Estrogen insert may help loss of urine from stress and urgency
DEAR DR. ROACH: I am an 83-year-old female with bladder problems. I get up two or three times a night and usually make it to the bathroom. I thought it would be good to see a doctor in case the problem got worse. An operation was mentioned, which I am not interested in, so they gave me a pessary, which has been good and bad.
It is comfortable and I don’t have to use the bathroom as often, but now I don’t get bathroom warnings and don’t always make it to the bathroom. I also leak urine with coughs and sneezes, which didn’t happen before. Now the doctor wants me to use Imvexxy inserts. After reading the side effects, I’m not sure that’s a good thing to do. What are your thoughts: Is the Imvexxy necessary? The side effects really scare me. — Anon.
ANSWER: You have symptoms of both urge incontinence (the sensation of needing to get to the bathroom right away to avoid an accident) and stress incontinence (losing urine with abdominal pressure, such as cough or sneeze). It is possible that you have two separate problems. However, loss of estrogen can cause the lining of the vagina and vulva to thin. This includes the urethra, which provides conscious control over urinary flow. It needs estrogen to close optimally, and older women often have stress or urge incontinence (or both, which is called mixed) due to lack of estrogen.