What is Urinary Incontinence?
Urinary incontinence is a problem with bladder and
sphincter control. It is the uncontrolled leaking of urine. If
the fear of leaking urine stops you from doing things you
enjoy, then it is time to think about treatment. Do not be
embarrassed to talk to your health care team about this
medical condition. There are treatment options waiting
for you!
What Causes Urinary Incontinence?
Urinary incontinence is not a disease. It is a symptom of a
wide range of health issues such as the short-term and long-
term issues listed below.
Short-term health issues:
•
Urinary tract infection (UTI)
•
Constipation (hard, dry stool)
• Medicine (such as diuretics, antidepressants,
antihistamines, others)
Long-term health issues:
•
Diabetes
•
Stroke
•
Multiple sclerosis
•
Enlarged prostate or prostate surgery for men
•
Childbirth or menopause for women
What are the Types of Urinary Incontinence?
Stress Urinary Incontinence (SUI)
Stress Urinary Incontinence (SUI) is a common type of urinary leakage. With SUI, the pelvic floor muscles (which hold the pelvic organs in place) have become weak and can no longer support the bladder and urethra the way they should. Coughing, sneezing, bending, lifting, straining or even laughing could put enough pressure on the bladder to cause it to leak.
Overactive Bladder (OAB) / Urgency Urinary
Incontinence (UUI)
Overactive Bladder (OAB) is a syndrome that often includes frequent urination and is associated with a sudden strong urge to void. This “gotta go” feeling makes you feel
that you will leak if you do not use the bathroom now. If you indeed do not make it, this urge-related urine leakage is known as urgency urinary incontinence (UUI). If you live with OAB, you may feel like you need to pass urine many times during the day. You may even wake from sleep many times a night to void. It is a very common health issue for many people and may increase with age. It is also common for
people with diabetes, multiple sclerosis or stroke.
Overflow Urinary Incontinence
This type of incontinence is when the bladder stays full. It cannot empty and so it overflows and leaks. Signs include many, small urinations each day, or ongoing dribbling. This is rather rare in women, but can be seen in people with diabetes, neurological disorders and/or a non-functional, underactive bladder. Most often overflow incontinence is seen in men who have prostate problems.
Mixed Urinary Incontinence
Mixed incontinence is a blend of these different types above. Some people have more than one type of urinary incontinence. Some people leak urine both with strong
physical activity (SUI) and have a strong uncontrollable sense of urgency (OAB.) This is mixed urinary incontinence. In these cases, it helps to know what is occurring and what is causing leaks to learn how to manage problems.
Diagnosis
A urologist or your health care team will start by asking questions. They will want to know about your
- Symptoms
- Medical history.
- Health habits and fluid intake.
- Change in your quality of life
- A complete review of the medications you are taking may reveal one that alters normal bladder or urethral function.
- Tests –
- Urine Routine, Urine culture
- Uroflowmetry
- USG Kidney ureter bladder prostate + Post void residual urine (PVRU)
- Cough impulse test to see urine leak
- Per vaginal examination in females to look for pelvic organ prolapse
Treatment of incontinence
Overactive bladder
There are a number of things you can do to manage. OAB Everyone has a different experience with what works best. OAB treatment includes
- Lifestyle Changes
- Prescription Medications
- Bladder Botox® Treatments
- Nerve Stimulation (peripheral and central)
- Surgery
Lifestyle Changes
For OAB treatment, health care providers may first ask a patient to make lifestyle changes These changes may also be called behavioral therapy This could mean you eat different foods, change drinking habits, and pre-plan bathroom visits to feel better
- Limit food and drinks that bother the bladder – There are certain foods and drinks known to irritate the bladder of some people You can start by avoiding diuretics – these drinks include caffeine and alcohol and they encourage your body to make more urine. Some foods and drinks that may affect your bladder:
- Coffee / caffeine
- Tea
- Alcohol
- Soda and other fizzy drinks
- Some citrus fruits
- Tomato-based foods
- Chocolate (not white chocolate)
- Some spicy foods
- Keep a bladder diary – Writing down when you make trips to the bathroom for a few days can help you understand your body better. This diary may show you things that make symptoms worse.
- Double voiding – This is when you empty your bladder twice. This may be helpful for people who have trouble fully emptying their bladder. After you go to the bathroom, you wait a few seconds and then try again.
- Delayed voiding – This is when you practice waiting before you pass urine, even when you have to go At first, you wait just a few minutes Gradually, you may be able to wait two to three hours at a time.
- Timed urination – This means you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day. You may try to go every two to four hours, whether you feel you have to or not. The goal is to prevent that urgent feeling and to regain control.
- Exercises to relax your bladder muscle. You may be familiar with exercises to strengthen your pelvic floor muscles, also called Kegel exercises. A special exercise using those same pelvic floor muscles may help relax your bladder during those “gotta go” moments. “Quick flicks” are when you quickly squeeze and relax your pelvic floor muscles over and over again So, when you feel the urge to go, a number of quick flicks may help control that “gotta go” feeling It helps to be still, relax and focus on just the exercise. Your health care team or a physical therapist can help you learn these exercises. Biofeedback may also help you learn about your bladder. Biofeedback uses computer graphs and sounds to monitor muscle movement. It can help teach you how your pelvic muscles move and how strong they are.
