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URINARY INCONTINENCE

DEFINITION:

Urinary incontinence is the involuntary loss of urine.

HOW COMMON IS URINARY INCONTINENCE?

Urinary incontinence is extremely common, much more so than people often think. Because it can be an embarrassing problem, people often do not discuss it with family or friends, and therefore most women don't realize how common it actually is. Surveys estimate that anywhere between 40-60% of women are affected by incontinence. It is also estimated that only half of affected women ever seek treatment. If incontinence affects your quality of life, ask your doctor about treatment options.

ARE THERE DIFFERENT TYPES OF URINARY INCONTINENCE?

The answer is yes. There are two main categories of urinary incontinence, commonly referred to as stress incontinence and urge incontinence.

  • Stress incontinence is the involuntary loss of urine that occurs with coughing, sneezing, laughing, picking up something heavy, or simply standing up from a seated position. If you leak urine after straining your abdominal muscles, you likely have stress incontinence.
  • Urge incontinence is the involuntary loss of urine that is typically associated with an urge sensation to get to the bathroom right away (not making it in time to the bathroom).  This condition is associated with "overactive" or "hyperactive" bladder.
  • Mixed incontinence: many women have a combination of stress and urge incontinence, and if this is the case, the condition is referred to as mixed urinary incontinence.
  • Global incontinence is defined as the true, continuous leakage of urine that persists at all times. It most commonly occurs due to a condition called a fistula, an abnormal connection between the urinary tract and the vagina.

WHAT ARE THE RISK FACTORS FOR URINARY INCONTINENCE?

  • Obesity
  • Diabetes
  • Prior vaginal delivery/multiple vaginal deliveries
  • Being post-menopausal
  • Previous surgery, particularly hysterectomy
  • Neurological disorders (stroke, Parkinson's disease, spinal cord injury)

HOW DO I KNOW WHAT KIND OF INCONTINENCE I HAVE?

First, speak with your physician. In many cases, the diagnosis may be made with a simple discussion with your doctor. In other cases, the cause may not be immediately evident, and a test called urodynamics may be indicated. This test usually involves placing small catheters into the bladder and rectum to measure pressures as the bladder fills and empties. It can often be very helpful in guiding the type of treatment that may be best for you, and also help to predict your response to treatment.

WHAT ARE THE TREATMENT OPTIONS FOR URINARY INCONTINENCE?

Treatment options differ, depending on the type of incontinence a woman has, its severity, and the underlying cause.

 

  • Stress incontinence
    • Kegel exercises: when mild, stress incontinence can often be treated with exercises for the pelvic floor muscles called Kegel exercises. To tighten these muscles, imaging that you are trying to stop the flow of your urine mid-stream.  Try to tighten and hold the contraction for 5-10 seconds, then release. Repeat for several cycles, and try to practice around 10 times per day. These exercises can also be performed with the help of a pelvic floor physical therapist.
    • Surgical options: there are several surgical treatments for stress urinary incontinence. Most involve the use of a synthetic mesh material that is placed under the urethra. Stress incontinence is thought to arise because of abnormal mobility of the urethra. The sling prevents this mobility that is caused by coughing, sneezing, etc, thereby restoring urinary control. There are also surgical sling options that involve a fascial sling (a section of the tendon from one of the abdominal muscles). This is also placed under the urethra to accomplish the same goal as the mesh.

 

  • Urge incontinence
    • Lifestyle modification: Many cases of urge incontinence can be managed with lifestyle modification.  Sometimes, simply adjusting what you drink, and urinating on a schedule (timed voiding) to avoid extreme urgency can avoid accidents and involuntary leakage.  Eliminating caffeine, alcohol, or citrus beverages can often be very helpful in reducing urinary frequency, urgency, and urge incontinence.
    • Medications: There are a large number of medications on the market to help reduce urinary urgency and unintended leakage. In general, they help reduce abnormal contractions of the bladder wall muscle that can trigger leakage. The main categories of medications include anticholinergics, beta-3 agonists, and tricyclic anti-depressants. These medicines can be used alone, or sometimes in combination. Common side effects of anticholinergics include dry mouth or constipation. Beta-3 agonists may cause cold-like symptoms (headache, sinus congestion) or increase in blood pressure. Tricyclic antidepressants may cause drowsiness are are usually taken at night.
    • Botox: Although mainly used in cosmetic procedures, Botox (botulinum toxin) can also be injected into the bladder wall to reduce abnormal bladder muscle contractions. This procedure is often considered in women who fail with or cannot tolerate oral medication.
    • Neuromodulation
      • Sacral nerve stimulation: In patients who do not respond well to oral medications, nerve stimulator surgery may be considered if you have severe urinary urgency and incontinence. In this procedure, your surgeon implants a small stimulator device that acts like a pacemaker to regulate the sacral nerves that control the bladder. The stimulation does not cause pain, and the procedure can usually be completed as an outpatient. The procedure does not work for everyone, so typically, there is a test phase that you can try by wearing an external version of the stimulator to gauge your response.
      • Tibial nerve stimulation: Another means of nerve stimulation that is performed by placing a small needle through the skin near to ankle to stimulate the tibial nerve. This is usually performed in weekly sessions lasting about 30 minutes each, for 8-12 sessions. Maintenance treatments at periodic intervals may also be recommended, depending on your response.

 

  • Mixed incontinence: components of both stress and urge incontinence exist together in women with mixed incontinence. In most cases, your doctor will address whichever type of incontinence is the predominant one first and then reassess your degree of bother. Of the medical options, the tricyclic anti-depressants are the most common choice based on their potential to treat both urge and stress incontinence.

 

  • Global incontinence: the true continuous leakage of urine can be caused by an abnormal connection between the urinary tract and the vagina. It also may be caused by a condition called intrinsic sphincter deficiency (inability of the urethral sphincter muscle to function properly). If you experience this type of leakage, there are variety of tests that may be necessary to diagnose the problem.  However, there are often very good surgical options available for treatment.

|    © 2014-2018 copyright Taraneh Shirazian, MD

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Joan H. Tisch Center for Women's Health

207 E 84th Street

New York, NY 10028

Phone: 646-754-3300

 

Email: info@wwcofny.com