Carolinas HealthCare System

Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is the loss of control over your bladder, and is a very common problem. Many women leak urine on occasion. In fact, some estimate that 40-60% of women will have to deal with urinary incontince at some point in their lives.For most, the leakage is mild. But for some, it can be severe. However, as any woman who has experienced an embarrassing accident knows, even relatively infrequent leakage can significantly affect her quality of life. Many women are told that this is a normal part of aging. However we believe that women should not have to live with urinary incontinence.

Urinary incontinence can be categorized in two types: Overactive Bladder or Stress Incontinence.

Patients with overactive bladder will often have frequent urination or a strong urge to urinate that is difficult to defer and may lead to urinary incontinence. Stress incontinence refers to leakage of urine with increased pressure on the bladder such as with laughing, coughing, sneezing, running, or exercising. When patients have symptoms of both types, it is called mixed urinary incontinence. It is important to determine which of these types the patient has because the treatment will differ.

Urinary Incontinence

Overactive Bladder

Patients with overactive bladder may benefit from behavior modification, pelvic floor physical therapy, biofeedback, and exercises or medications. CMC has a team of certified nurse practitioners and physical therapists specializing in incontinence and pelvic floor therapy. In difficult cases, minimally invasive procedures such as bladder botox injections or neuromodulation with Interstim therapy can help.

Stress Urinary Incontinence

Stress Incontinence is very common and often the result of trauma to the pelvis that may have occurred during pregnancy and childbirth. First line therapy is often pelvic floor physical therapy and exercises. There are no good medications for stress urinary incontinence in women. Once women have completed their childbearing, many will be a candidate for a minimally invasive outpatient procedure to support the urethra and muscles that control continence with a sling. These procedures are well tolerated, have very good success rates and are performed on an outpatient basis in 15 minutes or less. Often patients can resume normal exercise and activity within two weeks. These procedures were developed about 10 years ago and studies suggest that over 90% of patients are still satisfied with their sling. 

What causes Urinary Incontinence?

Urinary incontinence is a common, often embarrassing problem for millions of people. Although loss of bladder control is more common in women than in men, it is not necessarily an inevitable outcome of childbirth or menopausal changes, nor is it a normal consequence of aging. Urinary incontinence by itself is not a disease, but it is often an indication of another condition that should be treated.

Causes of temporary incontinence include:

  • urinary tract infections
  • constipation
  • some medications, including diuretics (water pills)
  • food or beverages that irritate the bladder
  • overindulgence in alcoholic beverages
  • over- or under-consumption of liquids.

Incontinence from any of these causes is usually easily managed with simple treatment or a change in habits.

Persistent urinary incontinence is almost always caused by an underlying physical problem, such as a urinary-tract obstruction, weakened muscles, or nerve problems.

This type of incontinence may result from:

  • pregnancy and childbirth (may not develop until many years after childbirth)
  • tumor in the urinary tract
  • bladder cancer
  • nerve damage to the bladder from neurological disorders, such as Parkinson's disease, stroke, or spinal-cord injury
  • damage to muscles or nerves as a result of hysterectomy
  • interstitial cystitis (inflammation of the bladder wall)
  • reduction in estrogen after menopause

How is Urinary Incontinence diagnosed?

The first step is a physical examination focused on your pelvic area. Your doctor may ask you how often you experience leakage, whether you have trouble in emptying your bladder, and similar questions. Your doctor may also ask you to keep a bladder diary for a few days. You may be asked to give a urine sample for urinalysis, which is a test for signs of infection, blood in the urine, or other abnormalities. Depending on the results of these tests, you may undergo further testing with specialized tests. These tests may include:

  • stress test - a test in which you cough hard or bear down while the doctor watches for urine loss
  • cystoscopy - a test that allows the doctor to see inside your bladder and urethra through a tiny lens attached to a thin tube inserted into the bladder
  • urodynamic tests - tests that measure pressure in the bladder when empty and when filling
  • postvoid residual urine (PVR) measurement - a test to determine whether you have problems emptying your bladder

What treatments are available for Urinary Incontinence

Treatment depends on the diagnosis and the severity of the problem. Your doctor will recommend the type of treatment best suited for your condition. In many cases, the doctor will suggest a combination of treatments.

Broadly speaking, treatments fall into four categories: behavioral changes, medications, medical devices, and lastly surgery. Within these categories, there are many options. Your doctor will discuss all appropriate options in detail with you and answer all your questions before beginning treatment.

In most cases, the doctor will suggest starting with the least drastic form of treatment.

These options include:

  • Kegel exercises - to help strengthen the muscles that control urination
  • Fluid and diet management
  • Electrical stimulation - to strengthen the pelvic floor muscles
  • Medications
  • Pessaries - removable diaphragm-like device that can aid in urinary incontinence

For most types of urinary incontinence, improvement can be dramatic following treatment. In addition to the lessening or elimination of physical symptoms, many women experience an overall improvement in the quality of their lives.

For more information or to schedule an appointment, please call 704-355-3149.

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