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On several occasions this fall, Timothy Chase, M.D, of Glen Meade Incontinence Center shared his knowledge and expertise in women’s pelvic health issues with other physicians, as well as with the general public.
On September 18, Dr. Chase was a featured faculty member at an important forum on women’s pelvic health at Wake Forest University School of Medicine in Winston-Salem. He taught physicians from around the country the latest surgical techniques for bladder slings and pelvic organ prolapse surgery. Dr. Chase served in the same roles at a second, very similar forum held at Carolinas Medical Center in Charlotte on September 26.
"It is a privilege I enjoy," said Dr. Chase. "Working with other physicians and sharing expertise can only improve the quality of health care for patients nationwide."
On October 15, Dr. Chase participated in a seminar about incontinence, fibroids and other gynecological conditions that was sponsored by New Hanover Regional Medical Center in Wilmington. The event was offered to the public free of charge.
Dr. Chase is co-director of Glen Meade Incontinence Center, which is a division of Glen Meade Center For Women’s Health where he is a partner. He practices both obstetrics and gynecology, and has significant expertise in the specialized field of diagnosing and treating urinary incontinence issues.
by Timothy L. Chase M.D., F.A.C.O.G.
Many women leak small amounts of urine from time to time. When the leakage becomes frequent or severe enough to turn into a social or hygienic problem, however, it is called urinary incontinence.
There are three main types of urinary incontinence: stress incontinence, urge incontinence, and mixed incontinence. If you leak urine when you cough, laugh, sneeze or exercise, it is most likely stress incontinence. If you suddenly get the urge to go to the bathroom but cannot get there in time, it is probably urge incontinence. The third type is a combination of the two.
Quite a common problem, urinary incontinence affects millions of women of all ages. The good news is that there have been dramatic improvements in the treatment of urinary incontinence in recent years.
The key to solving this problem is proper diagnosis. While urge incontinence is treated primarily with bladder retraining and medications, stress incontinence is treated primarily with surgery.
Surgical Slings Get You Back In The Swing of Things
Surgical treatments for stress incontinence have greatly improved. This is no longer the “bladder tack” of yesteryear. Older surgeries such as the MMK, Burch, and Anterior Repair required general anesthesia, a large incision, days in the hospital, and a long recovery period.
The latest treatment, called MiniArc, is performed in a 10- to 15- minute procedure that can be done under local anesthesia. The technique features a new minimally invasive approach that eliminates the need for surgical exit incisions in the patient’s skin.
During the procedure, the surgeon inserts a piece of mesh tape through the vagina and positions it under the urethra, the tube by which urine exits the bladder. The mesh tape creates a supportive sling or hammock under the urethra, allowing it to maintain its seal to prevent unintentional urine loss.
Patients treated with the MiniArc may be able to go home as early as a couple hours after the procedure and without a catheter. Patients can expect a short recovery period. Intended to last a lifetime, it’s clinically proven and the six board-certified physicians at Glen Meade Incontinence Center are among the first in the nation trained in these techniques.
Glen Meade Incontinence Center offers other sling procedures for stress urinary incontinence as well, all minimally invasive with a very quick recovery period. No one technique is suitable for everyone. Just as each of us is an individual, your doctor must personalize your treatment.
If urinary incontinence is affecting you, please see your doctor to benefit from these recent medical advances.
By G. Daniel Robison, IV, MD, FACOG
It can happen when you laugh, cough, sneeze, exercise or lift a heavy object. If it happens to you, don’t feel alone.
The involuntary leakage of urine due to body movement that puts pressure—or stress—on the bladder is known as stress incontinence. Other major types of bladder control issues include urge incontinence, which is the very sudden, very strong need to urinate, and mixed incontinence, which is a combination of the two. According to the National Association for Continence website (www.nafc.org), about 25 million Americans experience either temporary or chronic urinary incontinence, and approximately 85 percent are women.
"Stress incontinence represents the failure of the urethra to maintain a water-tight seal," explained G. Daniel Robison, IV, MD, FACOG, a partner with Glen Meade Incontinence Center. The failure may be the result of intrinsic sphincter deficiency (when the circular muscles called the sphincter are unable to keep the urethra closed), or poor bladder neck support (when the ligaments, tendons and muscles that support the pelvic organs weaken). Conditions that may cause pelvic muscles to lose strength include: damage sustained during pregnancy, childbirth, radiation, trauma or prior surgery, or age-related factors such as hormonal changes and loss of muscle tone. Obesity, menopause and smoking are additional risk factors.
