Some women have gotten used to suffering in silence and living in a compromised state of being: refraining from social activities out of fear of embarrassment; having to forgo certain foods or drinks that they enjoy; waking up late at night in a mad rush for the bathroom; dealing with the indignity and discomfort of wearing sanitary pads or diapers on a daily basis.
Yet through the expertise of Nina Bhatia, M.D., and Miles Murphy, M.D., M.S.P.H., F.A.C.O.G., these women—regardless of age—can get back to living their lives the way they would like.
At the North Wales office of the Institute for Female Pelvic Medicine & Reconstructive Surgery, Drs. Bhatia and Murphy effectively treat women who struggle with bouts of urinary incontinence. This highly prevalent condition afflicts an estimated 13 million people, 85 percent of whom are female, in this country alone. Although there are multiple causes of urinary incontinence, the two biggest risk factors, according to Dr. Murphy, are vaginal childbirth and genetic predisposition. Some women may view the condition as a “normal” part of aging or an unfortunate aftereffect of pregnancy, but it doesn’t have to be either.
“When you are dealing with problems of incontinence, there are certain aspects of life many women are not able to enjoy anymore,” says Dr. Bhatia. “A lot of women who don’t get help through treatment find that they don’t even want to leave the house anymore, and others will wear sanitary pads or diapers, which can be very costly; some women change pads up to 10 times a day.”
For the two basic types of urinary incontinence—stress incontinence, which occurs during activities that stress the body, such as running or even coughing or sneezing; and urge incontinence, which is caused by involuntary spasms of the bladder—women can benefit from multiple kinds of treatment. At the institute, these include customized behavioral and pharmacological options, as well as a number of minimally invasive surgical procedures.
“These are conditions that might prevent a woman from exercising, so they may be prone to gaining weight, which in turn makes the incontinence worse,” says Dr. Murphy. “Most folks are glad they had [a procedure] done, and most wish they had done it sooner, because they see how much freer they are. Once they have the problem fixed, they generally are able to take better care of their health in general.
“One in 11 women will have surgery for urinary incontinence or pelvic prolapse, but that’s probably only the tip of the iceberg in terms of the number of women who suffer from it,” he continues. “While it is very common, it is not a so-called normal part of aging; most think they should just deal with it, but there are so many great options in terms of treatment.”
Behavioral modalities include bladder retraining and pelvic floor stimulation, through techniques such as Kegel exercises and biofeedback to improve muscle control. When medications and behavioral therapies fail to alleviate one’s incontinence, however, minimally invasive procedures may be the best course of treatment. These include periurethral bulking agent injections, as well as Botox injections into the walls of the bladder. Another innovative treatment is the InterStim, which is a small electrode inserted beneath the skin in the small of one’s back to stimulate the nerve next to the bladder—“essentially a pacemaker for the bladder,” says Dr. Murphy.
The most common surgeries, however, are bladder neck suspension or sling procedures. The institute helped pioneer one sling procedure in particular known as AJUST, which is done using a single incision, made vaginally, compared with other slings that in the past have required multiple incisions in the groin area.
“The sling procedures have a high success rate, and the improvement in quality of life is often very quick,” says Dr. Bhatia. “It really doesn’t take too much time to recover, and there’s an almost night-and-day difference for people who struggle with stress incontinence. … A lot of patients [after a successful surgery] tell me they stop crossing their legs when they cough or laugh. Older patients say they’re excited because now they can play with their grandkids. They are freer to do the things they want to do.”
Urogynecology, a surgical discipline combining elements of urology and gynecology, remains a relatively new field of medicine, though the field is on the verge of becoming a board-certified subspecialty. For their part, Drs. Bhatia and Murphy have completed three years of post-OB/GYN training to make them “uniquely qualified” to treat urogynecologic conditions.
In addition, the institute is also actively involved in research, conducting trials in new medications, products and types of surgery. This enables the practice and its physicians to have a hand in developing new treatments and, in turn, stay on the leading edge of medical advancements in a rapidly evolving field.
“So many women have been suffering through this for so long,” says Dr. Bhatia. “Sexual function is very important, and some women who have stress incontinence will stop having intercourse, and this affects their relationship. But there are so many other issues tied to incontinence that can hamper or negatively affect a woman’s life.
“There are more conservative treatments that can be done, but even the surgeries for incontinence are generally short outpatient procedures, so we can get patients back to a normal routine—back to normal life—relatively quickly.”
The Institute for Female Pelvic Medicine & Reconstructive Surgery
1010 Horsham Road, North Wales, PA 19454