Urinary Incontinence
What is Urinary Incontinence?
Over 35 million of Americans experience involuntary loss of urine, called urinary incontinence. Some women may feel a strong, sudden urge to urinate just before losing a large amount of urine. On the other hand, others may lose a few drops of urine while running or coughing. In addition, some women may experience both symptoms. Urine loss also can occur during sexual activity, causing enormous emotional distress.
Incontinence can range from being mildly bothersome to totally debilitating. It keeps some women from enjoying many activities with their families and friends.
Women experience urinary incontinence as much as twice as often as men due to pregnancy and childbirth, menopause and the structure of the female urinary tract. Incontinence as a result of stroke, neurologic injury, birth defects, multiple sclerosis, Parkinson’s disease, and physical problems associated with aging.
Incontinence occurs because of a malfunction with the nerves and muscles that help to hold or release urine. The body stores urine in the bladder. The bladder connects to the urethra, the tube through which urine evacuates the body. In the act of urination, muscles in the wall of the bladder contract, forcing urine out of the bladder using the urethra as a conduit to the outside world. At the same time, sphincter muscles surrounding the urethra relax, allowing urine pass out of the body. Incontinence may occur if the bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. These different causes of incontinence can occur simultaneously with other pelvic floor disorders such as pelvic organ prolapse.
What are the Common Types of Incontinence?
Urge incontinence – loss of urine for no apparent reason while suddenly feeling the compelling desire or urge to urinate. Involuntary bladder contractions, referred to sometimes as overactive bladder, is the most common cause of urge incontinence. The bladder may leak urine during sleep or after drinking a small amount of water. This is typically accompanied by frequent urination and the need to get up in the middle of the night or nocturia. Urge incontinence should never be considered a “normal” part of aging. It is most assuredly a condition that can and should be treated.
Stress incontinence – incontinence that occurs with any Valsalva maneuvers, which can include coughing, laughing, sneezing, or other movements that put pressure on the bladder. Physical alterations in anatomy resulting most commonly from pregnancy, childbirth and menopause often cause stress incontinence.
Incontinence Treatments
Chronic incontinence can originate from a variety of circumstances. The nature and mix of therapeutic measures are tailored to the individual patient.
Exercises - Exercises to strengthen or retrain pelvic floor muscles and sphincter muscles, most often referred to as Kegel exercises. The purpose of these exercises is to reduce urinary incontinence episodes.
Bladder training - techniques that that include muscle conditioning which can alter the bladder’s schedule for storing and emptying urine.
Medications – the most common are anticholinergics. This group of medications inhibit contractions of an overactive bladder.
Biofeedback - Using electronic devices, or diaries, to track when bladder and urethral muscles contract, control over these muscles can be gained. Biofeedback can be used
with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Neuromodulation – an outpatient procedure whereby electrical stimulation is used to improve the nervous connections and communications of nerves which control the bladder.
Injections – Botox, a new treatment option for patients for urge incontinence, is injected into the detrusor muscle, paralyzing the overactive muscles.
Pessaries - firm but flexible ring inserted to press against the wall of the vagina and the nearby urethra in cases of incontinence. This compression and repositioning of the urethra can reduce stress incontinence in some patients.
Implants - substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Coaptite® and Microplastique® are two of the common bulking agents used at present time.
Surgical Therapy for Incontinence
There are many surgical options for incontinence that have a high rate of success. Surgical therapy for stress incontinence has improved considerably The procedure is typically performed on an outpatient basis. The majority of patients are discharged from the recovery room without a catheter postoperatively, and with minimal pain or discomfort.
A vaginal sling, the most commonly performed surgery. The sling creates a hammock of support to prevent stress urinary incontinence. The procedure, which involves placing a piece of synthetic mesh or tissue under the urethra, is done almost entirely through the vagina. A small incision is necessary just above the hairline or in the thigh creases for placement of some sutures or the mesh. The Arthur Smith Institute fellowship-trained pelvic floor surgeons offer retropubic, transobturator, and single-incision midurethral slings for various types of incontinence. Most patients undergoing incontinence procedures alone return to normal activities in 1-2 weeks.
