Urinary Incontinence

Urinary incontinence is the loss of bladder control. This type of pelvic floor disorder is very common and affects women of all ages. Unfortunately, many women are embarrassed and do not discuss their symptoms, even with their doctors.

What is Urinary Incontinence?

One in three women suffer from urinary incontinence. Some women develop urinary incontinence after childbirth, while others may develop it later in life. The symptoms associated with urinary incontinence can vary in severity. Lifestyle changes or medical treatment can help treat urinary incontinence in many women, but when those treatment options do not adequately control a woman’s symptoms, there are a variety of procedural and minimally invasive surgical options which are very effective at eliminating symptoms.

Types of Urinary Incontinence?

  • Stress urinary incontinence

    The most common type of incontinence, stress urinary incontinence is urine leakage during exercise, coughing, sneezing, laughing, or lifting heavy objects. Stress urinary incontinence can also occur when other body movements put pressure on the bladder. This type of incontinence occurs when the muscle that acts to keep the urethra closed during times of increased abdominal pressure does not function well anymore and allows urine to leak during those instances.

  • Urgency urinary incontinence (overactive bladder):

    This refers to urine leakage associated with an urgency to urinate. This type of urinary incontinence occurs when the bladder contracts without warning, causing urinary leakage.

  • Mixed incontinence:

    This type of incontinence implies that a patient’s symptoms of urinary leakage are due to a combination of stress and urgency urinary incontinence types.

  • Functional incontinence:

    This is urine leakage that occurs when a patient cannot reach a restroom in time because of physical conditions that limit their mobility such as arthritis.

  • Overflow incontinence:

    This is urine leakage that occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it.

What are Urinary Incontinence Symptoms?

Each woman may experience urinary incontinence symptoms differently. Many women feel that it can be an embarrassing and bothersome problem, and report that it impacts their quality of life. Most commonly, women experience symptoms related to urge incontinence and or stress incontinence. If you feel that your symptoms are impacting your quality of life, you should seek medical evaluation and treatment. Common symptoms of stress urinary incontinence may include:

  • Leakage of urine, especially when you cough, laugh, sneeze or with physical activity such as running and jumping.

The symptoms of urgency urinary incontinence include:

  • Leakage of urine associated with a strong urge to urinate. Many women notice that this becomes worse with several “triggers” including hearing the sound of running water, cold temperatures and anticipation of voiding.

Women may also experience a combination of symptoms related to both types of incontinence, which is known as mixed urinary incontinence.
Diagnoses of Urinary Incontinence
You will need to see your doctor at Encee Medical Center, where initial evaluation and testing will be done.  Questions about when and how often you experience incontinence will be determined. Your doctor could also do the following:

  • May conduct a physical examination that can help identify other conditions that may influence your bladder, such as pelvic organ prolapse
  • Ask you to cough with a full bladder to see if you leak urine
  • Ask you to keep a bladder diary. This diary requires you to record what you drink, as well as how much and how often. You will also measure the amount you urinate. This will help the provider learn more about your particular bladder symptoms
  • Check your urine for any sign of urinary tract infection

If needed, you may need to see a Urogynecologist, a physician who specializes in diseases and disorders of the female urinary tract. Your doctor might also conduct tests that could include:

  • Urodynamic testing to gain information about your bladder and urethra
  • 3D ultrasound to evaluate the status of your pelvic floor muscles
  • Cystoscopy to examine the inside of the bladder and urethra

Treatments

Treatments for Urinary Incontinence

Treatment for urinary incontinence may vary depending on an individual woman’s symptoms and goals for treatment. Your specific treatment will be determined after a thorough evaluation and discussion between you and the provider. At Encee Medical, we strive to provide individualized treatment plans to meet each woman’s goals and expectations with the overall aim being to restore your quality of life.
Many of the treatments offered are nonsurgical and involve rehabilitation of the pelvic floor muscles and retraining your body and bladder to work. However, office-based procedures as well as minimally invasive surgeries are often chosen by women to treat urinary incontinence. Sometimes, women will choose to pursue several treatment options to best alleviate their symptoms.

Stress Urinary Incontinence Treatment Options

Most therapies for reducing symptoms related to stress urinary incontinence focus on compensating for the decreased function of the urethral sphincter and pelvic floor muscles.

Lifestyle Changes

Some lifestyle changes can help reduce symptoms of stress urinary incontinence, including:

  • Keeping your bladder empty by urinating every two to three hours
  • Maintaining normal weight or losing weight, if overweight
  • Quitting smoking: Use of tobacco doubles the risk for developing pelvic floor disorders
  • Treating constipation and avoiding straining with bowel movements

Pelvic Floor Physical Therapy

Physical therapy of the pelvic floor is aimed at rehabilitating the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist, who will help you learn the most effective techniques. Some women need to improve their pelvic floor muscle function with strengthening exercises while others need stretching and relaxing exercises. Your physician will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary.

