1. 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

2. Urinary Incontinence Is it just a part of getting older? Hsin Wang, M.D. January 26, 2010

3. Definition  Involuntary loss of urine.  Daytime or Night time.  Daily or occasionally.

4. 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.

5. Normal Female Anatomy Detrussor Urethra (Bladder neck) B U C Vagina Rectum

6. Stress Urinary Incontinence  Weak muscle Surrounding Urethral result in Leaking of urine with activity

7. Urge Urinary Incontinence (Overactive Bladder) Spasming of the Detrussor Muscle Leads to urine Leakage.

8. 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

9. 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

10. 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

11. Diagnosis of Urinary Incontinence  History  Voiding Diary  Urodynamic Study  Physical Exam

12. Treatments for Urinary Incontinence  Stress Urinary Incontinence  Kegel Exercises  Lifestyle Modifications  Surgery  Urge Urinary Incontinence  Medications  Lifestyle Modifications: cut down on caffeine intake.

13. 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)

14. 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.

15. Lifestyle Modifications that May Improve Stress Urinary Incontinence  Break up tasks into smaller and lighter tasks  Loose Weight  Quit Smoking

16. 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.

17. 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.

18. Conclusion. Do you have to just deal with Urinary leaking?  NO  Talk to you doctor about possible interventions.  Change your lifestyle

19. 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.