When Simple Solutions Do Not Solve the Problem
If you have had a bladder control issue that has been more than situational and has occurred more than once or twice, it's time to consult with your family doctor or primary care physician. If you have a gynecologist , she or he will be able to direct you to a good urologist if necessary.
Your Doctor's Assessment is Key to the Solution
Because a woman's urinary system is so intricately tied to her reproductive system, a gynecologist can often make an initial survey of the problem and assist in ruling out any serious medical issues related to the incidents.
Basically, if no serious problems such as infection, tumors, blockages, kidney or liver functions are noted then the first line of defense might include turning to one or more of the six non-invasive, non-drug related solutions for female incontinence that are discussed in the Womens Forum Bladder Health Section article Simple Solutions for Minor Incontinence.
If none of these basic solutions have taken care of the problem then your family doctor and specialists may discuss the possibility of turning to other more complex solutions they are trained to assist you with.
Medications for Female Incontinence
The next line of defense or offence as it may seem is use of medications to inhibit or change the pattern of urinary incontinence. It is not a perfect science but a great percentage of women with urinary incontinence problems do respond favorably to the use of medications.
Medications can impede or stop many types of leakage from the bladder. If the problem is a form of overactive bladder muscles, there is a medication to relax those muscles or slow or stop the contractions that sometimes cause a woman to feel her bladder is overfull when it is not.
Perscription Drug Pros and Cons
When the issue is that the bladder has not been effectively emptied during voiding, drugs may assist in relaxing the urethra so that voiding is more complete. It is suspected that particular hormones which wane as a woman nears menopause, may be involved in some urinary retention problems and replacement estrogen could be helpful in that case.
Use of medication requires follow-up and careful monitoring by the prescribing Doctor since side effects and long term use of some medications can bring their own risk into the picture. Risks should be carefully considered and discussed with your physician before a drug therapy is begun. If it's clear that the benefits are worth the risk your doctor likely will advise trial use of the medication.
Surgical and Structural Corrections for Urinary Incontinence
Only if less invasive solutions fail do most physicians suggest surgical interventions for female incontinence. An fairly older but still viable solution, if the problem is a positional one in which the bladder is not properly positioned in the abdomen due to structural prolapse of the uterus or vagina is a pessary. Basically this is a ring shaped device which is inserted into the vagina to take the pressure off the neck of the bladder. These are not utilized as often as surgical intervention, however if the surgery is considered a low risk.
Physicians can actually do a "urodynamic" test in their offices that will predict the success of a surgical intervention to fix the problem. Basically surgeries can involve a variety of structural changes aiding the bladder function. Two most frequent surgeries include restructuring of the mouth of the urethra or creating a "bladder sling" to elevate the bladder in the abdomen. The bladder is often repositioned to aid emptying and alleviate undue stress on the urethera.
One surgery claiming 85% success is the Marshall Marchetti-Krantz procedure which must be done under anesthesia. Other surgeries create a form of sling to hold the bladder in place. All are considered last resort surgeries and some are not successful the first time. No guarantees are made for surgical interventions, the outcome can be different for different women.