Urinary incontinence (UI) is more common than most people think. Over 40 % of American women experience it at some point in their lives. The condition should not be considered a normal part of the aging process.
UI is the uncontrolled loss of urine. Normally, the bladder stores urine until it is voluntarily released. This involves an interaction between the brain, spinal cord, bladder and support structures in the pelvis. Any interference or damage to the support tissues can result in UI.
Although not a life-threatening problem, UI does have negative social implications. You may have fear of urine loss, concerned about urine odor and worried about being excluded socially. Some individuals may avoid events and social interaction with friends. Others will avoid sexual activity because of the fear of loss of urine.
If you suffer from bladder control issues, the following information will help describe the different types of urinary incontinence. In most situations, urinary incontinence can be corrected or significantly improved.
Types of Urinary Incontinence
Stress Incontinence is most common.
Symptoms: Loss of urine when coughing, sneezing, laughing, lifting, exercise.
Causes: Pregnancy, impact exercise activity, abdominal surgery, pelvic organ prolapse, hormone changes.
Urge Incontinence is second most common (overactive bladder).
Symptoms: Sudden uncontrollable loss of urine. May be precipitated by hearing water, standing up, getting out of bed, seeing a bathroom, entering your house.
Causes: Urinary tract infections, diabetes, neurologic conditions, hormone changes, abdominal surgery, radiation, Pelvic Organ Prolapse, or can develop without an apparent cause.
Symptoms: combination of both Stress Incontinence and Urge Incontinence
Symptoms: Usually a constant seepage of urine associated with the occasional loss of large volumes of urine when the individual coughs, laughs or moves.
Causes: Pain medication, muscle relaxants, antidepressants, and medications for overactive bladder are just a few.
Symptoms: A person needs to urinate but is unable to get to the bathroom in time.
Causes: Debilitating injuries or illnesses.
Diagnosing Urinary Incontinence
Correct diagnosis is the most critical step in recommending the appropriate treatment. Rather than improve the incontinence, incorrect treatment may worsen it. Your history of your condition is the most important factor in determining a treatment plan. Pairing this with your urologic physical exam, a physician will determine whether further tests are needed.
These might involve some of the following tests:
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 patient’s bladder and asking her to cough or strain to see if incontinence occurs
Urodynamic Testing: Series of advanced tests that gives the physician a detailed report on the function of the bladder, urethra and pelvic floor support structures
The history and physical exams are the two most important aspects of my evaluation. Through my career, I have found that I use less and less invasive diagnostic tests in order to make the correct diagnosis. I reserve the more invasive evaluations for the more complicated situations.
There are surgical and non-surgical options for the treatment of UI.
Non-Surgical Treatment Options
Non‐surgical treatments apply to all types of urinary incontinence. These options are more effective for lesser degrees of incontinence. These include:
Pelvic Floor Exercises: Either with a physical therapist who specializes in pelvic floor disorders and urinary incontinence or performing Kegel exercises at home
Lifestyle Changes: Weight loss, Yoga, Smoking cessation
Surgical Treatment Options
Surgical treatments for Urinary Incontinence are minimally invasive. A physician can perform an excellent surgical procedure, but if it is done for the incorrect diagnosis, it will fail.
Sling: The most successful treatment for Stress Urinary Incontinence. It is composed of a “polypropelene” mesh that is inserted underneath the urethra to provide the needed support. The success rate is greater than 90%.
Bulking Agents: This is used for a specific type of Stress Urinary Incontinence. A thick liquid compound is injected into the urethral wall to close the urethral channel tighter. This temporary “fix” may last 2 to 12 months.
Sacral Nerve Stimulation: Indicated for Urge Incontinence in patients who have failed with medications. A small wire or electrode is placed on those nerves that help coordinate the bladder function. This wire is connected to a small implantable pacemaker that sends a low level stimulation to the bladder and pelvic floor.
Botox injection into the bladder for urge incontinence.
If you are suffering from urinary incontinence and are looking for solutions, give us a call and we’ll be happy to customize a plan to meet your needs.
Dr. John Brizzolara is a nationally recognized urologist at Saline Memorial Hospital. He practices at Brizzolara Urology Associates in Benton.