Urology

Managing urinary incontinence

Thirty-one-year-old Arra Chung of Parkville has dealt with bladder control issues for as long as she can remember. During family vacations as a child, her parents started packing a portable toilet in the car to avoid her frequent stop requests. “I always had problems with bladder control, but I always found a way to manage them,” she says.

Until about a year and a half ago, when her urge incontinence seemed to get much worse. She had frequent accidents, found it impossible to sleep through the night, and was often racing to the bathroom when, just a moment before, she hadn’t felt the urge to go at all. All of this would be difficult for anyone to manage, but it was especially impossible for Chung, a high school math teacher. Leaving the classroom at a moment’s notice just wasn’t always an option.

Illustration courtesy of Medtronic (this is not an
endorsement of this device).

Chung is certainly not alone. An estimated 13 percent of women between the ages of 18 and 23 suffer from incontinence, proving

that it is not a problem reserved for older women. “I usually tell patients that pelvic floor disorders are the consequence of a life well lived,” says E. James Wright, M.D., chair of urology. A number of factors including childbirth, menopause and genetics—can play a role in incontinence, as can things like smoking and stress.

Treating each unique woman who enters the John’s Hopkins Women’s Center for Pelvic Health can be like solving a puzzle. It’s about learning who the patient is and what sort of incontinence issues she is experiencing.

Defining urinary incontinence

There are two basic kinds of urinary incontinence. Stress incontinence—urinary leakage that occurs with physical effort, such as coughing, sneezing or exercising—is less common, but often easier to treat. The more common type, urge incontinence (which Chung has), is spontaneous urine loss and the sudden need to void. It can be more
difficult to treat. Treatment options range from behavioral changes, physical therapy and medication to minimally invasive surgery and complex reconstructive procedures.

For many women, it doesn’t take much effort to see results. “A lot of people tell me that they can’t believe doing so little can make such a big difference,” says Laura Scheufele, a physical therapist who specializes in pelvic floor dysfunction.

Scheufele teaches patients exercises to strengthen the pelvic floor muscles, which support the bladder. In the beginning, patients might be asked to do exercises for as little as five minutes each day.

Other times, it’s not quite so easy. When Chung came to the Women’s Center for Pelvic Health, she tried medication, but was unhappy with the side effects. After discussing her options with Dr. Wright, Chung decided to try neuromodulation, a minimally invasive procedure that targets the communication problem between the brain and the nerves that control the bladder (see illustration).

Problem solved

After her procedure in mid-February, Chung saw improvement almost instantly. “I stopped going to the bathroom as much, to the point that I could sleep through the night,” Chung says. She’s also stopped having accidents, and can go the whole day at school without running to the bathroom. It took some trial and error working with the team,
but Chung is finally where she wants to be. She can focus her attention on her students—“my life is my kids,” she says—instead of mapping out the location of the closest bathroom.

To discuss a case or refer a patient call +1.443.287.6499.

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