- Avoid constipation. Constipation can put pressure on your bladder and worsen your OAB symptoms By keeping healthy bowel habits, you may be able to prevent constipation and help lessen OAB.
Prescription Drugs
When lifestyle changes aren’t enough, the next step may be
to take medicine. There are several drug types that can relax the bladder
muscle. These drugs, like anti-muscarinics and beta-3 adrenoceptor agonists, can help stop your bladder from squeezing when it’s not full. Anti-muscarinics and beta-3 adrenoceptor agonists can relax the bladder muscle and increase the amount of urine your bladder can hold and empty. Combination drugs, like using both anti-muscarinics and beta-3 adrenoceptor agonists together may help control OAB when one option alone isn’t working.
ANTICHOLINERGIC DRUGS – Anticholinergic drugs treat OAB by helping the bladder muscle to relax. Common medications include oxybutynin,tolterodine and solifenacin. They work well for the bladder but are also linked to many bothersome side effects such as dry mouth, constipation, blurred vision, and lately, some concern for causing confusion or dementia with longer-term use.
BETA 3 AGONIST – Another medication for OAB is mirabegron. It is not an anticholinergic medication, so it is not linked to any of the side effects described above. It is an alpha-agonist, so works a little differently on the bladder, but in the end has the same effect of getting the bladder to relax. It can cause increases in blood pressure so should be used with caution in patients with hypertension.
Bladder Botox® Treatment
If lifestyle changes and medicine aren’t working, there are other options. In appropriate patients, a trained urologist or urogynecology & reconstructive pelvic surgery (URPS) specialist can help. They may offer bladder Botox® (onabotulinumtoxin). Botox® works for the bladder by relaxing the muscle of the bladder wall reducing urinary urgency and urge incontinence. It can help the bladder muscles from squeezing too much.
Nerve Stimulation
Another treatment for people who need extra help is nerve stimulation, also called neuromodulation therapy. This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals
between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can
function properly and improve OAB symptoms.
Stress Urinary Incontinence
(SUI) Treatments
Choosing to have surgery is very personal. If surgery is suggested, there are many choices. It helps to learn as much as you can before you decide. You should work with a doctor who has experience in SUI surgery. Learn the risks and benefits of all your surgical choices, as well as what to expect during and after surgery, to make an informed choice that will be best for you.
Slings
Female Sling
The most common surgical treatment and the current standard of care for the surgical treatment of female SUI is the midurethral sling surgery. For this, a strip of soft permanent mesh is placed under the urethra to support urethral closure during actions that involve physical pelvic stress (coughing, sneezing, bending, lifting, jumping and running). It is a simple 10 to 20-minute, outpatient procedure with a small single cut in the vagina. This is done under limited anesthesia and is linked to a quick return to normal day-to-day activities.
Another type of female sling surgery, the pubovaginal sling, is a bladder neck sling. Here the tissue used to make the sling comes from the patient’s abdominal wall or leg (fascia), or donated tissue (bovine or cadaver).
Male Sling
A sling procedure may be offered to treat SUI in some men. The male sling is for urethral sphincter muscle support. For this, a soft mesh tape is placed under the urethra through a cut between the scrotum and rectum. It supports the urethra and sphincter muscle by pushing up on the urethra and causing some coaptation (closure) of the urethra to prevent leaks.
Bladder Neck Suspension / Colposuspension
The Burch Colposuspension, or bladder neck suspension, is surgery for female SUI that lifts the bladder neck up towards the pubic bone with permanent stitches. This is a bigger surgery with a cut through the abdominal wall (muscles and skin) to reach the deeper pelvic areas. Because of the cut into the belly, it takes a longer time to heal from this surgery compared to the more minimally invasive midurethral sling.
In some cases, it can be performed laparoscopically, which lessens the recovery time after surgery.
Bulking Agents (Injections)
This option is used to treat female SUI by “bulking up” the inner urethral lining and making the opening of the urethra smaller. Modern bulking agents are permanent materials that are placed into the tissues around the urethra and sphincter
muscle up towards the bladder neck. This may help the natural urethral closure function to stop leaks. Note that bulking agents are not FDA-approved for male SUI.
Artificial Urinary Sphincter
Implanting a device around the urethra, called an artificial urinary sphincter (AUS), may be an option for men and women. This is the most common treatment for males with SUI. In some cases, women may also be helped from this surgery, but due to other surgical options mentioned earlier, this is rarely needed in women. The AUS is a device with three parts:
1. An artificial urinary sphincter, which is a fluid-filled cuff placed around the urethra.
2. A fluid-filled, pressure-sensing balloon that joins to the cuff and regulates the pressure within the cuff. This balloon is placed in the lower abdomen.
3. A pump placed in the scrotum for men (and labia for women) that transfers the fluid between the cuff and the balloon to open and close the cuff (artificial urinary
sphincter). The pump is easily controlled by the patient. At rest, the AUS cuff is closed (full of fluid) to prevent leaks. When you decide to empty your bladder, you activate the pump to push fluid from the cuff to the balloon. This allows the urethra to open so that the urine can flow through and empty the bladder. If you have had radiation, scar tissue in the urethra, or other bladder problems, then this option may
not be the best option for you.