Incontinence

Urinary Incontinence

Urinary incontinence is a very common problem affecting as many as 30 million people in the United States.   Many patients are embarrassed about this problem and tend to not speak openly with their physician.  There is no reason to suffer in silence.  

What happens under normal conditions?

The bladder job is to store urine.  When everything is working correctly, first the brain tells the bladder it is time to release urine then the urethral sphincter (circular muscle) relaxes and lastly the bladder muscle contracts.  Incontinence occurs if closure of the sphincter is inadequate (stress incontinence) or the bladder muscle is overactive and contracts involuntarily (urge incontinence).

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine and is not necessarily a part of aging. It is a common condition experienced by men and women of all ages.

What are the different types of urinary incontinence?

Stress Urinary Incontinence: Stress incontinence is typically associated with physical activity like coughing, laughing, sneezing, lifting, straining, getting out of a chair or bending over. Damage to the pelvic floor from child birth can lead to stress incontinence.  This is also the most common type of incontinence in men that have had prostate surgery.

Urge Urinary Incontinence: Patients typically state “I can’t make it to the restroom in time”.  This urge to urinate is caused by an overactive bladder.  At times the patient may leak without warning, these patients typically wear depends or restrict liquids prior to an outing.  

Mixed Urinary Incontinence: Mixed incontinence is a combination of urge and stress incontinence.

Overflow Urinary Incontinence: Overflow occurs when the bladder never completely empties, which causes urine to leak.

Non-Surgical Management Options

Some of the causes of incontinence are temporary and easily reversible. Reversible causes include urinary tract infection, vaginal infection or irritation, medication, constipation and restricted mobility. However, in some cases, further medical intervention is necessary. Minimally invasive treatment options are those treatments that do not involve surgery and should be the first line of treatment for patients. However, they may also be used in conjunction with surgical therapy.

Fluid Management: This option consists of instructing a patient to increase or reduce their fluid intake. Incontinent patients may need to reduce the amount of caffeine or other dietary irritants (such as acidic fruit juices, colas, coffee and tea), while at the same time increase water intake to produce an adequate amount of non-irritating, non-concentrated urine. A recommended water intake is six to eight glasses per day.

Kegal Exercises:  Kegal exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You can do Kegal exercises discreetly anytime or any place.

Pelvic Floor Exercises: This conservative, non-surgical therapy is used to treat incontinence, urgency, pelvic pain, or to re-educate the pelvic floor muscle to restore and maintain bladder health.  The procedure tech will educate, evaluate, and instruct you on proper isolation and exercise of your pelvic floor muscles.  Using biofeedback technology, a computer recorder monitors the strength of your pelvic muscles and your progress throughout the therapy.  The computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a preset pattern of exercises.  Think of this as your personal trainer while you “do a circuit” of exercises just as they do for muscles in the fitness centers.  You will learn skills that will enable you to continue maintaining pelvic floor health throughout your life.

Electrical Stimulation during Biofeedback Therapy:  Your physician may decide that your pelvic floor muscles could benefit from an extra boost of exercise which can be provided by directly stimulating these muscles.  A very mild electrical stimulation causes the muscle to contract without your direct effort.  Many people also report this offers a sensation that guides them in identifying the correct muscles to contract.  The stimulation often is described as a tingling sensation – this is not painful- and is always adjusted to your specific comfort.  

Pelvic Relaxation Therapy:  The pelvic floor is a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum.  Contracting and relaxing these muscles helps to control bowel and bladder functions.  These muscles must relax to allow for urination and bowel movements.   A computer monitors the strength of your pelvic muscles and your progress throughout the therapy.  The computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a preset pattern of exercises.  These visual and audio “clues” allow you to learn to contract and, even more importantly, to relax the pelvic floor muscles. 

PTNS (percutaneous tibial nerve stimulation):  Is a minimally invasive way to improve urge incontinence in men and women.  A device is attached to a needle which is temporarily placed near the ankle.  The device delivers mild electrical impulses which travel up the nerves in the leg to the nerves that control the bladder.  Many patients see a reduction in the frequency and urgency of their bathroom visits and in the number of accidents they have.

Medication Treatments: Anticholinergics allow for relaxation of the bladder smooth muscle. These drug works well to treat urge incontinence but has side effects including dry mouth, confusion, constipation, blurred vision and an inability to urinate. 

Surgical Management Options

Surgical options are only considered after a full evaluation.  Typically non-invasive techniques will be tried prior to proceeding to surgical options.  The physician will need to identify the type of incontinent because the surgical options are designed to work specifically for each type of incontinence.

Urethral sling surgeries: This surgery technique is used to treat stress urinary incontinence involves placing a sling around the urethra to lift it back into a normal position. The sling is attached to the abdominal wall.

The sling material may be muscle, ligament, or tendon tissue taken from the woman or from an animal, such as a pig. It may also be composed of synthetic material such as plastic that is compatible with body tissues or of absorbable polymer that eventually disintegrates.

Interstim: Interstim therapy is a neuromodulation therapy that targets the communication problem between the brain and the nerves that control the bladder.  It is used to tread urge incontinence.  The patient will go through a trial assessment where a temporary device is attached in an in-office procedure.  Based on the outcome of the trial assessment the patient and physician may decided to proceed to a full implant, which is done under anesthesia at the hospital.

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