Stress Urinary Incontinence

Urinary stress incontinence is the involuntary loss of urine associated with laugh, sneeze, cough and physical activity. In some cases urine loss can also occur with sexual activity. These symptoms can be very embarrassing and can affect a women’s quality of life, causing her to avoid activities that she previously enjoyed. Women often keep these symptoms private, unaware that there are many medical and surgical options for treating this condition.

Overactive Bladder and Urinary Urge Incontinence

Overactive Bladder (OAB) is a syndrome of symptoms defined as urinary urgency that cannot be delayed, along with urinary frequency (urinating more than 8 times in 24 hours) frequently associated with nocturia (urinating at night.) It can also be associated with urge incontinence (sudden desire to urinate along with sudden loss of urine).

The initial treatment for OAB often involves a change in behavior such as learning to urinate on a schedule and also avoiding known bladder irritants such as caffeine. Patients suffering from OAB can also benefit from learning how to contract the pelvic floor muscles and manage an unwanted bladder contraction when it occurs. Medications can be prescribed to treat OAB but they require regular monitoring by a physician. Sacral Neuromodulation or Interstim ® is an FDA-approved treatment for OAB or Urge incontinence that has not responded to behavioral changes or medications.

Pelvic Organ Prolapse

Pelvic organ prolapse is the herniation of the pelvic organs through the vagina. Patients will often say they have a "fallen bladder". In reality, any portion of the vaginal walls can fall downwards, pulling with it the organ (bladder, rectum, or uterus) directly behind that wall. As a woman ages, and as certain stressors are placed on the female pelvic floor (such as childbirth and repetitive heavy lifting), the pelvic muscles and surrounding supportive tissues become weak and can no longer hold the female organs in their proper place. Genetics can also be a factor for developing prolapse. The female organs can begin to push through the vaginal opening
Symptoms of Pelvic Organ Prolapse (or POP):
  • Vaginal or pelvic pressure
  • Lower abdominal or lower back pain
  • An obvious or physical “bulge” protruding from the vaginal opening
  • Difficulty with urination due to a physical “kinking” of the urethra
  • Difficulty with defecation due to a possible stool-trapping rectocele
  • Having to “splint” or push the vaginal organs back into place in order to empty the bladder or have a bowel movement
  • Difficulty with intercourse or painful intercourse
  • A worsening of symptoms with standing, lifting or coughing

Anal Incontinence

Anal Incontinence (AI) is the involuntary loss of feces or gas through the anal canal. It is estimated that 2-15% of women in the general population suffer from AI. This is a socially debilitating condition and so it is widely believed that it is under-reported.

Treating AI is complex because there can be multiple causes but in women it is most often the result of injury to anal muscles during childbirth. The injury is sometimes not identified at the time it occurs but more frequently it is repaired poorly. Over time and with increasing age AI can develop.

The torn anal muscles can be repaired through “sphincteroplasty” but 70% of patients who undergo this procedure will still have AI five years after surgery. Substances such as collagen and silicone have been used to bulk or “plump” the sphincter muscles but each agent has drawbacks and so the ideal substance has yet to be identified.

Sacral Neuromodulation or Interstim® is an FDA-approved therapy for AI. In the U.S. is also approved for the treatment of Urinary Urge Incontinence and Urinary Retention.

Sexual Dysfunction in Women

Research suggests that 43% of American women have some form of sexual dysfunction. The majority of women who have gone through menopause will have some symptoms that reduce the quality of their sexual intimacy but hormonal changes are not the only cause.

The media today is saturated with information on the treatment of male sexual dysfunction. Women however remain hesitant to report sexual problems to their doctor, either due to embarrassment or because they are unaware that treatment options exist. There can be many causes of sexual dysfunction:
  • chronic medical illness
  • hormone imbalance
  • pelvic floor muscle spasm
  • stress and fatigue
  • endometriosis
  • blood flow disorders
  • depression and other psychiatric illnesses
  • side-effect of medications
  • drug abuse
  • pelvic infections
  • poor lubrication
  • scarring of tissue after cancer treatments

A multidisciplinary approach working together with a trained physical therapist, a trained sexual counselor and doctors of Chinese Medicine is often useful in treating the medical, physical and social aspects of sexual dysfunction.