Urinary Incontinence

Over 25 million Americans are affected by some sort of urinary incontinence which is the involuntary loss of urine (bladder control). Urinary incontinence is much more common in women than in men. The severity varies for each person ranging from small infrequent bladder leakage to sudden urges to urinate. This can be very embarrassing and disruptive. In some cases it isn’t possible to make it to the restroom on time.

Fortunately most people will benefit from simple lifestyle changes to gain control over their bladder again. For those who with more severe conditions treatment will vary depending on the type of urinary incontinence.

There are 3 types of urinary incontinence: stress, urge and overflow.

Stress Incontinence

The most common type of incontinence is “stress”. It is referred to as “stress” as it is leakage caused by increased pressure. Pressure can be a coughing, sneezing, lifting or bending over. Activities such as running, tennis, yoga and simple day-to-day movements like stepping off a curb or walking down stairs can cause an increase in pressure putting “stress” on the bladder.

Symptoms of Stress Urinary Incontinence

Symptoms range from minimal leakage to large volume loss of urine. Activities that may lead to bladder leakage include:

  • Laughing
  • Sneezing
  • Coughing
  • Exercise or jumping
  • Heavy lifting
  • Sexual intimacy

How does stress urinary incontinence cause bladder leakage?

Bladder leakage is caused by weakness of the ureter pelvic ligaments. During stress movement the ligaments will stretch and sag causing leakage.

Usually this happens after a pregnancy. The type of delivery, age, race, and size of the baby are all contributing factors.

Other risk factors include prior surgery such as a hysterectomy and increased straining from smoking, obesity, or constipation. Straining during a bowel movement can further stretch the ligaments. Estrogen plays a role in stress urinary incontinence.

Things that will help protect the muscles are C-section vs. vaginal birth and hormone replacement therapy.

What are some ways to prevent stress incontinence?

Patients may modify their risk factors by doing the following life style changes:

  • Quit smoking to minimize coughing
  • Lose weight
  • Decrease caffeine and alcohol consumption
  • Manage constipation
  • Modifying high impact activities.
  • Hormone replacement therapy

Physical therapy can improve strength of the muscles and ligaments preventing the passive loss of resistance. If you are experiencing vaginal dryness or notice that the leaking has been worse premenopausal, you may benefit from hormone replacement therapy or the MonaLisa Touch laser treatment.

What are some treatment options for stress incontinence?

  • Bulking agents – collagen
  • Botox to relax the bladder
  • Medications
  • Electrical nerve stimulation
  • Mid-Urethral Slings

If you are experiencing any of the symptoms of stress urinary incontinence, please see your physician for a diagnosis and treatment plan. To schedule an appointment with one of our board certified urologists, please call (425) 454-8016.

Urge Incontinence

Overactive bladder is a very sudden and strong urge to urinate that often leads to loss of urine. Bladder contraction, when it isn’t supposed to, causes urgency. In some cases the feeling is so overwhelming patients may experience leakage before making it to the restroom. When loss of urine occurs it is called “urge” incontinence.

These contractions can be caused by the nervous system or irritation in the bladder.

Causes of Urge Incontinence:

  • Inflammation or irritation
  • Cancer of the bladder
  • Bladder stones
  • Obstruction of the bladder (tumor or urinary stones)
  • Neurological disorders. These may include multiple sclerosis (MS), Parkinson’s disease, stroke, brain tumor, diabetes and spinal injury. Each of these can interfere with the nerves that control the bladder and cause incontinence.
  • BPH
  • Unknown

Other temporary causes that are easily treatable:

  • Urinary tract infections
  • Constipation

Treatment options for Urge Incontinence

  • Behavioral Modifications: Changing and training your bladder to improve function may include timed voiding, double voiding, Kegels, scheduled bathroom breaks and bladder training.
  • Medications: There are many medications available to improve bladder function.
  • PTNS: Percutaneous tibial nerve stimulation is a nonsurgical treatment delivered by a slim needle that is placed in the ankle where the tibial nerve is located. When the tibial nerve is stimulated, impulses travel to the nerve roots in the spine to block abnormal signals from the bladder and prevent bladder spasms. The requires 12 weekly treatments.
  • Bladder Botox injections Botox works by blocking the ability of some nerves to communicate with bladder or sphincter muscles. It is similar to Botox injections to facial muscles. Botox of the bladder is only temporary but very effective. The drug wears off approximately every 8 months to 1 year.
  • Implants: Interstim and Axonics implant devices are placed along the nerve root that controls bladder and bowel function. The device sends electric pulses to sacral nerves (located above the tailbone). A small neuro-stimulator is placed in the upper buttock area under the skin and attached to a lead. Patients use a remote control device to turn their device up or down or off.

    The implant normalizes voiding and bowel movements. Many patients “set it and forget it” and don’t even need to use their remote very often. Others prefer to choose daytime and nighttime programs.

    This technology first became available in 1997 and has been covered by most insurance companies including Medicare. Over the years there have been improvements in the battery and lead. Our physicians have been implanting patients since then and have seen many incredible successful outcomes.

If you are experiencing any of the symptoms of urinary incontinence, please see your physician for a diagnosis and treatment plan. To schedule an appointment with one of our board certified urologists, please call (425) 454-8016.

Overflow Incontinence

Overflow incontinence is the opposite of urge incontinence. It is when the bladder loses the sense of urgency. The patient doesn’t know that their bladder is full and needs to be emptied. This causes the the bladder to involuntarily lose urine (overflow). In some cases the patient may not be able to completely empty the bladder. This will also cause leakage.

Overflow is more common in men than in women. When the prostate is enlarged the bladder becomes overactive creating the urgency. Over time this weakens the bladder muscles making it harder to empty to bladder. When the bladder isn’t fully emptied it can become too full and cause “overflow” or leakage.

Causes of Overflow Incontinence:

  • Blockage
  • Weak bladder muscles
  • Nerve injury that affects the bladder
  • Diseases that affect the nerves including diabetes, Parkinson’s disease, multiple sclerosis and spina bifida
  • Benign prostate hyperplasia (BPH) – enlarged prostate
  • Pelvic prolapse of the uterus or bladder

Treatments for Overflow Incontinence include:

  • Medication
  • Catheters
  • Surgery

If you are experiencing any of the symptoms of urinary incontinence, please see your physician for a diagnosis and treatment plan. To schedule an appointment with one of our board certified urologists, please call (425) 454-8016.