Incontinence at UPMC in South Central Pa.

About half of adult women say they have had urine leakage at one time or another. Many women report it is a daily problem. Embarrassment and shame can prevent them from seeking help. Many mistakenly believe that nothing can be done to correct it.

Luckily, that is not the case! In fact, there is a range of treatment options available to help women conquer this concern. If you have bladder issues, you are not alone. As many as 18 million women of all ages face the inability to predict when and where urination will occur. This common disorder is known as urinary incontinence.

Symptoms of Urinary Incontinence

Urinary incontinence affects everyone differently. You may have urinary incontinence if you experience any of the following:

You leak urine when:

• Laughing
• Coughing and sneezing
• Jumping or exercising
• Lifting, bending or stretching
• Climbing stairs
• Getting up from a chair
• During intercourse

Or you:

• Leak urine as soon as you need to go to the bathroom.
• Feel that your bladder is never completely empty.
• Leak urine even when you drink small amounts of liquid.
• Leak due to triggers such as putting your key in the door or hearing running water.
• Have frequent uncontrollable urges to urinate that may result in incontinence.
• Go to the bathroom more than seven times per day.
• Have frequent leaking episodes.
• Get up more than one time at night to urinate.

If you are experience any of these issues, you should talk with your doctor about urinary incontinence and discuss your treatment options.

What is the cause of urinary incontinence?

Bladder control is a complex process that involves the brain, spinal cord, and muscles of the bladder and pelvis. Loss of bladder control can be caused by problems with any of these components.

Incontinence can be caused by a variety of problems. Some of the causes include normal changes in muscles because of aging, birth defects, pelvic surgery, injuries to the pelvic region or the spinal cord, neurological diseases such as multiple sclerosis and Parkinson’s disease, dementia, degenerative changes associated with aging such as difficulty walking and memory loss, and pregnancy and childbirth.

Types of Urinary Incontinence

Although urinary incontinence problems are most common in post-menopausal women, they can affect women of any age. Aging, pregnancy and childbirth are common causes of several types of urinary incontinence, including:

• Stress urinary incontinence—Stress urinary incontinence is an involuntary loss of a small amount of urine that occurs when laughing, coughing, sneezing or exercising and is typically due to weakness in the pelvic floor.
• Overactive bladder (urgency incontinence)— Overactive bladder is the strong, sudden urge to urinate that may lead to urinary incontinence that is usually caused by bladder spasms. It may also be caused by a disruption or abnormal message from the brain to the bladder.
• Mixed incontinence—Mixed incontinence occurs when patients experience both stress incontinence and urgency incontinence.

How do you diagnose urinary incontinence?

Because incontinence can be caused by a variety of issues and comes in many forms, treatment depends on the results of diagnostic tests by your doctor, which may include X-rays, blood work, and urine analysis, and examination of your bladder capacity, the amount of urine left in your bladder after urination, and urethral pressure.

Urodynamic Evaluation

Your doctor may order urodynamic tests that evaluate how well your bladder is working. Urodynamic tests can be simple or complex and can provide a range of measurements, including:

• How much urine you produce.
• The rate at which your bladder empties.
• The volume of urine remaining in your bladder after you urinate.
• The amount of urine in your bladder when you feel the need to urinate.
• How much urine your bladder can hold before involuntary urination occurs.

Your urogynecologist will evaluate the results of your urodynamic tests to determine if your bladder is functioning normally and recommend appropriate treatment, if needed.

You may also be asked to keep a diary of your bathroom habits. This “voiding diary” keeps track of how much you drink and urinate. An accurate diary gives your urogynecologist a clear picture of how often you go, how often you leak, what you drink, how often your drink, and more. Together, these items provide valuable details about your bladder.

How do you treat urinary incontinence?

Incontinence is not a hopeless condition. UPMC Pinnacle’s Bladder and Pelvic Health program is a comprehensive program offering effective treatments for urinary incontinence.

Our providers have many years of experience treating women with these conditions. Treatments vary from behavioral modification and physical therapy to advanced surgical techniques that can maximize an individual’s quality of life with minimal-to-no down time.

It is important to understand that the two different types of urinary incontinence, urgency incontinence and stress incontinence, are treated differently. Urgency incontinence is usually treated with behavioral modification, physical therapy, timed toileting as well as medications to control bladder spasms, which allows for your bladder to hold for longer and higher volumes of urine. Stress incontinence is usually treated with physical therapy and a procedure known as a midurethral sling.