"Stress urinary incontinence is surprisingly common and fortunately, highly treatable," said Dr. Robison. Like many other physicians, the doctors of Glen Meade Incontinence Center advocate trying non-invasive treatments before recommending surgical solutions.
"Simply losing weight and ceasing to smoke can make a difference for women who have these contributing factors," said Dr. Robison. He also enumerated pelvic muscle exercises, biofeedback and pelvic floor stimulation as non-invasive techniques that can be effective with some patients. Unlike for urge incontinence, there are no FDA-approved pharmaceutical medications for stress incontinence. Topical estrogen, however, can help some patients whose incontinence stems from hormonal changes.
Surgical Solutions
Surgical techniques for dealing with incontinence have improved dramatically over the past 15 years, primarily due to the introduction of mid-urethral slings— hammock-like supports made of a strong material that are placed beneath the urethera. Slings not only correct poor anatomic support, they may provide an additional degree of compression to the urethera. While there are various slings available to surgeons, tension-free vaginal tape (TVT) slings are the most popular procedures in the United States and Europe. The transobturator (TOT) approach is an alternative that uses a different incision site.
Not only highly effective with a long-term success rate of more than 80% and patient satisfaction of over 90%, these procedures are also much less invasive and more convenient for patients than previous surgeries for incontinence. Most sling procedures can be done on an outpatient basis and recovery is generally very quick.
"If you sometimes experience urine leakage simply going about everyday activities, ask your doctor about treatment options," said Dr. Robison. "Too many women assume this is a natural part of aging and just accept it. In reality, almost all of them can be cured."
Dr. Robison joined Glen Meade Center for Women’s Health in 1999 and he achieved full partner status in 2002. He practices both Obstetrics and Gynecology and he is accepting new patients. Dr. Robison has significant expertise in the specialized field of diagnosing and treating urinary incontinence issues. In 2003, he co-founded Glen Meade Incontinence Center (GMIC) to help women in southeastern North Carolina regain their confidence and restore their dignity.
By Rachel Z. Jones, MD, FACOG
"Generally, our nervous system will tell us that we need to urinate when our bladder is half to two-thirds full, although the bladder will continue to stretch to hold more urine," said Rachel Jones, MD, a partner with Glen Meade Incontinence Center. In some people, however, a very sudden, very urgent message to urinate is given—regardless of how much urine is in the bladder. For people with this problem, it is virtually impossible to get to the toilet in time.
This type of bladder control problem, known as urge incontinence, is also sometimes called overactive or spastic bladder. Two other major types of incontinence are stress incontinence (urine leakage when a person laughs, coughs, sneezes or exerts herself) and mixed incontinence (exhibiting symptoms of both stress and urge incontinence).
"Urge incontinence occurs when the nerve passages from the bladder to the brain do not function properly," said Dr. Jones. "These abnormal bladder contractions cause urine to leak out at inappropriate times." The condition can result from nerve damage (such as spinal cord injury or stroke), neurological disease (such as multiple sclerosis or Parkinson’s disease), or irritation to the bladder from infections, inflammation, bladder stones or even bladder cancer. In many cases, physicians cannot determine the specific cause of a person’s urge incontinence.
However, the physician experts at Glen Meade Incontinence Center can successfully treat it in most cases.
Because the causes of urge incontinence and stress incontinence are not the same, physicians must treat them very differently. For example, recently developed surgical techniques, such as tension-free slings, are generally very effective for stress incontinence, but do not work to cure urge incontinence.
In most cases, urge incontinence is treated with one or more of the following solutions:
- Medications, such as Detrol®, VESIcare® and Toviaz™
- Behavioral modifications, including biofeedback and dietary restrictions (limiting caffeine, alcohol, arbonated drinks and artificial sweeteners)
- Bladder training
- Physical therapy, such as pelvic muscle exercises
- Minimally invasive surgery
Women who have tried other treatments and still experience bladder control problems may find relief with InterStim Therapy. An FDA-approved treatment, InterStim Therapy works with the sacral nerves, which control the bladder and the muscles related to urinary function. If the brain and sacral nerves don’t communicate correctly, the nerves do not tell the bladder to function properly. InterStim Therapy corrects this communication problem by stimulating the nerves with mild electrical pulses.
"There is also a very real emotional component to urinary incontinence," said Dr. Jones. "Some women withdraw from their daily lives for fear of being embarrassed, and simply resign themselves to living with the problem. Women need to be proactive with the treatment of their urge incontinence problem, because with treatment, almost all patients can resume their normal, active lives."
For more information about all forms of female urinary incontinence, visit www.GetBladderControlNow.com.
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