• Urinary Incontinence

    In the United States, 20 million women have some form of urinary incontinence. Because of anatomical differences in men and women, there is a substantial difference between the sexes in the various types of incontinence.

    Urinary incontinence, the loss of voluntary bladder control causing leakage of urine, can be a temporary or chronic condition. It can occur when you are straining (lifting, sneezing, coughing), when your bladder is full, or when you have a bladder infection. Each cause has its own methods of diagnosis and its own treatment plan. In some cases, incontinence may have several different causes.

    Types of Incontinence

    Stress Incontinence

    Stress incontinence results when certain activities increase abdominal pressure, which in turn puts pressure on the bladder. Leaking can be triggered by laughing, sneezing, lifting heavy objects, or exercise. This is a common type of incontinence and may be caused by the weakening of the muscles that support the bladder or the weakening of the muscle sphincter that controls the flow of urine.

    Urge Incontinence

    Urge incontinence, previously called overactive bladder, is the loss of bladder control following a strong urge to urinate. Sometimes, you are unable to hold urine long enough to make it to the bathroom. It may be caused by a urinary tract infection, certain medications, or nerve damage from multiple sclerosis, Parkinson's disease, stroke, or spinal cord injuries. The nervous system controls messages sent from the bladder to the brain via the spinal cord, including the signal that it is time to urinate.

    Overflow Incontinence

    With overflow incontinence, there is a constant or frequent small amount of leakage of urine from a bladder that does not empty. As the bladder remains full, the muscle stretches as more urine accumulates in the bladder. Over time the muscles become less effective at contracting to empty the urine. This causes a feeling that you need to urinate frequently. Often, you will not feel that you are emptying your bladder completely.

    Conditions such as diabetes may prevent the bladder from emptying completely, resulting in the symptoms described above. Certain medications such as over-the-counter cold pills and tranquilizers may also cause these symptoms.

    This type of incontinence is important to treat. If the urine remains long enough in the bladder, infections may occur. These infections could affect the kidneys and potentially pose serious health risks.

    Treatment for Urinary Incontinence

    Lifestyle changes

    There are several things you can try to help manage urinary incontinence:

    • Avoid bladder irritants. Some people find that coffee, other sources of caffeine, citrus, or alcohol increase the urge to urinate. Temporarily avoiding these beverages may cause your symptoms to improve.
    • Schedule your liquid intake. Most of the liquid you drink will reach your bladder within 2 to 3 hours. Therefore, it's best to time your intake of large quantities of fluids to those hours when you know you'll be near a restroom.
    • Know your medications. Certain medications (diuretics) can increase your urinary frequency for several hours until their effect subsides. Discuss with your doctor when is the best time for you to take them and plan accordingly.
    • Try collectors and pads. There are a number of devices available to catch urine. Small amounts can be managed with sanitary napkins. Larger amounts can be absorbed by protective undergarments with high-tech linings that prevent moisture from breaking down your skin. The use of collectors and pads in conjunction with scheduling your liquid intake can turn many incontinence problems into minor nuisances.

    Medications Certain types of urinary incontinence may be treatable with medications. In postmenopausal women, pelvic floor relaxation is the most common cause of stress incontinence. Urgency and overflow incontinence may respond to anticholinergic medicines that weaken the bladder muscle. Alpha-adrenergic medicines that strengthen the sphincter may also be helpful in some cases.

    Talk to your physician about the pros and cons of using medications to treat urinary incontinence as some medical problems may contraindicate the use of medications. If you have bladder trouble, check with your physician before using any other medications, including over-the-counter drugs and herbal supplements as many have urinary side effects.

    Surgery

    There are several surgical procedures for the various types of incontinence. These procedures are usually reserved for people who have tried conservative treatments without success and are healthy enough to undergo surgery.

    • Retropubic Suspension: When the bladder or urethra has fallen out of place, this procedure is used to attach the tissue next to the bladder or urethra to the pelvis, correcting the position.
    • Sling procedures: Depending upon your clinical diagnosis, a biological material is used to support, as a hammock, the urethral bladder neck.
      • Pubovaginal Fascial: The surgeon attaches a piece of tough, tendon-like material called fascia around the bladder neck to keep urine from leaking out.
      • Suburethral Sling: When the urethra has fallen out of position or when the sphincter muscle of the urethra is weak, this procedure is used to place a sling under the urethra. It acts as a hammock to support the neck of the bladder and to prevent leaks.
      • Newer Sling Procedures: New, less invasive, safer suburethral sling procedures like tension-free vaginal tape (TVT) and transobturator tape (TOT) may be a treatment option.
    • Sacral Nerve Stimulation: With sacral nerve stimulation, surgery is performed to place a thin lead wire with a small electrode tip in the lower spine near the sacral nerve. A nerve stimulator continuously sends electronic impulses to the sacral nerve. This electronic stimulation therapy creates a bladder pacemaker, which reduces or eliminates urge incontinence.
    • Bulking Injections: When the sphincter muscle of the urethra is very weak, a substance called "bulking material" is injected into the tissues around the urethra. This causes the sphincter to become more narrow, and thus resistance to urine leakage increases.

    Other Treatment Options

    Other treatments for urinary incontinence include:

    • Behavioral Therapy: Bladder retraining is often an initial treatment for incontinence, and requires that you have at least some control over bladder function. For example, if you know that you tend to leak urine three hours after you urinate, you could empty your bladder every 2½ hours, then gradually increase the interval between trips to the bathroom.
    • Exercises: Not all the muscles involved with bladder control are automatic. You have control over the sphincter that holds urine in. Therefore, you can exercise it to strengthen it by doing Kegel exercises. You may be referred to a pelvic floor exercise therapist for this option.
    • Devices: Pessaries are devices inserted into the vagina. Most are designed to improve the function of the bladder sphincter by supporting the floor of the bladder.
    • Catheterization: Regularly emptying the bladder by inserting a catheter keeps the urine from spilling uncontrollably. Patients with neurogenic bladders learn how to do this by themselves. Those who are incapable of caring for themselves may have professional caregivers, such as nurses, perform this procedure regularly.
    • Biofeedback: By using electrical sensors, it is possible to make the contractions of the sphincter muscle visible or audible. While attached to such a device, you are encouraged to increase the signal, which strengthens the involved muscle.
    • Collagen implant: Collagen implants are performed with a local anesthetic as an outpatient procedure. Collagen is injected into the lining of the urethra or the neck of the bladder to act as a bulking agent. This allows the urethra to close tightly enough to prevent urine from leaking out. The result is similar to the way the body functions naturally, and usually, urinary control will be improved and restored.
    • Botulinum toxin: Botulinum toxin type A (Botox) injections are a new treatment option for people with overactive bladder syndrome. Botox is injected into the detrusor muscle, which paralyzes the overactive muscles and is a simple outpatient procedure.
  • Make an Appointment

    (781) 744-8000