Advanced Endometriosis Center NJ

Advanced Endometriosis Center NJ is one of the leading endometriosis treatment place in NJ areas.

What is “incontinence”?

Most people consider their “waste products” offensive. Regardless of what bathroom activities are involved, it is a private matter. This is why it can be upsetting—and even life-changing—when incontinence happens for a woman before reaching the restroom. This type of failure to hold in urine or feces not only can cause embarrassment, but also hygiene problems and severe social isolation which can then progress to intimacy failure, depression, and other psychological conditions. As such, urinary or fecal incontinence should be considered a serious condition in which the sufferer deserves a remedy as soon as possible. A specialist like Dr. Ulas Bozdogan of NJ Endometriosis has expertise and vast experience in correcting whatever functional failure is responsible for your incontinence and highly regards the sensitive nature of such a condition.

What is incontinence?

You are designed to keep all of your parts in. Skin keeps your blood in; your eyes’ walls keep in the fluid that gives them their structure. Your gallbladder keeps in bile, released over time to aid in digestion.

But your body is not a perfectly balanced machine when it comes to utilization—the processing of energy produces waste products that need elimination. Because constant elimination would cause hygienic risks and socially indiscreet incidents, we have benefited by the evolution of “containment” chambers for urine and feces—your bladder and rectum, respectively. These have an anatomy based on muscles to squeeze out waste but also sphincters that can stay closed until you desire to lose these “materials.” Thus, elimination of waste remains a private matter under voluntary control.

When there is a failure of your “container” to contain, either by problems with the associated muscles or sphincters of either your bladder or rectum, waste is eliminated spontaneously and unpredictably. Elimination of waste is no longer voluntary, but spontaneous and unpredictable: this is what is referred to as incontinence.

What is the anatomy involved?   

There are four components to continence, all of which must be in good shape to keep things tidy for you:

1. Structure of the chamber (i.e., your urinary bladder and rectum)

Since either must be a container or sorts to hold urine or feces, the structure of each must be intact.

2. Musculature (that gives that structure its tone)

The muscles involved differ, depending on whether the bladder or rectum is being discussed:

• Muscles of your bladder are in the wall (structure) of it, and respond to increasing volume by contracting against that volume of liquid (urine). There is also muscle around the urinary sphincter to maintain a tone by which it remains closed. To urinate, the pressure on the liquid volume by the wall’s muscular contractions must be greater than the pressure that holds your sphincter closed: when this happens, its closing ability is overcome and urine exits.
• The muscles of your rectum involve muscles that move feces down the tract (peristalsis), but also two separate groups of muscles which open and close two separate sphincters—an internal and an external sphincter. Like the locks of a canal, these must be open and closed sequentially to allow “loading” followed by “expulsion.”

3. Sphincter (that can open and close)

The sphincter is a circular “lasso” that can loosen (open) and tighten (close). Each of your sphincters remain closed via a tone that is maintained by the muscles (above). They open when propulsive forces overwhelm this tone.

4. Nerves to your musculature and sphincters is under voluntary control, but also has an involuntary input from your sympathetic and parasympathetic (autonomous) nervous systems. These autonomic systems orchestrate the tone that keeps them closed, the relaxation that allows them to open, and whatever sequential steps that are necessary so that you don’t have to actively think about urinating or having a bowel movement. Once you decide to consciously go to the restroom and initiate the process, that process is pretty much automatic due to your autonomic nervous system.

How do you become incontinent?

As described above, all of the components work together to—ideally—to keep things in until you want them out. As pressure builds in your bladder or rectum, however, your ability to willfully keep your sphincters closed becomes progressively more difficult. In other words, waiting too long will result in an accident. That’s one way, but this is normal and does not involve disease or abnormality.

What is abnormal is the following:

Urinary Stress Incontinence

• When the sphincter is weak, it takes less pressure to overcome its tone to remain closed, and you can lose urine or feces with much less content within your bladder or rectum, especially with sudden exertions, such as laughing, coughing, or sneezing.
• When the normal position of your urinary sphincter changes due to relaxation of supporting structures (from the forces of pregnancy, delivery, obesity, or the loss or hormones due to meopause), it may not remain “tucked closed,” but be in a continuing “puckered open” position.