Behavioral Approaches to Urinary Incontinence

*Mostly used to treat urgency incontinence.

• Scheduled toileting.A person with urinary incontinence is prompted to empty their bladder at a predetermined timed interval as opposed to waiting until there is an urge to void. This is frequently recommended as therapy for frail elderly, bedridden, or Alzheimer's patients.
• Bladder retraining. Bladder retraining involves scheduled toileting, but the length of time between bathroom trips is gradually increased in order to hold larger volumes of urine. This therapy trains the bladder to wait for larger time intervals and has been proven effective in treating urgency and mixed incontinence.
• Pelvic muscle rehabilitation. This technique involves pelvic muscle exercises which may be used alone or in conjunction with biofeedback therapy, vaginal weight training, and pelvic floor stimulation to stimulate pelvic nerves.

Medications for Urinary Incontinence

*Mostly used to treat urgency incontinence.

Medications may be prescribed to help control incontinence. Medications relax your bladder and reduce spasms or instability. These drugs help prevent your bladder contracting spontaneously.

Drinking less water is not a good way to avoid problems with urinary incontinence because this may cause dehydration. Concentrated urine caused by dehydration can cause the lining of the bladder and urethra to become irritated and actually make your incontinence worse. Drinking two to three quarts of water a day may help. Some fluids, like alcohol and caffeinated drinks, may make your incontinence worse. Stop drinking any fluids two to three hours before bedtime.

Other Treatment Options for Urinary Incontinence

After the cause of the incontinence has been determined, your provider may recommend timed voiding, fluid restrictions, and medications to address issues that cannot be changed with behavioral modification. If these provide some or no relief, then there are other treatments such as botox injections into the bladder wall and InterStim.

• InterStim®—InterStim is a small, surgically implanted device that is programmed to provide mild electrical stimulation to your sacral nerves at the base of your tailbone. The sacral nerves are responsible for sending messages to your brain related to bladder and urinary function. The electrical stimulation helps to improve communication between the brain and the sacral nerves so your bladder and pelvic floor muscles can function properly.
• BOTOX®—Botox works by relaxing the overactive bladder muscles increasing to bladder’s ability to store urine and reduce urinary incontinence. Injecting Botox directly into the bladder muscle is done under local anesthesia in a doctor’s office using a small camera that enables the urogynecologist to visualize the bladder.

Not every treatment will work for every patient and sometimes patient will need a mixture of treatments to maximize outcomes.

For stress incontinence, treatment options can consist of physical therapy, pelvic floor exercises, or a patient may use an over the counter product called Imprezza™, which is similar to a tampon in that it stabilizes the urethra during increased abdominal pressure. The current mainstay treatment for stress incontinence is a mid-urethral sling. The mid-urethral sling is an outpatient procedure that is usually performed in the operating room and can provide cure rates up to 90 percent. It has been used in the U.S. for 20 years with significant clinical data that supports its treatment outcomes, safety profile with minimal risk.

• Mid-Urethral Sling Surgery – If more conservative measures have been unsuccessful in treating your incontinence, your doctor may recommend sling surgery. Mid-urethral sling surgery uses a piece of synthetic material to stabilize the urethra and facilitate it to close. The procedure helps prevent involuntary urine leakage when coughing, sneezing, laughing or exercising.
  Other sling options, such as the bladder neck sling, use your own native tissue. Bladder neck slings can be performed for individuals who do not want synthetic material placed or for individuals who have had complications from mid-urethral slings.
• Periurethral Bulking – Certain forms of stress incontinence may be caused by weakened muscles that close the urethra. Along with a sling, a substance can be injected around the urethral muscles to create bulking that improves the ability to close the urethra and prevent incontinence. This can be done in the office or in the operating room.

How do you deal with urinary incontinence?

You don’t have to deal with incontinence or “just live with it.” Bladder issues, like many other health concerns, are easier to treat the earlier you detect the problem. Medicare and most insurance cover treatment for incontinence, though the out-of-pocket cost will be different depending on any copays or deductibles

Bladder issues don’t have to stop you from enjoying life. Contact us today at 717-988-1451 to find out the facts about urinary incontinence and what you can do about it!

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