Urinary Incontinence
What is urinary incontinence?
Urinary incontinence is the uncontrol able loss of urine. The amount of urine leaked can vary
from only a few drops when you cough or sneeze to entirely emptying your bladder without
warning. It is far more than a physical problem with many people suffering emotional
consequences such as depression, isolation, and loss of dignity. Fortunately there are
successful treatment options to help control incontinence.
How common is urinary incontinence?
You are not alone! This is a common condition that can occur at any age. It is estimated that 1
in 4 women wil suffer from significant urinary incontinence at some point in their lifetime.
While less common, incontinence affects mil ions of men as well. Despite the frustrations
caused by the loss of bladder control fewer than half of all people with incontinence seek help,
often because of embarrassment or because they don’t realize that help is available
What are the types of urinary incontinence?
You may not realize it, but there are different types of incontinence. You may also have a
combination of different types of leakage. Determining what type of incontinence you have or
is the most bothersome is important because the treatment options may differ significantly.
Stress incontinence - This is usually experienced as leakage with coughing, sneezing,
laughing, lifting, exercising, doing activities, sexual relations, or anything that increases pressure on the bladder. The amount of leakage is usual y smal (drops), but can be more severe. • Urge incontinence – This is also known as “overactive bladder”. This type of leakage is
usual y associated with frequency of urination, a need to urinate frequently at night, and an intense urge to urinate with very little warning. Often leakage occurs when a person just cannot get to the bathroom in time. This is not really a problem with the bladder, but more of a problem with abnormal signals to the bladder from the nerves and muscles. • Overflow incontinence – This occurs when the bladder cannot fully empty. This may be
caused by a blockage or narrowing of the urethra such as an enlarged prostate in men, scar tissue, or a prolapsed bladder. Overflow incontinence may also occur when the bladder stops contracting due to medications, nerve injury, or chronic overstretching of the bladder muscle. Symptoms include dribbling urine throughout the day, a weak urinary stream, or the feeling of a need to urinate, but sometimes can’t. • Mixed Incontinence – This is common condition which includes a combination of one or

