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Spring 2007

New Approaches Explored for Urinary Incontinence

Between 30 percent and 40 percent of women over 65 years old will experience urinary incontinence. Few will seek medical attention.

While the involuntary leakage of urine is treatable, many women think it’s inevitable and simply accept it, says Shlomo Raz, M.D., co-director of UCLA’s Division of Female Urology, Urodynamics and Reconstructive Surgery.

“Incontinence is a disease that women keep in the closet,” Dr. Raz says. “It impacts tremendously on quality of life. It limits what they do, where they go. They’re afraid to laugh or cough.”

Urinary leakage can be due to problems of the bladder (urge incontinence) or urethra (stress incontinence). In many cases, behavior modification, fluid restriction, pelvic exercises and biofeedback can help control incontinence. Medications to relax the bladder can effectively control urge incontinence. If conventional treatments fail, surgical options may be recommended. “A new implanted pacemaker device stimulates the sacral nerve, which influences bladder control,” notes Larissa Rodríguez, M.D., co-director of the division.

For stress incontinence that does not respond to behavioral modification and pelvic exercises, physicians can perform a sling procedure in which a hammock of soft mesh is inserted to support and compress the open urethra. Surgeons can also inject a bulking agent into the urethra to help reduce leakage.

Dr. Rodríguez and her colleagues are studying the use of stem cells derived from a patient’s fatty tissue to regenerate a faulty urethra. Such a treatment, if deemed effective, is about five years away.
Tips to Control Incontinence

Behavioral modification can often control some symptoms of urinary incontinence, explains Jennifer Anger, M.D., M.P.H., division head at Santa Monica-UCLA Medical Center and Orthopaedic Hospital.

Her tips for patients:
  • Limit fluid intake to 1 to 1 1/2 liters per day (the “eight glasses a day” advice is unnecessary).
  • Minimize fluid consumption after 7 p.m. • Minimize alcohol and coffee consumption, which increases urine output.
  • Perform pelvic exercises (“Kegels”) daily. Consult your physician about proper technique and duration of these exercises.

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