Urinary incontinence is an inability to hold your urine until you get to a toilet. It is often temporary, and it always results from an underlying medical condition. Women experience incontinence two times more often than men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from strokes, multiple sclerosis, and physical problems associated with old age. Older women more often than younger women experience incontinence. But incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages.
If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. Our compassionate and skilled urologists can help you and provide treatment for any underlying medical condition.
Incontinence in women usually occurs because of problems with muscles that help to hold or release urine.
The body stores urine--water and wastes removed by the kidneys--in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body. During urination, muscles in the wall of the bladder contract which forces urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence occurs if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.
Types of Incontinence
If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause are common events that cause stress incontinence. It is the most common form of incontinence in women, and is treatable.
Pelvic floor muscles support your bladder. If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken. Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.
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Urge Incontinence or Overactive Bladder
If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions. Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." It may result from overactive nerves controlling the bladder. Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when someone else is taking a shower or washing dishes). Involuntary actions of bladder muscles can also occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors, and injury--including injury that occurs during surgery--all can harm bladder nerves or muscles.
People with functional incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age.
If your bladder is always full so that it continually leaks urine, you may have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles. Tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.
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Other Types of Incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence--and this combination in particular--are sometimes referred to as "mixed incontinence."
"Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.
Diagnosis
Successful treatment starts with the proper diagnosis. We specialize in the urinary tract system at Georgia Urology and will help you take the first step toward relief by diagnosing the type of incontinence you have. In-depth evaluations may include:
If you have a referring gynecologist, our urologist will prepare and send a report to help him/her choose the best treatment for you.
Treatment
Treatment for urinary incontinence varies for each patient based on their type and severity. In general, non-invasive therapies are tried first and may include:
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Behavioral modifications including timed voiding, dietary changes, weight loss, or changes in medication may be the only treatment necessary in mild cases.
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Pelvic floor rehabilitation may be prescribed to strengthen pelvic muscles to improve bladder control. Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises, which are taught by professional Physical Therapists in many of our convenient Georgia Urology office locations in the metro Atlanta area.
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Therapists may also use biofeedback and electro-stimulation devices as training aids.
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Electro-Stimulation which uses brief doses of electrical stimulation is used to strengthen muscles in the lower pelvis in a way similar to exercising the muscles. This can stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.
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Biofeedback uses measuring devices to help you become aware of your body's functioning. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
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Timed Voiding or Bladder Training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak.
Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying. These techniques may be effective for urge and overflow incontinence.
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Medications are used for urge incontinence to control overactive bladder. Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally. Some of these medications can produce harmful side effects if used for long periods. Talk to your doctor about the risks and benefits of long-term use of medications.
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Sacral Nerve Stimulation Therapy or InterStim involves using a small device to send mild electronic pulses to the nerves in the lower back to help with communication between the brain and the bladder. Our urologists offer this procedure which can be thought of as a pacemaker for the bladder, to relieve symptoms of urge incontinence.
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Bulking agents can be injected into tissues around the urethra to assist the sphincter muscle to prevent leakage. This adds bulk and helps to close the urethra to reduce stress incontinence.
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Catheterization may necessary to empty your bladder if you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis.
For difficult cases stress incontinence, surgery to alleviate incontinence may be recommended after other treatments have been tried. Most stress incontinence results from the bladder dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the bladder up to a more normal position.
At Georgia Urology, our skilled urologists offer a number of minimally invasive surgical treatments which have high success rates and are performed as a simple outpatient procedure.
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Urethral sling procedures can treat stress incontinence with a high success rate. A permanent mesh is used to create a small hammock or sling under the urethra for support. This simple technique can be performed by our urologists in less than half an hour, with virtually no visible incision. Post-operative pain and recovery is minimal and in many cases, patients can return to normal activities in a few weeks.
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Prolapse Management for the many women who suffer with urinary incontinence and co-existing pelvic organ prolapse or "drop". In addition to pelvic floor rehabilitation, Georgia Urology offers minimally invasive surgical options to re-support the pelvic organs.
With an increased awareness that urinary incontinence is a treatable medical condition, patients with incontinence can be managed effectively or even cured. You need not be embarrassed by incontinence, call Georgia Urology today and schedule an appointment to see an experienced urologist at one our our convenient Atlanta area locations.