General Information

Urinary incontinence commonly affects both men and women over the age of 40. Common risk factors for urinary incontinence can include advancing age, obesity, or women who have experienced natural childbirth. There are 4 main types of bladder incontinence.

Stress Incontinence

This is caused by sudden physical movements, such as coughing, sneezing, laughing, jumping, or lifting. Stress incontinence is common following pregnancy or childbirth, menopause, surgical trauma, or pelvic radiation. It often occurs because of weakening or damage to the muscles that hold the urine in the bladder, such as the pelvic floor muscles and urethral sphincter.

Urge Incontinence

Urgency is the symptom of a sudden need to urinate. People with urge incontinence experience a very sudden need to void and cannot make it to the bathroom in time. Urge incontinence usually results from overactivity of the bladder muscle.

Mixed Incontinence

This is when patients have a combination of both stress incontinence and urge incontinence. For many people, either urge or stress incontinence is often more bothersome than the other, but both can occur.

Overflow Incontinence

This issue occurs when a person is unable to completely empty the bladder by urinating and is associated with frequent uncontrolled leakage. The bladder becomes too full, and as a result, urine “overflows” and incontinence occurs. It can be caused by an enlarged prostate, diabetes, spinal cord injuries, or other neurological issues.

Diagnosis

Diagnosing urinary incontinence primarily involves observing and recognizing patterns, as well as a physical exam. Some patients may fill out a bladder diary for a few days to get a better idea of when the incontinence happens. Urinalysis is important to rule out other treatable causes of incontinence, such as infection.

Physical Examination

This may be a bit intimidating for the patient, but for the doctor, it is routine and normal. The simplest test will start with a request to remove clothing from the waist down. For males, the doctor may inspect the prostate gland, known clinically as a digital rectal examination. During this examination, a finger is inserted into the anus, and the size of the prostate is estimated from the impression. For women, a brief pelvic exam is often performed.

Urine Tests

A urine dipstick test is usually conducted to determine if the problem is related to a urinary tract infection. During this test, a sample of the patient’s urine is collected, and a testing stick is dipped into it. The stick changes color in the presence of bacteria, blood, and/or protein in the urine.

Bladder Scan

A residual urine test can also be conducted to determine if the patient is emptying the bladder well. The objective of this test is to determine how much urine remains in the bladder after the patient voids. This can be determined using an ultrasound or by draining the contents with a catheter, which is a long flexible tube that is passed along the urethra into the bladder.

Treatment

The good news is that there are many treatments for incontinence. The treatment that will be best for you will depend on the type of incontinence. Discuss your specific circumstances with our urology specialists to define a personalized treatment plan.

Self-Managed Therapies

These involve behavior modifications and pelvic floor exercises. Pelvic floor exercises, called Kegels, are used to strengthen the pelvic floor muscles, improve pelvic alignment, and help with bladder control. Behavioral modifications for addressing leaking urine can involve:

• Reducing or eliminating bladder irritants from your diet (e.g. coffee, carbonated drinks, citrus juices)
• Timed urination (practicing control)
• A strict fluid intake regimen
• Reducing your weight, especially in case of obesity

Medication

Drug therapies may include oral and topical treatments. Medication is best for urge incontinence.

• Oral therapies include anticholinergics, selective alpha-blockers (mainly for men), and beta-agonists.
• Topical estrogen can be applied vaginally for post-menopausal women

InterStim Sacral neuromodulation (SNM)

This is a treatment for urge incontinence. SNM involves non-invasively stimulating the sacral nerve with a weak electrical current delivered by electrodes, effectively acting as a bladder pacemaker. The procedure is typically done in the operating room in two stages. The first stage is a trial to see if it improves symptoms. If the therapy works, then the electrodes and battery are placed internally.

Botox

This is a treatment for urge incontinence. Botox involves an injection of medication into the bladder using a special camera or scope that is placed in the bladder through the urethra. This can be done in the office or as an outpatient procedure.

Percutaneous Tibial Nerve Stimulation (PTNS)

This is a treatment for urge incontinence. PTNS involves weekly 30-minute treatments given in the office that may continue for 2-3 months. During these procedures, a small acupuncture needle is inserted into the ankle area, and a weak electrical impulse is delivered.

Sling

This is a treatment for stress incontinence. The sling procedure involves making a small incision in the vagina, just below the urethra, and a piece of synthetic mesh material is placed around the urethra. This is an outpatient procedure. The goal of the sling is to provide extra support to the urethra and eliminate leakage with coughing, laughing, or sneezing.

Bulkamid

This is a treatment for stress incontinence. Bulkamid involves an injection using a small camera or scope and injecting a gel into the urethra in several positions. Bulkamid consists of 3-4 injections of a gel material into the wall of the urethra. By adding additional volume to the wall of the urethra, it helps prevent urine from leaking out of the bladder during normal daily activities. This is an outpatient procedure.