Urinary Incontinence
Incontinence is a common problem that many adults experience. It is often a source of embarrassment for the individual, and can impact their daily lives in many ways. Speaking with a physician is the first step in addressing the causes of incontinence. Their evaluation of your symptoms and medical history will identify the type of incontinence you are experiencing.
Types of Urinary Incontinence
- Stress – Leaks occur when pressure is applied to the bladder; typical causes are exercise, sneezing, coughing or laughing.
- Urge – Also known as overactive bladder. This is a sudden, intense need to urinate. Common causes include damage to the bladders nerves and/or muscles and infection. Certain medications may also trigger this type of incontinence.
- Overflow – The inability to completely empty your bladder can cause leaks to occur post-urination. Causes include weak bladder muscles, nerve damage and other medical conditions that prevent urine from passing through your urinary tract (enlarged prostate, tumor). Certain medications may also trigger this type of incontinence.
Cases of incontinence are often a mix of these factors, and aging increases the likelihood of experiencing incontinence. However, multiple treatment options are available that are minimally invasive, and proven to be effective means of providing relief.
Urinary Incontinence Evaluation: What to Expect
During your initial visit, you will discuss your medical history with your physician, and inform them of any medications you are currently taking. They will ask you several questions related to your incontinence, take a urine sample and administer a pelvic examination to check for signs of prolapse, weakening of urinary tract structures or anatomical irregularity that may be contributing to the problem. You may then be asked to undergo an ultrasound if your physician deems it necessary.
The results of these processes will enable your physician to identify the probable causes of incontinence, and devise a customized set of treatment options for your specific case.
Urodynamic Assessment
A urodynamic assessment is administered if regular evaluation does not reveal an obvious cause of incontinence. It is primarily an assessment of the bladder's ability to hold and completely empty itself of urine. During this assessment, the patient is first asked to empty their bladder, and a small catheter is inserted to determine if the bladder has been fully drained. Imaging equipment is used to examine the bladder filling (via an inserted tube carrying water) and emptying. During this time, pressure monitors measure pressure inside the bladder, and sensors measure muscular and nervous system activity. The combination of these processes helps diagnose the type and severity of the incontinence.
Treatment Options
Stress Incontinence
- Pelvic floor therapy: This non-surgical option is designed to rehabilitate and/or strengthen the muscles of your pelvic floor. It is a six week program consisting of a 20-40 minute sessions, during which a device is placed in the vagina to stimulate those muscles. Between the weekly treatments, you will be given a set of exercises to perform, and testing will be conducted to monitor your progress. This treatment option often results in improved bladder control for many women.
- Surgery: If surgery proves necessary, a small sling will be inserted underneath the opening of the urethra. The sling supports the urethra, keeping it closed when it experiences pressure (coughing, sneezing, exercise, etc.). The sling is inserted via a small incision, and patients typically experience minimal complications from this procedure.
Urge Incontinence
- Behavioral changes: By avoiding irritants, like caffeine, carbonated soft drinks and acidic foods, you can see improvement in your bladder control.
- Medication: Specialized medication, taken 1-2 times per day for a period of 2-3 months, can improve bladder control significantly.
- Percutaneous tibia nerve stimulation (PTNS): This acupuncture treatment involves inserting a needle at the ankle; the needle is connected to an electrical pulse generator that sends electrical stimulation, via the tibial nerve, to the sacral plexus, which controls bladder function. Outcomes include reduced frequency, urgency and improved bladder function.
- Botox: Injecting Botox along the lining of the bladder temporarily relaxes the bladder's muscles. An anesthetic is administered as part of the procedure, so that the patient does not feel pain during the process. One-time Botox treatment is effective for approximately 6 months, with many patients undergoing repeat injections as needed. Though rare, a small percentage of patients may experience a bladder infection following treatment, and others may experience a temporary inability to empty their bladder without medical assistance.
- Neurostimulator implant: An electrode that stimulates the sacral nerve is implanted, connected to a controller implanted on the buttocks. The electrode regulates neural communications between the nerve and the brain, providing more control of frequency and urgency of urination.
Cystocele
Also known as anterior prolapse, this condition occurs in women when the tissue separating the bladder and the vagina weakens, allowing the bladder to protrude into the vagina. This can obstruct the passage of urine, and causes difficulty completely emptying the bladder.
Cystocele is often caused by putting strain on the supporting muscles of your pelvic organs. Common types of strain include child birth, violent coughing and heavy lifting. Non-surgical treatments can be effective in moderate cases, but severe cases can necessitate surgical procedures.