Posted by on April 15, 2014 - 6:52pm

Loss of bladder control, or urinary incontinence, is a problem that millions of women face. The involuntary loss of urine can range in presentation; it can be minimal, from a few drops when you laugh, exercise, or cough. Or, it can be an accident when you suddenly urge to urinate and can't keep it in. Most episodes of urinary incontinence are the result of altered pressures or stress on the muscles and nerves that help you pass or hold urine in. Hormone changes can also affect muscle strength. Like your vaginal tissue, the muscle tissue in and surrounding the bladder and urethra (the short tube that passes urine from the bladder out the body) requires estrogen to remain supple and strong. When estrogen levels drop in menopause, the tissue around the bladder and urethra thin and weaken,which can lead to incontinence.

The most common types of urinary incontinence include stress incontinence and urge incontinence. Stress incontinence occurs when the pressures from activities such as laughing, coughing, and sneezing cause leakage. Urge incontinence occurs when you have the urge to urinate and your bladder squeezes at the wrong time. Often, these two types can create a mixed picture. Other bladder problems that can happen are nocturia, when you must wake up multiple times throughout the night to urinate, and dysuria, painful urination.

If you think you have incontinence, visit a professional to learn more about the variety of options you have for treatment. A professional can be your primary care physician, gynecologist, urologist, and even a urogynecologist. Your physician may recommend lifestyle changes such as limiting alcohol or caffeine intake, recording a voiding diary, or strengthening your pelvic floor muscles with Kegel exercises. Beyond this, therapies also include devices inserted into the vagina to hold up the bladder (pessaries), a variety of medications, and surgery if necessary. Your physician will also be the one to exclude other potential causes of bladder problems including infection and neurological damage.

To learn more about urinary issues or other symptomatology that arise during menopause, visit Northwestern's menopause website here.

Posted by on January 29, 2013 - 9:52am

Overactive bladder affects an estimated 33 million Americans, the majority of whom are older women. Two treatments have recently received FDA approval.

On January 25, FDA approved Oxytrol for Women, the first over-the-counter treatment for overactive bladder in women ages 18 years and older. Oxytrol for Women is a patch that is applied to the skin every four days. Oxytrol for Women contains oxybutynin, a medicine that helps relax the bladder muscle. Oxytrol will remain available for men with overactive bladder by prescription only.     Read the News Release

FDA approves Botox to treat overactive bladder

On February 18, 2013, FDA expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics. When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence.

Read the News Release

Posted by on October 17, 2012 - 9:22am

Pelvic Organ Prolapse (POP) affects approximately 30- 50 percent of all women between the ages of 49 and 80. It's a condition that usually occurs in women as they approach and move through menopause. Women who have given birth are more likely to be diagnosed with POP, as are Caucasian women, smokers, women who are overweight, and women who have suffered severe pelvic injuries.

Surgical treatment is not always necessary, and one surgical procedure could put the patient at risk for serious complications. When doctors use transvaginal mesh to provide the support for tissues compromised by POP, they may be compromising the health of their patient.

Pelvic Organ Prolapse occurs when weakened muscles and connective tissues in the pelvis allow the uterus, bladder or bowels to drop into the vaginal canal. Sometimes this weakening is so minor that women don't feel any symptoms. In these cases, treatment is usually unnecessary, or doctors may prescribe Kegel exercises or lifestyle changes, which can reverse symptoms and prevent further weakening.

Some women experience more moderate to severe symptoms. In these cases, surgical procedures may be performed in order to correct POP. Prior to the use of transvaginal mesh, doctors used a patient's own tissues to support the weakened muscles. However, once transvaginal mesh was approved by the Food and Drug Administration (FDA), it became the medical device of choice for many surgical procedures to correct POP.

Transvaginal mesh  used for POP was approved in 2002 under the FDAs 510(k) Clearance Process, which is a "fast-track approval" program for new devices that share similarities with similar pre-approved devices on the market. Unfortunately, vaginal mesh products do not perform as successfully as their similar mesh product counterpart, which is used to treat hernias.

Vaginal mesh erosion is the main culprit of the thousands of transvaginal mesh complications reported to the FDA since the early 2000s.

Complications associated with vaginal mesh can include:

  • Erosion of mesh material into the vaginal tissues and/or other organs
  • Protrusion of the mesh into the vagina
  • Pain in the vaginal canal and/or pelvic region
  • Pain or discomfort during sexual intercourse
  • Incontinence
  • Difficulty with bowel movements
  • Unusual discharge or bleeding

It can often require more than one revision surgery in order to reverse any damages related to transvaginal mesh and there could be permanent health issues.   Women with POP should understand their risk with regards to Pelvic Organ Prolapse and its treatment. Non-invasive surgeries should be used whenever possible, and if surgical intervention is necessary, women should be aware of the risks of vaginal mesh.

Guest blogger:  Elizabeth Carrollton writes for




Posted by on April 13, 2012 - 10:51am

A type of exercise called pelvic floor muscle training is effective for treating adult women with urinary incontinence (the involuntary loss of urine) without risk of side effects, according to a new report from the U.S. Agency for Healthcare Research and Quality (AHRQ). The report also found that drug-based treatments can be effective, but the degree of benefit is low and side effects are common.

"Urinary incontinence can affect women in a variety of ways, including physically, psychologically and socially—and some of these impacts can be severe," said AHRQ Director Carolyn M. Clancy, M.D. "This new report will help women and their clinicians work together to find the best treatment option based on each patient's individual circumstances."

Urinary incontinence is extremely common in adult women, affecting approximately 25 percent of young women, up to 57 percent of middle-aged and postmenopausal women, and approximately 75 percent of older women in nursing homes. The condition can impose significant, potentially debilitating lifestyle restrictions. The cost of incontinence care in the United States averaged $19.5 billion in 2004, and by one estimate the annualized cost of women's nursing home admissions due to urinary incontinence was $3 billion. Six percent of nursing home admissions of older women are attributable to urinary incontinence.

Researchers concentrated on two kinds of incontinence: stress incontinence, or the inability to retain urine during coughing or sneezing; and urgency incontinence, which is an involuntary loss of urine associated with the sensation of a sudden, compelling urge to urinate that is difficult to defer. Both types usually occur when the urinary sphincter fails, often as a result of weak pelvic floor muscles, which support the uterus, bladder, and other pelvic organs.

Exercises to strengthen the pelvic floor muscles, similar to Kegel exercises, were found to be effective in increasing women's ability to hold their urine. Pelvic floor muscle training combined with bladder training improved mixed (stress and urgency) incontinence, the report found. Estrogen treatment was found to be effective in treating stress incontinence, but with some side effects. Another drug treatment, the antidepressant duloxetine, was not found to be effective, while carrying high risk of side effects.

Overall, the report found that the drugs reviewed showed similar effectiveness. However, with some drugs, more women discontinued treatment due to bothersome side effects. The report provides comprehensive information about side effects with each drug to help clinicians and patients choose treatments with the most benefits and least harms.

Researchers said that while there is much evidence on clinical measures for treatment of urinary incontinence, such as grams of urine lost, there are fewer measures of quality of life related to the condition and its treatments.  The full report and summary publications for consumers and clinicians are available  HERE