Though urinary incontinence can make you feel frustrated for your restricted lifestyle, don’t: you have lots of treatment options
If there’s one thing I can tell you after 20-plus years of treating urinary incontinence and women’s urologic health issues, it’s that we’ve all peed or almost peed our pants at least once. Perhaps your last “accident” was ages ago and hardly memorable. Perhaps you “leaked” the last time you sneezed, coughed or giggled.
This sort of involuntary release of urine and the frequent urge to urinate can indicate that a person has a form of urinary incontinence, including overactive bladder (OAB), a condition the Urology Care Foundation says affects an estimated 33 million American men and women.
Incontinence is often thought of as an unavoidable aspect of the aging process or something you get used to over time – but this is simply not the case. Urinary incontinence and overactive bladder are treatable and often avoidable medical conditions. And while there is no one-size-fits-all treatment for continence issues, there is an array of treatment options available to get men and women struggling with incontinence and limiting their activities back to doing what they love.
Urinary incontinence & OAB basics
Urinary incontinence is the uncontrolled leaking of urine. I likely don’t have to tell someone experiencing incontinence that it can be embarrassing or interfere with day to day activities and quality of life. Urinary incontinence symptoms vary based on the type of incontinence.
Stress incontinence is recognized by an involuntary loss of urine during activities that increase abdominal pressure such as coughing, laughing, sneezing, lifting, exercise or holding your breath. Age, pregnancy, vaginal and cesarean delivery, pelvic organ prolapse, weak pelvic floor muscles, and previous pelvic surgery all increase a person’s risk of developing stress incontinence.
Urge incontinence, as its name suggests, is marked by the frequent, uncontrolled need to urinate. Sometimes referred to as overactive bladder, this type of incontinence is often accompanied by an uncontrolled release of urine or a “leak.”
Overflow incontinence is the involuntary loss of urine associated with overstretching the bladder. The most common symptoms are stress incontinence and constant dribbling. Overflow incontinence is most common in men.
It is possible and common for someone to experience mixed incontinence, which is a combination of stress incontinence and overactive bladder symptoms.
Urinary incontinence is not a disease in and of itself, but rather a symptom of many conditions including pelvic organ prolapse, estrogen deficiency, weak or stretched pelvic floor muscles, overactive bladder muscles or the bladder muscle’s inability to contract properly. Lifestyle factors such as diet and the use of medications to treat other conditions can also cause incontinence symptoms.
Urinary incontinence treatment options
Men and women experiencing incontinence have a variety of treatment options available to them including dietary changes, pelvic floor exercises, bladder retraining, nerve stimulation, medication and surgery.
Some foods and beverages can irritate the bladder and worsen incontinence symptoms. Caffeinated and carbonated beverages, alcoholic drinks, and acidic juices and fruits are best limited or avoided. Spicy foods can also irritate the bladder. We offer our patients nutrition counseling services, which can help them assess their dietary choices and how they might be affecting their incontinence symptoms.
A vaginal pessary is a small, removable device that is inserted into the vagina to reduce OAB symptoms caused by bladder prolapse. It’s important to work with your medical provider to find a correctly fitted pessary that meets the patient’s lifestyle needs and wants.
Bladder retraining & double voiding
Bladder retraining is behavioral therapy with an end goal: to increase the amount of time between trips to the restroom and the amount of fluid your bladder can hold. We often have our patients complete a voiding diary, and then work with them to develop techniques and strategies to increase the intervals between urination. For some this means creating a structured voiding schedule, for others, this simply means using suppression techniques to delay.
Restroom retraining may also benefit some patients. Bending forward from the waist before sitting down, and leaning slightly forward while seated can improve bladder emptying as can double voiding. The double voiding process begins like your usual trip to the restroom: the individual empties their bladder, remains seated on the toilet for an additional 20-30 seconds, until their bladder empties a second time or you can stand up briefly then sit back down. Some women find it helpful to lean forward, resting their elbows on their knees, or to apply light pressure to their abdomen with their hands. It’s important not to force urination.
Biofeedback & physical therapy
Kegels are a great way to build up the pelvic floor muscles and decrease the symptoms of incontinence, but engaging the muscles in the pelvic floor can be difficult for some women. During biofeedback therapy, computer graphs and audible tones help a woman to identify which muscle groups she is activating. Biofeedback is used to teach women how to control and strengthen their pelvic floor muscles.
Biofeedback is sometimes a precursor to physical therapy, which is used to help strengthen the pelvic floor muscles and decrease incontinence symptoms.
Healthcare providers often prescribe anticholinergics to treat incontinence. This class of medication works by blocking the neurotransmitter acetylcholine from reaching its receptor, preventing involuntary nerve impulses from reaching the muscles in the urinary tract.
Oral medication is a common treatment for a number of incontinence conditions, but it doesn’t work for everyone. This is certainly the case for many overactive bladder and incontinence patients: some have great success with medication while others do not notice a difference in symptoms.
Nerve stimulation techniques
There are two methods of neuromodulation therapy currently available for treating incontinence, InterStim and percutaneous tibial nerve stimulation (PTNS). Both target the sacral nerve located at the bottom of the spine.
Percutaneous tibial nerve stimulation is an FDA-cleared nonsurgical treatment that consists of 12 in-office treatments conducted week after week. Small electrical pulses are introduced to the sacral nerve via the tibial nerve located inside the ankle. These electric pulses target specific neural tissue and “jam” the pathways transmitting unwanted signals to the bladder.
InterStim is an FDA-approved surgical procedure for people who have not had great success with other conventional treatments. InterStim involves implanting a small stimulator in the upper buttock, underneath the skin. Small electrical pulses are introduced to the sacral nerve to improve bladder control.
Odds are you’ve heard of the many curative powers of onabotulinum toxin A, brand name Botox. Sometimes used to help migraine sufferers, Botox has been approved by the Food and Drug Administration to treat OAB in patients who have had little success with oral medication. Botox helps reduce the bladder muscles’ contraction frequency, helping reduce the symptoms of OAB. Like all treatments, Botox poses potential risks to the patient such as urinary retention and urinary tract infection.
Surgical options are available and are primarily used to treat stress incontinence. Surgical options include bulking agent injection, urethral sling or bladder neck suspension and artificial urinary sphincter implantation. I find it important to note that while there are some risks associated with using surgical mesh in some instances, urethral slings are extremely effective for female stress incontinence and have been in use since 1968.
Developing a treatment plan that’s right for you
Treatment for urinary incontinence is dependent on the symptoms, the patient’s medical history and the results of a formal examination. Based on the diagnosis and the patient’s expectations, our team will work to develop a treatment plan that works for the individual.
Most urologic specialists will start with a more conservative approach to treatment to start and work their way toward the more invasive surgical options. There are a number of highly effective and minimally-invasive treatments available for all kinds of incontinence, but what works best for one patient is often very different from what works for another.
Don’t let incontinence keep you from doing what you love. Schedule an appointment today!