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Hsin Wang, MD Grew Up in Ann Arbor, MI University of Michigan Wayne State University School of Medicine Oakwood HealthCare Medical Center In private practice since 2003
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Urinary Incontinence Is it just a part of getting older? Hsin Wang, M.D. January 26, 2010
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Definition Involuntary loss of urine. Daytime or Night time. Daily or occasionally.
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Three Types Stress Urinary Incontinence: activity induced loss of urine. Commonly while coughing, laughing, running, lifting. Urge Urinary Incontinence (Overactive Bladder): Loss of urine associated with spasming of the detrussor muscle. Mixed (stress and urge): involuntary loss of urine due to both activity and spasming of the detrussor muscle. 30% of women have a mixed component.
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Normal Female Anatomy Detrussor Urethra (Bladder neck) B U C Vagina Rectum
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Stress Urinary Incontinence Weak muscle Surrounding Urethral result in Leaking of urine with activity
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Urge Urinary Incontinence (Overactive Bladder) Spasming of the Detrussor Muscle Leads to urine Leakage.
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How is Urinary Incontinence Related to Getting Older? Risk Factors for Stress Urinary Incontinence Multiple Vaginal Births Big Babies Use of Forceps during vaginal births Perimenopause/Menopause status Lifestyle
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How is Urinary Incontinence Related to Getting Older? Perimenopause/menopause status: Declining Estrogen levels weaken pelvic muscles that are designed for bladder and urethra support. Pelvic Floor Muscles Are Estrogen Dependent
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Is Urinary Incontinence Only due to Getting Older? NO! Lifestyle is a big risk factor: Overweight. Repetitive heavy lifting, stooping, squatting. Chronic cough due to lung condition Nicotine use
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Diagnosis of Urinary Incontinence History Voiding Diary Urodynamic Study Physical Exam
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Treatments for Urinary Incontinence Stress Urinary Incontinence Kegel Exercises Lifestyle Modifications Surgery Urge Urinary Incontinence Medications Lifestyle Modifications: cut down on caffeine intake.
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Treatments for Stress Urinary Incontinence Kegel Exercises: Tighten vaginal/pelvic muscles and hold 10-15 seconds, repeat 5 times. Do 8-10 times a day. Reminders: Traffic light, washing dishes, car commercial Physical Therapists available to teach these exercises! Midurethral Sling Procedures Outpatient Surgery Quick Recovery 95-98% Effectiveness with long-term efficacy (greater than 10 years)
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Midurethral Sling Procedure Designed to support urethra to prevent urine leakage. Outpatient surgery. Takes 20-30 minutes Small vaginal incision (2- 2.5 cm) Back to daily activities within 1-2 days. Activity restrictions for 4 weeks after procedure. No sex, no tampons, nothing in the vagina. No heavy lifting, pulling or pushing over 20 pounds.
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Lifestyle Modifications that May Improve Stress Urinary Incontinence Break up tasks into smaller and lighter tasks Loose Weight Quit Smoking
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Treatments for Urge Urinary Incontinence Medication Anticholinergics : relaxes the detrussor muscle, reduces detrussor spasms. Examples: Oxybutynin, Ditropan, Detrol LA, Vesicare, Enablex Lifestyle Modifications Decrease caffeine intake Bladder retraining.
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Conclusion So is Urinary Leaking just a part of getting older? Yes Some factors are age related Perimenopause/menopause No Some factors are due to lifestyle and therefore can be modified.
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Conclusion. Do you have to just deal with Urinary leaking? NO Talk to you doctor about possible interventions. Change your lifestyle
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Obstetrics Gynecology Associated Physicians, PC (OBGAP) www.obgap.com T. Eduardo Garcia MD, Charles Gonik MD Hsin Wang, MD, Julie Mladic, DO, Ethan Goldstein, MD Commerce Office 248-366-0100 Corner of Union Lake and Commerce Rd Bloomfield Hills Office 248-335-9207 Corner of Telegraph and Square Lake Rd.
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