By Joshua Ebel, MD
Blanchard Valley Urology Associates
Many women suffer from urinary incontinence, also known as urinary leakage. For some, this can be a slight dribble with activity that is a daily inconvenience. For others, it can be a major source of embarrassment that interferes with daily life. Just because incontinence is common, it doesn’t mean you have to live with it. There are a variety of solutions out there depending on your goals and the type of incontinence you have.
The first step in addressing the problem is to identify what kind of incontinence you have. The two main forms of incontinence are stress incontinence and urge incontinence.
Urge incontinence is usually associated with acute urges to go to the restroom, accompanied by leakage. Many women with this also suffer from overactive bladder symptoms including frequency, urgency and getting up at night. Medications are an option for many women with urge incontinence, however, they are not effective in all cases. Some women benefit from therapies such as bladder Botox injections or sacral nerve stimulation.
Stress incontinence is the most common form of incontinence. It is often the result of weakened pelvic floor muscles or weakness of the urinary sphincter, which leads to leakage with coughing, sneezing, standing or other activities. While medications can help with urgency, there are no good medication options for stress incontinence. Across the country, mesh slings are often used to correct this form of leakage. While slings can be effective, some women suffer from mesh complications and many wish to avoid mesh entirely when addressing their leakage.
One good mesh alternative is to tighten the support structure of the urethra robotically – an approach called the Burch Colposuspension. This is a great option for women who lack support of the urethra, but, traditionally, is not as effective for women with weak sphincter muscles.
An exciting new option for women suffering from a weak sphincter is urethral bulking. Bulking has been around for many years, but older options only lasted for one to two years. A new form of bulking agent is now on the market and is known as Bulkamid. This product can be injected in the office and promises relief for up to seven years.
What makes Bulkamid different from prior forms of bulking is the material itself. It is a hydrogel (meaning substance that is mostly water) that forms soft pillows in the urethra. These pillows resist the leakage of urine and are not quickly absorbed like prior bulking materials. The Bulkamid system is also small and intended for office use.
Not everyone is best served by a bulking agent. Check with your urology provider to discuss the variety of options for treating incontinence, and decide what method is most optimal for you.
