Although women can experience urinary incontinence (UI) during their life, the frequency of UI tends to occur more often when you get older. This loss of bladder control stems from hormonal changes that affect muscle strength in your pelvic area. Women who are pregnant, giving birth, or going through menopause are all likely to have urinary incontinence. So, does menopause cause urinary incontinence? It is a contributing factor, but there is more to it.
What is Overactive Bladder?
Millions of Americans deal with a condition called overactive bladder (OAB). Symptoms can include the sudden uncomfortable urge to urinate, going to the bathroom too frequently, and even leakage of urine (for more information about Overactive Bladder go to https://geoffnussmd.com/services/overactive-bladder/). Over the past 20 years or so, drug companies developed medications aimed to help control symptoms of OAB. The most common class of medications used to treat overactive bladder are called “anticholinergics.” These pills help relax the bladder muscle and provide relief.
One of the bad things about medications for OAB is that you have to continue taking them to continue to have relief of your symptoms. In other words, these pills do not work like an antibiotic. you cant take them for a week or two weeks and then be cured. Also, they can have unpleasant side effect including dry mouth and constipation.
Dementia from a medication?
To make matters worse, new research shows that long term use of anticholinergic medications may make you more likely to get dementia. In a large study, doctors found that women and men over the age of 55 taking anticholinergic medication regularly for over a year were more likely to develop dementia than people who did not. ( You can read more at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353 and https://time.com/5614803/anticholinergic-drugs-dementia-risk ) While the results are not definitive, they are concerning. We doctors usually consider medications as low risk ways to make people better, but we don’t always know all the bad side effects that medications can cause.
Do the risks outweigh the benefits?
Anticholinergic medications are good for treating OAB, but I have to say that this new research makes me concerned. I know that medication can help and may be the right choice for many of my patients, but I also want my patients to know that there are other good alternatives to medications for treating overactive bladder. Many of these are new and exciting ways that can even give patients freedom from needing medications.
The bottom line is that if you are taking medications for overactive bladder or you think you might have overactive bladder and want to learn about all the options for you, don’t hesitate to come in to see me so that we can find a treatment plan that works for you!
What Exactly Is The Deal With Vaginal Mesh?
Many women are understandably concerned about surgically implanted mesh in the vagina. A lot of issues have come up in the past few years regarding this subject and since there is so much information out there it can be very confusing. I think it is useful for us to briefly touch on what mesh is used for in vaginal surgery in order to more clearly understand what is happening currently with vaginal mesh.
Most mesh is man-made and permanent and has a woven-type pattern. This make it ideal for your body to grow tissue into the mesh during the healing process. Basically, the mesh provides the framework or support for the body’s natural tissue, which has been lost due to many different factors. We will talk about this in a future post. In vaginal surgery, surgeons have used mesh to correct two things. The first is stress incontinence, or leakage of urine when you sneeze or cough. The second is vaginal prolapse prolapse, or a fallen bladder or rectum. When it was first developed, there were many companies that made products to help with both incontinence and prolapse. However, there were some patients who started to have mesh exposure in areas such as the vagina, bladder and other pelvic organs. This was not only painful, but also posed a high risk of infection. As more and more lawsuits came about, many companies stopped making mesh to put into the vagina.
What Does the FDA Say About Vaginal Mesh Right Now?
The FDA stands for the Food and Drug Administration and it is a part of the federal government that regulates many things in the healthcare industry including approving and monitoring the safety of drugs and medical devices. In April of 2019, the FDA ordered the last two companies making mesh implants used to fix vaginal prolapse with a vaginal incision to stop because it did not think that those companies had shown that the mesh was safe for humans. (To read more, click on this link: https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants)
The FDA did not order companies to stop making mesh to correct stress incontinence, commonly known as slings. Slings are very effective at treating stress incontinence and have been around for over 20 years! They also have a low complication rate if properly implanted and the FDA still approves of mesh slings to treat stress incontinence. In fact, it is the most common surgery to treat stress incontinence nationwide. (To read more, click on this link: https://sufuorg.com/about/news/message-about-fda-statement-on-mus.aspx)
The FDA also did not order companies to stop making mesh to fix vaginal prolapse from an abdominal approach. Surgeons can now use a new and exciting way to fix prolapse that is done with tiny abdominal incisions and a surgical robot. The mesh surgeons use for this procedure has been shown to be safe and very effective.
So I Have Mesh That a Doctor Put In, What Should I Do?
It is very important to understand that just because the FDA said that the companies did not show that vaginal mesh for prolapse was safe for women, it DOES NOT mean that mesh IS UNSAFE FOR WOMEN, NO MATTER WHAT. In most cases, vaginal mesh for prolapse works and there are no ongoing issues. I always tell patients that if you are not having any problems such as pain, bleeding or recurring infections, then it is very likely that you to have it removed or revised. That being said, if you are concerned about mesh in your body, it would just take a quick visit to a specialist who understands vaginal mesh (a urologist or urogynecologist) to help make sure you are ok.
What Do I Do if I Have Prolapse But Don’t Want Mesh?
Not to worry, there are still many options. I always tell my patients that just because you are either concerned or afraid of vaginal mesh, that should not mean you can’t have your incontinence or prolapse problem fixed.
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