What is urinary incontinence?
Urinary incontinence simply means leaking urine. Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
What are the types of urinary incontinence?
Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, runs, or exercises.
Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. Women with this type of urinary incontinence may leak urine on the way to the bathroom. If you have an “overactive bladder” (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.
What causes urinary incontinence?
Urinary tract infection (UTI)—UTIs sometimes cause leakage and are treated with antibiotics.
Diuretic medications, caffeine, or alcohol—Incontinence may be a side effect of substances that cause your body to make more urine.
Pelvic floor disorders—These disorders are caused by weakening of the muscles and tissues of the pelvic floor and include urinary incontinence, accidental bowel leakage, and pelvic organ prolapse.
Constipation—Long-term constipation often is present in women with urinary incontinence, especially in older women.
Neuromuscular problems—When nerve (neurologic) signals from the brain to the bladder and urethra are disrupted, the muscles that control those organs can malfunction, allowing urine to leak.
Anatomical problems—The outlet of the bladder into the urethra can become blocked by bladder stones or other growths.
What lifestyle changes can help decrease urine leakage?
Lose weight. In overweight women, losing even a small amount of weight (less than 10% of total body weight) may decrease urine leakage.
Manage your fluid intake. If you have leakage in the early morning or at night, you may want to limit your intake of fluids several hours before bedtime. Limiting the amount of fluids you drink also may be useful (no more than 2 liters total a day). Limiting alcohol and caffeine may be helpful as well.
Train your bladder. The goal of bladder training is to learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every 3–4 hours during the day and every 4–8 hours at night).
What types of exercise and physical therapy can help treat urinary incontinence?
Kegel exercises can help strengthen the pelvic muscles. These exercises are helpful for all types of incontinence. Biofeedback is a training technique that may help you locate the correct muscles. In one type of biofeedback, sensors are placed inside or outside the vagina that measure the force of pelvic muscle contraction. When you contract the right muscles, you will see the measurement on a monitor.
What devices are available to help treat urinary incontinence?
A pessary is a device that is inserted into the vagina to treat pelvic support problems and SUI. Pessaries support the walls of your vagina to lift the bladder and urethra. They come in many shapes and sizes. Usually you can insert and remove a support pessary yourself. Pessaries may provide relief of symptoms without surgery. An over-the-counter tampon-like device also is available that is designed specifically to help prevent bladder leaks.
What medications are available to help treat urinary incontinence?
Drugs that control muscle spasms or unwanted bladder contractions can help prevent leakage from urgency urinary incontinence and relieve the symptoms of urgency and frequency.
Mirabegron is a drug that relaxes the bladder muscle and allows the bladder to store more urine. This drug is used to treat urgency urinary incontinence and relieve the symptoms of urgency and frequency.
Injection of a drug called onabotulinumtoxinA into the muscle of the bladder helps stop unwanted bladder muscle contractions. The effects last for about 3–9 months.
What types of surgery are available to treat SUI?
Slings—Different types of slings, such as those made from your own tissue or synthetic materials, can be used to lift or provide support for the urethra. The synthetic midurethral sling is the most common type of sling used to correct SUI. This sling is a narrow strap made of synthetic mesh that is placed under the urethra.
Colposuspension—Stitches are placed on either the side of the bladder neck and attached to nearby supporting structures to lift up the urethra and hold it in place.
If surgery is not an option for you or has not worked for your SUI, urethral bulking may help. A synthetic substance is injected into the tissues around the urethra. The substance acts to “plump up” and narrow the opening of the urethra, which may decrease leakage.
What procedures are available to treat urgency urinary incontinence?
Sacral neuromodulation—This is a technique in which a thin wire is placed under the skin of the low back and close to the nerve that controls the bladder. The wire is attached to a battery device placed under the skin nearby. The device sends a mild electrical signal along the wire to improve bladder function.
Percutaneous tibial nerve stimulation (PTNS)—PTNS is a procedure that is similar to acupuncture. In PTNS, a slender needle is inserted near a nerve in the ankle and connected to a special machine. A signal is sent through the needle to the nerve, which sends the signal to the pelvic floor. PTNS usually involves weekly 30-minute office sessions for a few months.
Sterilization means a permanent form of birth control. For women, this is tubal sterilization, for men this is a vasectomy. There are several different types of sterilization for women, all are offered at Northwest Iowa Surgeons. All are considered permanent and not meant to be reversed. None protect against sexually transmitted infections.
Postpartum tubal ligation- this is done just after the birth of a baby. If a woman has had a vaginal delivery, a small incision is made under the navel and portions of the fallopian tubes are removed. If the baby is born via cesarean section, portions of each fallopian tube are removed at the time of surgery.
Laparoscopic tubal ligation is done in the operating room under anesthesia. A small incision is made in the navel and one other down near the pubic hair line. A thin camera is used and clips are placed across each tube to prevent the sperm and egg from coming together. This type of sterilization is effective right away. Following women for several years after this type of surgery shows it to be highly effective but there is a risk of tubal or ectopic pregnancy which can be a medical emergency. Pregnancy rates following this type of sterilization are between 2 and 10 women out of 1,000.
Hysteroscopic sterilization is usually done in the office with little to no need for medication. A small camera is passed through the cervix and into the vagina. Sterile devices are placed into each tubal opening. These devices cause scarring that allow the tubes to close. It is not immediately effective. A woman must use back-up birth control for three months until an x-ray study can be done (hysterosalpingogram) to see that the tubes are closed off. After following women for more than 5 years, there is a less than 5 in 1,000 risk of failure.
Laparoscopic salpingectomy is surgery that uses small incisions and a camera to remove both fallopian tubes. It is done in the hospital under anesthesia. It will likely involve a slightly longer surgery time, one more incision and a small increased risk of complication as compared to laparoscopic tubal ligation with clips. It may be offered as current research suggests that removal of the entire fallopian tube may reduce some women’s risk of ovarian cancer at an older age although research is still ongoing.