About urinary incontinence
Urinary incontinence is the uncontrolled loss of urine. Under normal conditions, the bladder stores urine until it is voluntarily released. This involves a complex interaction between the brain, spinal cord, bladder and support structures in the pelvis. Anything that interferes with this interaction or causes damage to the support tissues can result in a person developing urinary incontinence.
This condition is much more common than most people think occurring in greater than 40% of American women. The condition should not be considered a normal part of the aging processes and occurs in all age groups. In fact recent studies show that urinary incontinence is becoming quite prevalent among younger women.
Although not a life‐threatening problem, urinary incontinence does have negative social implications. You may be obsessed by fear of urine loss, concerned about urine odor and worried about being excluded socially. You may feel you are no longer attractive and even lose your sense of sexuality. You may stop exercising or fail to start a weight loss program because of fear of losing urine while exercising. Feeling alone and isolated, some women may distance themselves from their spouses, family members and relatives. Some individuals may restrict or avoid excursions outside the home, social interaction with friends and family. Others will avoid sexual activity because of the fear of loss of urine.
If you suffer from bladder control issues the following pages will help inform you on the different types of urinary incontinence. This information will allow you to better understand the type of urinary incontinence you suffer from. Being better informed will help guide you in deciding what type of treatment would be best for you. In the great majority of situation urinary incontinence can be corrected or significantly improved. Physicians that specialize in the diagnosis and treatment of urinary incontinence have the training and knowledge to help you with this condition.
Types of urinary incontinence
Stress, urge and mixed are the most common. Less-common types are overflow and functional
Symptoms: Loss of urine with coughing, sneezing, laughing, lifting, exercise or maybe just walking. The increased pressure created on the bladder by these activities overcomes the muscular support of the urethra allowing urine to escape.
Causes: Pregnancy, impact exercise activity, abdominal or pelvic surgery, pelvic organ prolapse, change in hormone status.
Urge incontinence (overactive bladder)
Symptoms: Sudden uncontrollable loss of urine usually associated with a strong urge to void. May be precipitated by hearing water running, arising from a sitting position, getting out of bed, seeing a bathroom, or starting to enter your house.
Causes: Urinary tract infections, diabetes, neurologic conditions, hormone changes, prior bladder or pelvic surgery, radiation, pelvic organ prolapse, or it can develop without any apparent cause.
Symptoms and causes: combination of both stress incontinence and urge incontinence
Symptoms: Usually a constant seepage of small amounts of urine associated with the occasional loss of large volumes of urine when the individual coughs, laughs or moves. May also have significant urinary frequency, getting up frequently at night and wetting the bed while asleep.
Causes: Certain medications such as pain medication, muscle relaxants, antidepressants, and medications for overactive bladder are just a few. Other causes are diabetes, spinal cord injuries, neurologic conditions and pelvic organ prolapse.
Symptoms: A person is aware of the need to urinate but is unable to get to the bathroom in time.
Causes: Debilitating injuries or illnesses.
Diagnosing urinary incontinence
By paying particular attention to the activities, situations and conditions that seem to bring on, or cause you to have difficulty controlling your bladder, you will be able to have some insight into the type of urinary incontinence you have. Should you decide to seek medical help with your incontinence the more detailed information that you furnish your physician will aide him in making a more accurate diagnosis. The physician's correct diagnosis as to the type of incontinence a patient has is the most critical step in recommending the appropriate treatment. If the incorrect treatment is recommended the incontinence will not improve and may worsen. Your history of your condition is the most important aspect in determining what treatment is appropriate for you.
From your explanation of your condition and the urologic physical exam your physician performs a determination will be made as to whether further diagnostic test are needed to better evaluate your situation. These might entail some or all of the following tests.
Types of diagnostic testing for urinary incontinence include:
- Urinalysis: microscopic evaluation of your urine
- Residual urine: Measurement of how much urine is left in the bladder after a person voids
- Cystoscopy: Looking in the bladder with a small flexible telescope.
- Stress test: Placing saline into the patients bladder and asking her to cough or strain to see if incontinence occurs.
- Urodynamic testing: Series of advanced test that gives the physician a detailed report on the function of the bladder, urethra and pelvic floor support structures.
According to Charles Secrest, MD: "I have learned through the years that the history I take and the exam I perform are the two most important aspect of my evaluation. Through my carrier, I have found that I use less and less invasive diagnostic tests in order to make the correct diagnosis. I reserve the more expensive and invasive evaluations for the more complicated situations."
Treating urinary incontinence
Oxybutynin (ditropan), Vesicare, Myrbetriq, Tofranil (imipramine), Levsin SL, B and O suppositories for overactive bladder. Flomax, Tenex (guanficine) and Valium for overflow incontinence caused by urinary retention.
Pelvic floor exercises
Perform Kegel exercises at home first and if no significant improvement we will refer you to Heather Brooks, PT, at our Center for Reconstructive Urology. Heather is a physical therapist who specializes in pelvic floor disorders and urinary incontinence. Please ask her for details regarding her program and expertise.
A sling is the most successful option with a more than 90% success rate. Slings are used to correct hypermobility of the urethra causing leakage with activities. Slings are also effective in the treatment of intrinsic sphincter deficiency related to scar tissue around the urethra and bladder neck from previous anti-incontinence bladder suspension procedures.
We implant two types of slings:
- Polypropylene mesh pubovaginal sling (Lynx) or mini-sling (Solyx)
- Collagen based biological graft sling (Suspend)
This is an 'in office' procedure under local anesthetic. Bulking agents offer a minimally invasive treatment option for stress urinary incontinence. Macroplastique is a silicone gel that is injected into the middle part of the urethra where it fills this potential space and bulks the urethral channel. This bulking effect closes the bladder neck and urethra and thus forms a seal to prevent leakage, yet patients are still able to void. This treatment is primarily used to correct intrinsic sphincter deficiency (ISD).
Another 'in office' procedure, Botox is a chemical that is injected into the muscle of the bladder to prevent bladder spasms and treat urge incontinence and OAB. The patient receives local anesthetic and usually a mild sedative before the procedure. Botox comes in various strengths and is mixed with normal saline (salt water) and then injected into the muscle layer of the bladder at multiple points. This is a highly effective way to treat the overactive bladder. Temporary urinary retention occurs in 2-7% of patients and is easily treated. The vast majority of patients respond very well to this treatment.
Urgent PC is a low-risk, office-based treatment for overactive bladder and associated symptoms of urinary urgency, urinary frequency, and urge incontinence. This device delivers percutaneous tibial nerve stimulation (PTNS) via a tiny needle that is temporarily inserted into this small nerve in the ankle The sessions last for 30 minutes over 12 weeks, and then most patients will return monthly for periodic booster treatments. Some patients with urinary retention may respond to Urgent PC and begin voiding more normally again.