Urinary Incontinence

It is estimated that more than 15 million people in the U.S. suffer from urinary incontinence, the inability to control urine flow. There are four different forms of urinary incontinence:

Stress incontinence – Those with stress incontinence experience a leaky bladder caused by an increase in abdominal pressure. The increase in pressure may be caused by coughing, laughing, sneezing, jogging, lifting or increased body strain.

Urge incontinence – Also referred to as overactive bladder, patients suffering from urge incontinence may experience a sudden urge to urinate and are unable to make it to the toilet.

Mixed urinary incontinence – A combination of stress and urge incontinence.

Overflow incontinence – Overflow incontinence is characterized by frequent urination caused by the bladder’s inability to empty properly.

Weak muscles in the urinary tract or damage to the nerves that control urination often cause bladder control problems. Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. Urge incontinence is caused by an overactive bladder muscle.

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Diagnosis

Your urologist may ask you to keep a bladder diary for several days to document the amount of liquid you drank, how often you urinated, how much you urinated and the number of incontinence episodes. In addition to a bladder diary, urinary incontinence and overactive bladder can be diagnosed during a physical examination and may require several tests including a urinalysis, cystoscopy or video urodynamic testing.

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Treatments

There are several non-surgical treatment options for mild cases of urinary incontinence. Pelvic floor exercises to strengthen the bladder pelvic muscles, bladder training, medicine and simple lifestyle changes – such as fluid and diet management – are commonly recommended. Pelvic floor exercises typically include kegel exercises which involve tightening the pelvic muscles and holding the contraction for five to 10 seconds at a time. In more severe overactive bladder cases, urologists may recommend:

InterStim

This is a sacral neuromodulation therapy prescribed when traditional treatments (pads, bladder exercises) are unsuccessful in treating the condition. TUCC providers Elias Hsu, M.D.,and Juan Montoya, M.D., are highly trained in utilizing InterStim for overactive bladder patients.

The sacral nerves, located near the tailbone, control the bladder and muscles related to urinary function. In many overactive bladder cases, the brain and sacral nerves do not communicate correctly, which impacts normal bladder function. InterStim modulates the sacral nerves with mild electrical pulses, similar to what a pacemaker does for the heart. If the therapy is successful in eliminating overactive bladder symptoms, the wire is eventually connected to a small implant placed under the skin. InterStim has the potential to give patients desired bladder control and greatly improved quality of life. Learn more about InterStim.

Botox Injections

Botox injections may also be recommended as a treatment option for overactive bladder. Overactive bladder is marked by a sudden, uncontrollable urge to urinate, which can lead to the involuntary loss of urine, otherwise known as a leaky bladder. Botox injections work to relax the bladder muscle and thereby decrease the involuntary bladder contractions and leakages. These injections are performed as outpatient procedures at TUCC.

Surgery

Surgery is another treatment option for severe cases of urinary incontinence. Common surgical procedures include:

Sling Procedures – A sling or hammock is created using body tissue, synthetic material or mesh and is placed around the bladder neck and urethra to help control urine flow and minimize the occurrence of stress incontinence.

Bladder Neck Suspension – this procedure provides support to the urethra and bladder neck.

Artificial urinary sphincter – during this procedure, a small, fluid-filled ring is implanted around the neck of the bladder to keep the sphincter shut until the patient is ready to urinate. When ready, a valve implanted under the skin is pressed causing the ring to deflate, opening the sphincter and allowing urine to flow from the bladder.

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