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Urinary Incontinence

What types of urinary incontinence are there?

  • Stress – loss of urine with cough, sneeze, physical activity, intercourse, etc.
  • Urge – i.e. overactive bladder, like the commercial “gotta go, gotta go,” where there’s a sudden urge and loss of urine before reaching the bathroom.
  • Mixed – a combination of the above two
  • Other – for example, overflow incontinence where bladder is too full for a number of possible reasons and urine “overflows” and leaks uncontrollably sometimes with cough or urge and sometimes without either.

How common is this?

  • Estimates show that up to 40% of women experience urinary incontinence. In nursing homes, it’s as high as 70%.
  • Stress urinary incontinence is the most common with over 10 million women affected.

What are the causes/risk factors?

  • Childbirth is the biggest risk factor for stress incontinence.
  • Menopause/aging, smoking, obesity, functional/cognitive impairments, hysterectomy, medical problems/medications are some of the other causes.

How’s the diagnosis made?

  • A good history and physical exam to start.
  • A questionnaire may be used as well.
  • Urinary diaries help to document when and why leaking occurs.
  • In-office diagnostic testing such as urodynamics.
  • Cystoscopy (looking in the bladder with a telescope/camera) in the office or operating room.

What’s urodynamics? How’s it done, and is it painful?

  • Urodynamic testing is a non-invasive bladder test done in the office. There may be minimal discomfort, but usually there is no pain.
  • To start the test, the patient voids (urinates) on a special toilet that measures the urine flow and amount. So, it’s recommended to come in with a full bladder. Afterwards, a small, flexible catheter is inserted into the bladder to measure bladder pressure. This is where most patients have slight discomfort, but this is done in a matter of seconds and the discomfort almost always subsides immediately. Another small catheter is placed in the vagina to measure abdominal pressure. There is usually no pain or discomfort with the placement of this catheter. The bladder is then gently filled with sterile water or saline through the bladder catheter while bladder and abdominal pressures are being monitored on a computer. Throughout the filling process, your doctor will ask you to cough, bear down, etc. to see if leaking occurs and at what bladder volume and pressure. Your doctor will also ask you when you feel the urge to urinate and determine if your urge comes at a normal bladder volume. After the bladder filling is complete, your doctor will measure the pressure in your urethra (tube that exits the bladder and carries urine out) by slowly pulling the bladder catheter out. The catheter is then placed back into the bladder, and you then empty your bladder into the special toilet used at the beginning. The catheters are then removed, and the test is complete.
  • Urodynamic testing gives you and your doctor an accurate diagnosis, so that you are ensured the correct treatment options are considered.

What are the treatment options?

  • Stress – this is usually treated surgically. Most common treatment now is the sling procedure, where a piece of mesh is placed below the urethra to limit mobility and leaking.
  • Urge – medication is usually used for this class of incontinence.
  • Pelvic floor rehabilation – this is a non-invasive therapy that helps to strengthen the pelvic floor muscles. This can be done alone or in conjunction with any other treatment. This is done in our office and has been found to be very effective. It has many other indications including constipation, pelvic pain, pain with intercourse, muscle spasm, muscle wasting, among many others.
  • A midurethral sling is a surgery for women with stress urinary incontinence. There are several different surgical options.

Talk to your doctor about incontinence. We are here to help.

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