Women's Healthcare Associates of Redding

The Secret You Share...

...with an estimated 20 to 25 million other women in the U.S.

Jennifer, a 47 year old north state dental hygienist remembers the morning her routine Pilates workout with her friends was cut short by an unexpected, but not unfamiliar, problem. "I was wearing a new pink leotard in honor of Breast Cancer Awareness week. In the middle of a strenuous exercise I felt dampness that just wouldn't stop. The light color of the garment did nothing to hide my embarrassing episode as I hurried to the locker room. Thank goodness I was among my closest (and very supportive) friends. It was still almost a year before I felt comfortable returning to the gym."

Jennifer's problem is one you probably already know as urinary incontinence (UI) and it represents many different but related conditions. What you may not know is just how common UI really is-especially in women over age 40-or how new treatments can dramatically improve the quality of your life. UI, or the uncontrolled loss of urine, is one of the top five most common chronic medical conditions affecting women of all ages. Americans spend at least 2 billion dollars a year on protective garments such as pads and diapers. Many women (and unfortunately, other healthcare providers) have been taught to think that leakage of urine after having children or as a woman ages is normal. It is common, but that does not mean it is normal. LEAKING IS NEVER NORMAL.

UI is often categorized into several different types.

For most women there are 3 types that account for over 85% of their problems: Stress Incontinence, Urge Incontinence and Mixed Incontinence.

• Stress Incontinence is the loss of urine with exercise, coughing, sneezing, laughing, or any activity that increases pressure in the abdomen. This usually results in the frequent loss of small amounts of urine.
• Urge Incontinence is the uncontrolled and irresistible need to urinate. It comes from the bladder contracting when it shouldn't and is also called overactive bladder. It can result in losses of large amounts of urine.
• Mixed incontinence is a combination of the two types listed above and is the most common type seen in my practice.

Treatment Options

The treatment of these conditions ranges from simple lifestyle modifications and special exercises to surgery. Most women will have several options available to choose from. The process starts with you and your decision to seek help. You can expect a discussion from your healthcare provider to determine the things that bother you most, a focused exam, and review of your medical history and medications. After this visit and any additional testing, a treatment plan should be discussed with you in detail.

Treatments can include many options such as: Kegel exercises (to strengthen pelvic muscles), bladder training, pessaries, medications, stimulated pelvic floor strengthening and biofeedback, collagen or other material injections around the urethra, or minimally invasive surgery (most outpatient or overnight stay) with rapid recovery. The most important part of the decision is to choose a doctor who specializes in this very sensitive area of medicine. Obstetrician/Gynecologists, Family Medicine and Urologists have traditionally been the primary source of treatment for these problems. These specialties have contributed to the development of a new sub specialty of OB/GYN called Urogynecology. A Urogynecologist is a Board Certified OB/GYN with special training (fellowship) in the care of women with UI, rectal incontinence, and prolapse or "dropping" of the pelvic organs. This is soon to be the fourth boarded subspecialty of OB/GYN. This is a very sensitive and complex area and it is rapidly evolving. Most Urogynecologists work in Continence Centers where: state of the art care and research can be provided in a comfortable and empowering environment focused on this unique problem. Many doctors are adding some urogynecology services to their office. The scope of treatment and experience varies widely and you should consider your options carefully especially if you are considering surgery.

Redding now has a university level Continence Center: Asuriti -- Center for Continence and Pelvic Wellness -- is a center for patient treatment, research. and education directed by the north state's only fellowship trained Urogynecologist. A web site is in production and will be available soon at www.dr4women. Other nationally recognized web-based sources of information are listed below:

• National Association for Continence - www.nafc.org
• The American Urogynecologic Society - www.augs.org
• The Simon Foundation for Continence - www.simonfoundation.org

Leakage of urine is a common but not a normal part of many women's lives.
You are not alone and help is available, easy to fit into your life, covered by almost all insurances, and very effective. The next step is yours ...

Richard Mooney M.D. FACOG is a Urogynecologist in practice in Redding for 14 years.

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