What is Incontinence?

Urinary incontinence is the uncontrollable loss of urine. The leakage can vary from only a few drops when you cough or sneeze to entirely emptying your bladder without warning. It can cause emotional consequences such as depression, isolation, and loss of dignity. Fortunately there are successful treatment options to help control incontinence.

Evaluating Your Condition

The first step is to tell your doctor about your bladder control problem. A full history will be taken and tests will be performed. Tests may incude:

Urinalysis and Culture – Testing of a urine sample for signs of infection

Cystoscopy – Examining the inner lining of the bladder with a small lighted telescope

Urodynamics – A small catheter placed in the bladder monitors pressures and records bladder behavior.

Types of Incontinence

Stress Incontinence is usually experienced as leakage when coughing, sneezing, laughing, lifting, exercising, having sex, or anything that increases pressure on the bladder. Urge Incontinence, or “overactive bladder”, usually occurs as frequent urination, a need to urinate frequently at night, and an intense urge to urinate with very little warning. Often leakage occurs when a person just cannot get to the bathroom in time. Overflow Incontinence occurs when the bladder cannot fully empty, which may be caused by a blockage/narrowing of the urethra or when the bladder stops contracting due to medications, nerve injury, or chronic overstretching of the bladder muscle. Symptoms include dribbling urine throughout the day, a weak urinary stream, or urge to urinate, but inability to do so. Mixed Incontinence is a common condition which is a combination of one or more of the above.

Timed Voiding — This means urinating on a set schedule instead of waiting until you have the urge to urinate. This empties the bladder and helps prevent accidents.

Bladder Retraining – If you have urinary frequency and urge incontinence, you may be able to do Kegel exercises to “retrain” your bladder. Each time you feel the urge to urinate, try to stop the feeling by contracting your pelvic floor muscles. Try to hold your urine a little bit longer each time.

Dietary Changes – Avoid foods that may act as bladder irritants and diuretics, making you urinate more often. These include caffeinated drinks and alcohol.

Pelvic Floor Muscle Exercises (Kegel Exercises) – The pelvic floor muscles act as a hammock to hold the bladder and urethra in place. These muscles function as the “on and off” switch for the bladder and also help keep the urethra closed. Kegel exercises help by strengthening the pelvic floor muscles and can improve bladder control. Your medical team can teach you how to do Kegels, and may use biofeedback sensors to ensure that you’re exercising the right muscles.

Bulking Agents ‑ A material is injected under the skin of the urethra to “bulk up” the tissue and create a tighter seal. The minimally-invasive procedure is performed with a cytoscope.

Mid-urethral Slings — This surgical procedure places a ribbon of mesh under the urethra via a small incision in the vagina. When abdominal pressure increases, as with a cough, sneeze, or athletic activity, the sling provides support to keep the urethra closed, preventing loss of urine.

Medications ‑ Numerous prescription drugs can help relieve urinary urgency, frequency, and urge incontinence by relaxing the bladder muscle, which increases its capacity. Some examples include Myrbetriq, Ditropan XL, Detrol LA, Vesicare, Sanctura, Oxytrol, and Enablex.

Sacral Nerve Stimulation — This neuromodulation therapy involves the electrical stimulation of the sacral nerves, which affect bladder function. The therapy does not work for everyone, so a test phase is needed to see if you are a candidate for the procedure. If testing is successful, the permanent device, similar to a pacemaker, is implanted in the upper buttock. A thin wire connects the device with the nerves that control the bladder reflexes and electrically stimulates the nerves.

Posterior Tibial Nerve Stimulation (PTNS) — This is another form of neuromodulation in which a small acupuncture needle is placed behind the ankle bone and next to the tibial nerve, which carries signals to the sacral nerves. The needle is electrically stimulated for about half an hour, then removed. This office procedure will be repeated weekly for 3 months. If successful, longer intervals between stimulation may be possible.

Botox Injections ‑ Botox blocks the release of nerve chemicals (neurotransmitters), which cause muscles to contract. When injected into the bladder muscle, Botox temporarily weakens the muscle contractions that are causing urge incontinence. The procedure takes about 10 minutes or less and is done in the office. The benefits of Botox injections last about 6 months.

Self-Catheterization — This is a safe procedure and once you learn it, it is not difficult or painful. You pass a small tube or catheter into your bladder several times a day to empty your urine.

Neuromodulation — This reversible therapy can be effective for certain forms of urinary retention. Please see Sacral Nerve Stimulation for additional information.

Surgery — This may be required when the cause of incontinence is the narrowing of the urethra from scar tissue or from vaginal prolapse.