Neurogenic Bladder

• When the muscles involved in your bladder wall become “hypertonic” (contracting beyond the normal resting tone), even a normal sphincter closure can be overcome and urine can leak. This is usually a nerve disorder with the muscles being overstimulated to contract. It is also referred to as Urge Incontinence or Overactive Bladder.

Fecal Incontinence

• Fecal incontinence can result from infection or dysfunction which increases the transit time of waste through your intestinal tract. The body, when faced with an infection there, will speed up to eliminate the infection faster. You will see this, however, as diarrhea, and the expulsive forces can overcome your ability to keep the anal sphincter closed. This is normal. Like “waiting too long” to urinate, this is just an accident, not a disease of your sphincter.
• Your sphincter can sustain damage from chronic constipation, leaving it with less tone. Continually overstretching the sphincter with large, hard bowel movements can take a toll over time.
• Your sphincter can sustain structural damage from childbirth in which there are tears or an episiotomy, and healing or the repair don’t “take” to reestablish the anatomy correctly.

How do hormones figure in? Or Menopause?

The sphincters rely on correct anatomical placement for support within your tissue to maintain the right strength of contraction to stay closed. With loss of estrogen as you approach menopause, this support may weaken, affecting their ability to withstand even normal pressures presented to them, leading to incontinence. Such incontinence may not wait until menopause, but may begin during your approach to menopause, which could be years before.

How is incontinence corrected?

This depends on the site of weakness or hyperactivity.

For urinary incontinence: if the sphincter is normal but the bladder muscles are hyperactive (urge incontinence), medication can be taken to tone down that overactivity. These are designed to manage your autonomic nervous system [SEE ABOVE].

If there is stress incontinence, that is, if the sphincter is weak or positioned incorrectly, surgery can be done (from the vaginal route) to resuspend your sphincter into a correct position for maximum closure tone. This can be done with sutures or synthetic materials to provide this support. (It can also be done inside your pelvis using robotic minimally-invasive surgery.)

If the problem is hormonal, a vaginal cream or other methods of hormonal (estrogen) supplementation can help correct incontinence. Biofeedback in cooperation with a pelvic floor physical therapist can help train you to unconsciously keep your sphincter closed.

For fecal incontinence: since this type of incontinence is always due to an anatomical problem, surgery is necessary to reconstruct the circularity of the sphincter and then reapproximate any controlling muscles that have fallen away from it. This is done from a vaginal approach.

Who is a specialist in incontinence?

According to Dr. Bozdogan of NJEndometriosis,

“A specialist in incontinence is a doctor who has had experience in ‘urogynecology,’ that is, who is well versed in the relationship between a woman’s anatomy and her urinary and gastrointestinal tracts. Such a specialist has an appreciation of not only what parts are working or not working, but the big picture of how everything works together. Such a specialist has had extensive experience in surgically restoring the anatomy and physiology when necessary.”

However, he also adds,

“An incontinence specialist also respects the quality of life for a woman afflicted by incontinence—that is, the devastating compromise in her activities of daily living that incontinence creates, the depression, the social isolation, and the embarrassment. Such a specialist will not see incontinence as just a condition, but as a personal emergency.”

As a specialist in incontinence, Dr. Bozdogan can assess your specific problem with urodynamic testing to identify the exact cause. (A misdiagnosis—e.g., urge vs stress incontinence—will waste your time on treatments that won’t work.) From there, he can remedy your problem from medicine to vaginal slings (for restoring support) to culposacropexy. A culposacropexy is an internal support technique that can reestablish your anatomy using the da Vinci robot for a functional and cosmetic result with a minimum of discomfort and “down time.” The robotic approach has had the highest success in permanently fixing the problem.

Make an appointment with Dr. Bozdogan

Whether incontinence is a minor inconvenience or is ruining your life, you deserve to have it corrected as soon as possible, and that can begin with an evaluation at NJEndometriosis. You should live the life you want and not a life that is based on avoiding embarrassment. Beyond that, you also deserve to enjoy a normal sex life without such fears. You also deserve a life free of the hygienic worries and infections that often accompany incontinence.