pelvic organ prolapse overactive bladder stress incontinence urinary incontinence joseph t stubbs

Urinary Incontinence

Urinary incontinence is the uncontrollable leakage of urine causing a social or hygienic problem and is objectively demonstrable. It affects an estimated 13 million adults in the United States, with approximately 85% of those affected being women. Among its causes are birth trauma and disease processes that contribute to the weakening of the pelvic floor muscles and the decline of hormone levels that come with menopause.

Although urinary incontinence increases with age, it is not a natural consequence of aging.

There are four main types of urinary incontinence in women:

  • Stress incontinence
  • Urge incontinence
  • Mixed incontinence
  • Overflow incontinence
  • Stress incontinence

    Stress incontinence, is by far, the most common type of incontinence which accounts for about 75% of cases seen by physicians and can occur in any stage throughout a women’s life: high school, college, pregnancy, following childbirth, and on into menopause. It is a loss of urine that happens during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. Most of the time, this condition results from weakening of the pelvic supportive structures for the bladder, bladder neck, and urethra that can occur due to pregnancy, childbirth, obesity, lack of hormonal support, and prior pelvic surgery.

    Urge incontinence

    Urge incontinence is the “gotta go, gotta go” leakage which occurs with a sudden uncontrollable urge to pass urine, and is usually attributable to overactive bladder. Sometimes coughing, the sound of running water or hand/dish washing may trigger the urge incontinence. A bladder can become overactive because of an infection which irritates the bladder lining. The nerves that normally control the bladder can also be responsible for an overactive bladder. In other cases, the cause may be unclear.

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    Mixed incontinence

    Mixed incontinence is a combination of both conditions above -- stress and urge incontinence.

    Overflow incontinence

    This occurs when the bladder cannot adequately empty itself and urine simply leaks out when the bladder is overfilled.  In such cases the bladder is not functioning properly because its nerve supply is impaired. These women do not feel the urge to pass urine. The bad habit of delaying the need to pass urine in certain occupations (assembly line worker, critical care nurse), medical conditions like diabetes, heavy alcohol users, and spinal cord injuries can cause this type of incontinence.

    The three major categories of treatment are: behavioral, pharmacological, and surgical.

    Behavioral Therapy

    Behavioral Therapy is to help train women to behaviorally control mild to moderate incontinence. For example, certain foods and beverages contribute to urgency or increased frequency (i.e., urge incontinence). Therefore, many women find that reducing or eliminating their caffeine intake lessens these symptoms. Also, timed voiding and bladder retraining, which involve urinating on a set schedule during the day regardless of the need or urge to void, is often helpful.

    Pelvic Muscle Exercises

    Pelvic Muscle Exercises (sometimes called “Kegel exercises”) can be helpful for mild stress or urge incontinence. When properly and consistently performed these exercises can strengthen the sphincter muscles and lessen the degree of incontinence.

    Biofeedback

    Exercise and behavioral training can both be enhanced by biofeedback and thereby help women with both stress and urge incontinence. During biofeedback training, a probe inserted into the patient’s vagina sends images to a television monitor, which allows patients to watch the muscles’ response as they are squeezed. The monitor helps women know when they are contracting the proper muscles, and it guides the training sessions toward better muscle endurance.

    Pharmacological therapy

    Pharmacological therapy utilizes a number of prescription medications which help control overactive bladder and are called anticholinergics. Other drug therapies for stress incontinence work by enhancing urethral closure pressure. If pelvic-floor muscles have atrophied, estrogen replacement may restore some strength.

    Medical Devices

    Medical Devices are for women who do not experience relief with non-surgical treatments but do not yet wish to undergo surgery. Options available are urethral plugs and patches, vaginal tampons, pessaries (diaphragm-like devices that support the vagina), catheters, pelvic organ support devices, external collection systems, and absorbent products.

    Surgery

    There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of the incontinence. Some of the more common procedures performed are bladder neck suspension or sling procedures, periurethral bulking injections (collagen injections around the urethra), restoration of the normal support of the pelvic floor, implantation of an artificial urinary sphincter or sacral nerve stimulator.

    Conclusion

    Approximately 80% of women affected by urinary incontinence can be cured or improved. Yet despite the high success rates in treating incontinence, only one out of every twelve people affected seeks help. There are many types of treatments available in the management of urinary incontinence, and through a detailed evaluation, we can recommend the treatment that is appropriate for you.

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