How is incontinence evaluated?
The first step is to tell your doctor about your bladder control problem. A full history will be
taken to understand your pattern of leakage and determine what type of incontinence you
have. In women, a pelvic exam will likely be performed to check for problems or abnormalities.
In men the penis and prostate will be examined.
Other tests you may have:
• Urinalysis and Culture – Testing of a small sample of urine for signs of infection • Cystoscopy – A smal lighted telescope used to examine the inner lining of the bladder • Urodynamics - A small catheter placed in the bladder and rectum to monitor pressures in the bladder. The sensors are then connected to a computer to record the bladder’s behavior.
What are the treatment options for incontinence?
The treatment options for incontinence depend on the type of incontinence you have. Your
symptoms, age, and any underlying medical problems may also affect your treatment.
The main treatment options are listed below. If you have a mixture of types of incontinence
more than one treatment may be necessary.
Stress Incontinence
Urge Incontinence
Overflow Incontinence
Pelvic floor muscle exercises Neuromodulation
Behavioral therapy
Timed Voiding
– timed voiding means urinating on a set schedule instead of waiting until you
have the urge to urinate. This empties the bladder and helps to avoid accidents.
Bladder retraining – If you have urinary frequency and urge incontinence you may be able to
use Kegel exercises to “retrain” your bladder. Each time you feel the urge to urinate, try to stop
the feeling by contracting your pelvic floor muscles. Try to hold your urine a little bit longer
each time. Then calmly walk to the bathroom.
Dietary changes – Some foods may act as bladder irritants and diuretics making you urinate
more often. These include caffeinated drinks and alcohol.
Pelvic Floor Muscle Exercises (Kegel Exercises)
The pelvic floor muscles act as a hammock to hold the bladder and urethra in place. These
muscles function as the “on and off” switch for the bladder and also help keep the urethra
closed. Kegel exercises help with the identification, control, and strengthening of the pelvic
floor muscles and often help improve bladder control.
How to do Kegels:
Tighten the muscles of your pelvis as if you were trying to stop your urine stream, but do not do
the exercise while you are urinating.
Count to ten, then release. Try not to move your leg,
buttock, or stomach muscles. Do at least 10 of these exercises at least three times a day. You
can do these exercises while doing something else such as watching TV or reading.
In Biofeedback a specially trained therapist can help you maximize these exercises. In this
technique a smal sensor is placed in the vagina or rectum. When you contract and relax, your
muscles give off signals. The sensors read these signals and show them on a computer screen.
This way you can learn whether you are exercising the right muscles. Biofeedback is often
combined with several behavioral techniques.
Specific treatments for stress incontinence
Bulking Agents
Material, such as collagen or silicone, can be injected underneath the skin of the urethra to help
“bulk up” the tissue creating a tight seal. The procedure is minimal y invasive and can be done
in the office or in the hospital in an outpatient setting using a cystoscope. While effective the
procedure may need to be repeated at some time down the road if your incontinence returns.
Mid-urethral slings
This is a surgical procedure done in the operating room usual y under sedation with local
anesthesia. Three small incisions are made: A less than 1-inch incision in the vagina and 2 mini
incisions between the labia and inner thigh. In some cases only a single vaginal incision in
made. A ribbon of mesh is then placed under the urethra and brought out through the inner
thigh incisions using specially designed instruments. The sling lies under the urethra acting as a
“hammock”. When abdominal pressure increases, as with a cough, sneeze, or athletic activity,
the sling provides support to keep the urethra closed, preventing loss of urine. The procedure
takes about 15 minutes and you can go home within a few hours.
Specific treatments for urge incontinence
In many cases medications may be prescribed to help relieve urinary urgency, frequency, and
urge incontinence. These medications are called, anticholinergics and work by relaxing the
bladder muscle and increasing the amount of urine the bladder can hold. The side effects of
these medications include dry mouth and constipation; however you may note other side
effects. There are many different kinds of medications on the market. Some examples include:
Ditropan, Ditropan XL, Detrol LA, Vesicare, Sanctura, Oxytrol, Enablex, Toviaz, and Sanctura.
This is also known as Sacral Nerve Stimulation or InterStim. It involves the electrical
stimulation of the sacral nerves, located in the lower area of your spinal cord and passing
through your tailbone. The sacral nerves affect bowel and bladder function and electrical y
stimulating these nerves may change your symptoms.
InterStim has been approved for the treatment of urinary urgency/frequency, urge urinary
incontinence, and some forms of urinary retention. It is important to note that the therapy
does not work for everyone.
Botox Injections
Botox can be injected into your bladder muscle using a cystoscope. The procedure takes about
15 minutes or less and can be done in the office under local anesthesia, or in the operating
room using sedation or general anesthesia. The procedure is done on an outpatient basis.
Botox acts by blocking the release of specialized chemicals from nerves, know as
neurotransmitters, which cause muscles to contract. The effect is to temporarily paralyze or
weaken the muscles that it is injected into. The benefits usual y last for 6-9 months, and then
the procedure may need to be repeated if successful. The main risk is temporary urinary
retention, which occurs in 3-15% of patients and may require the use of self-catheterization to
empty your bladder.
Botox is not yet FDA approved for use in the bladder, and your insurance may not cover the
costs of the procedure.

Specific treatments for overflow incontinence

You may be asked to pass a small tube, or catheter into your bladder several times a day to
empty your urine. This is a safe procedure and once you learn it is not difficult or painful. A
nurse will go over the procedure and give you instructions and supplies.
InterStim is FDA approved and effective for certain forms of urinary retention. Your doctor can
give you more information.
This may be required when the cause is narrowing of the urethra from scar tissue or from
vaginal prolapse.

Source: http://www.flagstaffsurgical.com/files/Urology/Conditions%20Procedures/Urinary%20Incontinence.pdf

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