Pessary Therapy

pessary is a small silicone device that is inserted into the vagina to provide slight pressure on the urethra which helps to keep it closed. This will allow you to control leakage of urine and still be able to urinate normally. Pessaries are usually used temporarily to avoid surgery in women who have not completed their families or have medical problems that make surgery risky. Some patients wear a pessary only when they are performing activities which worsen leakage, such as exercise. Alternatively, some women choose to wear their pessary throughout the day. If you are interested in trying a pessary, one of the doctors at Encee Medical Center, can discuss this further with you.

Urethral Bulking Agents

A Urogynecologist may also recommend injecting a substance to help “bulk up” your urethra. Your physician will evaluate you to determine if you are a good candidate for this procedure. There are several different types of bulking agents. These can be administered one to three times a year as an injection in the office setting. Bulking agents allow you to be active immediately but will wear off after several months. This is an attractive management option for women with stress incontinence that would like a procedural option but are unable to tolerate a minimally invasive surgical procedure due to other medical problems.

Surgery 

Surgery for urinary incontinence is intended to compensate for the weakened sphincter muscle and support around the urethra. Surgery is often low-risk and is usually very successful. Your Urogynecologist will discuss the surgical options then help you to select the treatment that best suits your specific goals. These procedures have a high cure rate, but, as with all procedures, there are also risks involved. Your Urogynecologist will help you weigh the risks and benefits of the different surgical procedures and help you decide on the best option for you.

Urgency Urinary Incontinence/Overactive Bladder

Most medical therapies addressing urgency urinary incontinence focus on decreasing the abnormal contractions in the bladder, which lead to urinary leakage.

Lifestyle changes

Some lifestyle changes can help reduce symptoms of urgency urinary incontinence, including:

  • Keeping your bladder empty by urinating every two to three hours
  • Limiting fluids which worsen incontinence including alcohol, caffeinated beverages, and high-sugar beverages

Pelvic Floor Physical Therapy

Physical therapy of the pelvic floor is aimed at rehabilitating the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist who will help you learn the most effective techniques. Some women need to improve their pelvic floor muscle function with strengthening exercises while others need stretching and relaxing exercises. Your Urogynecologist will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary.

Medications

There are a variety of medications that treat incontinence. These medications are especially useful for treating an overactive bladder associated with urgency urinary incontinence; however, many patients with mixed symptoms of urgency and stress incontinence may benefit from medical therapy.
Some medications that may help with urinary incontinence include:

  • Local vaginal estrogen: Low-dose topical application of estrogen to the vagina may help rejuvenate and tone tissues in the urethra, reducing some of the symptoms of urinary incontinence in post-menopausal women.
  • Anticholinergic oral medications: There are many different types of these medications, which can be prescribed by your doctor, that when taken daily help treat urgency incontinence or overactive bladder.
  • Beta agonists: Mirabegron (Myrbetrig®) is a daily medication that you take by mouth that relaxes the bladder muscle and decreases abnormal or unwanted contractions.

Procedures

Sometimes, lifestyle changes and medications might not adequately manage a woman’s symptoms of incontinence. There are several minimally invasive procedures which are low risk and effective at treating refractory (non-responsive) urgency urinary incontinence. These are performed by the urogynecologist after you have been evaluated and determined if you are good candidate for this treatment option.

  • Botox: Injections of onabotulinum toxin (Botox®) into the bladder muscle may reduce urinary leakage episodes in women with urgency incontinence or overactive bladder. This is a procedure performed in the office where onabotulinum toxin is injected directly into the bladder muscle through a small telescope placed in the urethra (cystoscopy). Onabotulinum toxin injections are very effective and take about two weeks to take effect. Since this medication is not permanent, injections may be needed every six to nine months.
  • Sacral Neuromodulation: This is a minimally invasive procedure performed in the office or under sedation in the operating room, in which a thin wire is connected to a neurostimulator (similar to a pacemaker) and delivers small impulses to the nerves that control the bladder. The therapy targets the sacral nerves which travel from the spinal cord to pelvic muscles and organs, including the bladder. The first step of this procedure is a test phase, which allows women to trial the therapy and determine whether their symptoms are adequately controlled. If women have success with the test phase, a permanent version is placed in the operating room.
  • Percutaneous Tibial Nerve Stimulation: Another way to regulate the nerves to the bladder is via percutaneous tibial nerve stimulation. This procedure is less permanent than sacral neuromodulation and ideal for women who want to avoid a procedure in the operating room. Percutaneous tibial nerve stimulation utilizes a tiny acupuncture needle placed in the skin over the ankle to deliver electrical pulses to the tibial nerve. The procedure is done in the office weekly for about three months. It is painless and does not have any risks or side effects.

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