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Day 7: Incontinence



Incontinence - Dr. Ethan Goldstein

11 Million American women have a secret - they suffer from urinary incontinence, the leakage of small amounts of urine or frequent and sometimes uncontrollable urination.

Dr. Ethan Goldstein, an Obstetrics/Gynecology specialist on staff at DMC Huron Valley-Sinai Hospital, is helping women understand that they don’t need to suffer in silence. “Incontinence is not a normal part of life, and you shouldn’t just accept it, says Goldstein. “It’s usually treatable and often curable.”

“It frequently occurs as women age, but it is not a natural consequence of aging,” says Goldstein. “Younger women of childbearing age and female athletes may also experience incontinence. You shouldn’t be embarrassed by incontinence. All types of urinary incontinence can be treated, but early intervention is very important.”

Types of Incontinence

Stress Incontinence: Coughing, laughing, heavy lifting and strenuous activities can bring on urine leakage in women with stress incontinence. This form of the condition is usually caused by a weakening of the pelvic floor muscles (the muscles that surround and support the urethra and bladder). This weakening of the pelvic floor muscles is sometimes caused by childbirth and/or surgery.

Urge incontinence: This type of incontinence occurs when the muscle wall of the bladder is overactive. Women who experience urge incontinence may have the sudden urge to urinate and often can’t make it to the bathroom in time. Also known as overactive bladder, this form of incontinence can be due to infections in the bladder or urethra and muscle spasms from a variety of causes.

Mixed Incontinence: Many women experience both urge and stress incontinence. This is called mixed incontinence. In this mixed form of incontinence, the two types of incontinence may be caused by different factors and must be examined and treated independently.

Identifying the cause of incontinence is the first step in successfully treating the disorder. The incontinence experts at Detroit Medical Center are highly skilled in incontinence diagnosis and have helped hundreds of women with urinary incontinence and pelvic floor disorders. Diagnosing the cause may involve a patient history, various tests of urine and blood, ultrasounds and urodynamic testing, which helps your doctor see how well your bladder and muscles work and can help explain symptoms of incontinence.

Innovative Treatments
Incontinence treatments include non-surgical and surgical options.

Non-Surgical Treatments include specialized physical therapy to help strengthen the muscles that support the urethra and bladder. Medications that control muscle spasms can help prevent urine leakage. A device called a pessary can prevent incontinence by supporting the pelvic organs and pressing against the urethra. This simple device is specially fitted for each patient and can be inserted by the patient or by the physician.

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. In most minimally invasive surgical treatments a synthetic mesh tape or sling is placed under the bladder neck (urethra). This tape functions as a "hammock" supporting the urethra in times of stress, such as coughing, sneezing, laughing, and jumping.

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Ethan Goldstein, M.D. 
DMC Huron Valley-Sinai Hospital

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