel exercises. Patients begin with the lightest weights, wearing the cone at least 15 minutes, twice a day. Gradually, the weight is increased.

Surgery
Surgery is 90% effective for genuine stress incontinence - as long as the patient controls the other factors which affect the condition.

Have you experienced incontinence symptoms? Perhaps Dr. Cucco can help you. Call Dr. Cucco at 563-3010.