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Incontinence

What is it?

Women may experience unwanted leakage of urine during activities like coughing, laughing, lifting, straining, exercise, changing position (seated to standing) and even sexual intercourse. It can be embarrassing and limit women's social and personal relationships along with physical activity.

Why does it occur?

The bladder and urethra require appropriate neurologic coordination and control as well as adequate support from the surrounding muscles and tissue in the pelvis. Leakage (stress) of urine during staring, coughing, exercise can result from weakness of the support structures or compromise to the control mechanisms of urination

Risk factors for stress incontinence:

  • Obesity
  • Pregnancy: Many women experience some leakage during pregnancy but typically resolves after pregnancy
  • Vaginal delivery
  • Hysterectomy/Pelvic surgery
  • Post-menopausal
  • Medications: diuretics
  • Ethnicity: Caucasian women have higher risk
  • Strenuous activity
  • Smoking

How is it evaluated and why?

We have urologists who specialize in female urinary issues and can provide a comprehensive evaluation. This will start with an in-depth discussion about your symptom severity and their impact on your life. For example, they may ask you if you use absorbent pads to manage your leakage or questions about your fluid intake. Your physician will perform a detailed physical examination.

In many cases, your physician may recommend urodynamic studies to further evaluate the dynamics of your bladder muscle and function. They may also perform an ultrasound of your bladder.

What are my treatment options?

You and your urologist will help you decide which option is best suited for your condition and lifestyle.

Treatment:

  • Behavioral therapy: This may constitute simple lifestyle changes like avoidance of excess fluid intake, caffeine or alcohol intake or any activities which make the leakage worse.
  • Weight Loss: In addition, weight loss can improve symptoms. Some studies have shown that losing 7% of your overall body weight (e.g. 150lb person with 10lb weight loss) may significantly improve symptoms.
  • Pelvic Floor Exercise:Commonly known as Kegels, these exercises are performed daily to strengthen weak pelvic floor musculature. Like any exercise routine, they must be performed on a daily basis and for at least three months before deciding if you need to move on to a different treatment option. Your physician may recommend additional therapy with a physical therapist that specializes in pelvic floor rehabilitation.
  • Pessary: Pessaries are a small rubber device that is inserted inside the vagina and act to mechanically support the urethra and bladder to prevent leakage. Placement is easily performed in the office and does not require surgery. There are many types, shapes and sizes of pessaries and your physician will help choose the appropriate one for you. These devices do require periodic removal and cleaning. They may be best suited for older patients, those not healthy enough or do not desire surgery or those still in their child bearing years.
  • Medication: While there is no medication in the US to specifically treat stress urinary leakage, your physician may suggest trying a medication initially if you have additional symptoms of urinary urgency or frequency. These symptoms may be a sign of an overactive bladder muscle which can benefit from pharmacologic therapy.
  • Surgery:If your leakage does not respond to conservative treatment options then you may want to consider a surgery or procedure to help restore the support system of the urethra/bladder. Most of these procedures are do not require an overnight stay in the hospital.
  • Urethral Sling: A minimally invasive surgery performed through a small one-inch vaginal incision. A piece of supportive synthetic suture material is placed underneath the urethra for support. It has a high success rate (80-90%) of cure or symptom improvement. Recover time does require limitations of physical activity for up to 6 weeks.
  • Burch Procedure: This procedure may be performed in conjunction with a robotic surgery to repair vaginal prolapse. It is performed by placing sutures inside the pelvis to lift up the urethra and provide support.
  • Urethral Bulking: This procedure is performed by placing a small camera through the urethra and can even be performed in the office. After the camera is placed a substance or filler agent, typically collagen or silicone/graphite beads, are injected in to the wall of the urethra to narrow the opening and prevent urinary leakage.