Women across Chicago are keeping a secret — one they may even be afraid to discuss with their doctors. It’s costing them money, causing daily stress, and taking a toll on their social lives. The secret: urinary incontinence, or a “leaky” bladder.
The good news is many treatments can offer relief for women suffering from urge incontinence, including an alternative approach: Hypnotherapy. New research shows that clinical hypnotherapy, a form of cognitive therapy, can help women learn to control their bladders without medication or surgery.
Urogynecologist Shameem Abbasy, MD recently joined the team at Swedish Covenant Hospital to treat women with urinary and fecal incontinence as well as uterine and vaginal prolapse. She is building a Women’s Health practice that focuses on helping women with these and other pelvic issues (plus, she is one of just a few Chicago physicians trained in da Vinci robotic surgery to correct pelvic organ prolapse).
A recent case study reported by Abbasy and two other physicians at Loyola Medical Center showed how hypnotherapy reduced one woman’s urge incontinence from daily to less than once a month — a sign of this therapy’s potential for dramatic success.
What is urge incontinence?
While stress incontinence is urinary leakage women experience when sneezing or coughing, urge incontinence is uncontrolled leakage of urine that is preceeded by an urge to urinate that is difficult to defer, says Abbasy. Sometimes it’s just a few drops; sometimes the entire bladder empties. And some women have urges to urinate that simply won’t go away, she explains.
Women experiencing urge incontinence are typically 50 and older, but the condition can affect anyone. In fact, Abbasy’s recent case report focused on a 29-year-old woman with a life-long history of the condition.
Besides age, risk factors include obesity, diabetes, stroke, depression, radiation to the pelvis (as in treatment for cervical cancer), and childhood enuresis (like bedwetting or trouble with toilet training). Urinary tract infections can transiently cause or worsen urinary incontinence.
Embarrassment keeps many women from seeking help for the condition. “You’ve got women spending a lot of money on incontinence pads,” says Abbasy. “They’re kind of suffering in silence. It starts to affect people’s quality of life, because they can’t leave the house if it’s severe; they may not go on vacation or someplace where they don’t know where toilets are,” she explains. But the condition is treatable.
How hypnotherapy/cognitive therapy works
Abbasy says the first key to understanding hypnotherapy is to acknowledge the deep connection between mind and body. “Hypnotherapy is a state of focused attention,” she says. “In this case, it’s the connection between the mind and bladder.”
In normal physiology, the brain sends signals to the bladder like “do not urinate” and “it’s not time,” or even, “we’re not full enough,” says Abbasy. Women with urge incontinence may have a problem with “central control” — the area of the brain that acts as the decision-making CEO of the body — and the wrong signals are sent to the bladder.
Hypnotherapy treatment helps patients make the mental connection between mind and bladder. “We work with the patient to develop mental imagery, visualizing the brain sending a message down to the bladder,” says Abbasy. “Some people think of a color or a light traveling down their spine, or a telephone line — whatever works for them.”
Patients practice this guided imagery as well as breathing techniques at appointments, and then take the practice home and use it every day. By repeating the practice daily, patients retrain their brain to send correct signals, reducing leakage incidents. In another study Abbasy and her co-researchers conducted in which women used a CD of guided imagery twice a week for two weeks, half of the participants saw a 75 percent reduction in leakage episodes.
“This treatment gives patients skills they can take with them the rest of their lives,” Abbasy says.
When is a patient ready for hypnotherapy?
“A patient has to be motivated for hypnotherapy. It’s not for everyone,” says Abbasy. Some examples of patients who might have success are those who have used hypnotherapy for other treatments, like smoking cessation. Patients who experience urge incontinence with certain triggers (like washing their hands or the sound of running water) are also good candidates.
Hypnotherapy makes a great treatment partner
Abbasy often uses hypnotherapy in conjunction with other treatments, including medication and physical therapy. She starts by teaching patients to keep a daily diary of their fluid intake and leakage episodes to spot patterns that may be easily changed to reduce incontinence. “Using more than one treatment may attack the disease process at more than one area,” says Abbasy.
“Medications work on the bladder muscle. Physical therapy works on the pelvic floor muscles that are engaged when a woman is trying to hold back urine,” she explains. “Hypnosis works on getting the message down from the brain to the bladder to relax until a woman is ready to urinate.” Tackling the issue from multiple angles increases the rate of success.
More resources for incontinence
Women with incontinence can receive many kinds of treatment at Swedish Covenent Hospital, from physical therapy and medications to education on body mechanics and biofeedback therapy. Total Control group classes at Galter Life Center are designed to help strengthen and re-educate pelvic floor muscles.
Editor's note: Jenni Prokopy, the freelance writer behind this article, is also a popular local blogger and founder of ChronicBabe.com, an online community for younger women with chronic health issues. Look for a profile on Jenni next month on WellCommunityChicago.org.