Urinary incontinence is the unintentional leakage of urine or loss of bladder control. Incontinence affects millions of Americans, both men and women. Although about half of the older population experiences episodes of incontinence, bladder problems are not a natural consequence of aging. Urinary incontinence can be slightly bothersome or totally debilitating.
Stress Urinary Incontinence
Stress incontinence refers to the type of urine leakage that results from coughing, sneezing, lifting, or anything that causes increased pressure on the bladder. This is usually due to weakness of the pelvic floor and the bladder support mechanisms most often related to pregnancy, menopause or pelvic surgery.
Treatment options for stress incontinence are numerous, from non-surgical such as Kegel exercises, biofeedback techniques, medications and vaginal pessary to surgical procedures that range from endoscopic to vaginal or suprapubic.
A variety of bulking agents, such as collagen or carbon spheres are available for injection into the urethra. These agents “bulk up” the bladder neck and urethra to help close or “coapt” the bladder outlet and reduce stress incontinence.
The vaginal approach has become the state of the art way to treat stress incontinence by the use of a “sling” or “vaginal tape” to elevate the mid urethra for support. This is a very short outpatient procedure that has minimal downtime and does not require a catheter.
Urge incontinence is when the urge to urinate is so strong that you begin leaking before you are able to make it to the bathroom. It is caused by an uninhibited bladder contraction that escapes control of the central nervous system. Some causes of urgency leakage are :
- Urinary tract infections
- Damage to the nervous system caused by Multiple sclerosis, Parkinson’s Disease, Alzheimer’s Disease, Stroke or other medical problem.
- Bowel problems
A diet high in bladder irritants such as coffee, tea, chocolate, or acidic fruit juices This condition often times responds to pharmacologic agents that suppress the bladder muscle (detrusor) spasms and hyperreflexia. Bladder retraining and Biofeedback which is implemented in the “Bladder Fitness Program” can help the patient to control unstable contractions of the pelvic floor and bladder muscle.
If a behavioral or pharmacologic approach is not effective in controlling urge incontinence, or non-obstructive urinary retention ,then a reversible treatment called the “Interstim” therapy may be considered. Interstim Therapy is where a neurostimulator is implanted to electrically stimulate the sacral nerve that controls the voiding function.
This type of incontinence is leakage from a bladder that fails to empty properly and may be the result of severe bladder or urethral obstruction, a neurologic lesion or diabetes.