Urinary incontinence is defined as the involuntary loss of urine which the patient describes as being “wet”. Urinary control is maintained by an intact nervous system which directs the muscles and sphincters of the pelvis. If there is compromise of the nervous system (neurologic disease such as Parkinson’s, Alzheimer’s, Diabetes, etc.) or the muscles/sphincters (trauma, surgery, radiation, infection) then urinary control may be adversely affected.
In addition to the above, there are general causes of incontinence which often vary by gender particularly as men/women age. In men, there may be overflow incontinence in which the bladder is blocked often by an enlarged prostate. In women, there may be stress incontinence, caused by laxity of the pelvic muscles which occurs with age and is often accentuated as a result of childbirth.
Both men and women suffer from urgency incontinence (i.e., getting to the bathroom in time). This occurs as the bladder becomes fibrotic (less compliant) with age. As a result of this, older adults can’t postpone urinating and void more frequently that younger people. The same is true for older people whose bladder awakens them at night and often interferes with what had been ‘normal’ sleep habits.
There is treatment available for all forms of incontinence and urinary urgency and frequency. These run the gamut from behavioral therapy, timed voiding, medication and surgical procedures.
Thousands of patients annually are plagued by urinary leakage, yet many feel reluctant to raise this sensitive issue with their doctor. Many patients have been led to believe this is a “normal part of the aging process” or “an unavoidable consequence of childbirth”. Although age and child bearing can impact the bladder, this is an area where there are a growing number of treatment options which can improve the quality of life.
It’s critical to understand there are two types of urinary leakage. And it’s important to differentiate between the two as the treatment options depend on the type.
Stress Urinary Incontinence is the involuntary passage of small amounts of urine that occurs when one laughs, coughs/sneezes or exercises. This is often experienced after pregnancy/childbirth but can also be seen with significant weight gain and conditions associated with chronic pushing/coughing such as chronic constipation or asthma. It may also be more noticeable after the onset of menopause.
Stress urinary incontinence is treated with physical exercises. When this fails, there are surgical options. Surgery for stress urinary incontinence is an outpatient procedure with excellent outcomes.
Conversely, Urgency and Urge Incontinence is the involuntary passage of urine that is accompanied by the desire to urinate. Individuals feel they are unable to “make it to the toilet in time”. Patients often describe specific triggers, such as “putting a key in their apartment door” or “opening the bathroom stall”. This condition is often more noticeable with age, and is often worsened by bladder irritants. The most common bladder “triggers” are caffeine, tobacco, alcohol and artificial sweetener.
For urgency and urge incontinence, counseling and behavioral modifications are sometimes all that is required to improve bladder symptoms. For some, bladder medications provide relief. There are many medications from which to choose, including a newer medication with fewer side effects. When these options fail to bring relief, patients may choose to have a Botox bladder injection which will relax the bladder and thus prevent the spasms which are responsible for the leakage. Or, they may choose to try a sacral neuromodulator which is a tiny device that sends an electrical impulse to the bladder to prevent involuntary bladder contractions and therefore improve leakage.
In 2017 we are fortunate to have many tools in our armamentarium to offer to those suffering with urinary leakage. Please give us a call or request an appointment online to see how we can help.
Ms. X is a middle aged woman with two children. Ever since the delivery of her last baby, she developed urinary leakage. It happened when she coughed or had a heavy cold. Over the last three years, she recalls that the leakage got worse. Not only did she have a problem when she had a cold, but she leaked during her workouts, or even if she tripped off the curb or suddenly dashed for the subway. The constant leaks had a great impact in her active lifestyle and self esteem. She begun to wear a pad every day, and sometimes she wore a heavy pad. Ms. X said that she felt a heaviness and pressure in her pelvis, usually by the end of the day.
Her gynecologist recommended that she have a consultation with our office regarding treatment. On examination, she was found to have a dropped bladder, which would account for the heavy feeling in the pelvis. Urine squirted out of her urethra when she was asked to cough during the pelvic examination. Her problems were fairly clear to us by the end of the consultation.
A Urodynamics test at our office was done to determine how we could best help her. Once her problem was better defined we scheduled outpatient surgery. During that session we would correct both the dropped bladder and the urinary incontinence problem. She took off two weeks from work post surgery to allow her to rest and heal.
Since the surgical procedure she feels great with resolution of both of her problems. Ms. X is no longer experiencing leakage during her day to day activities. She now enjoys her workouts and has had no need to wear pads. Her quality of life and self esteem have improved greatly. She indicated in our last visit that she is ready to get out there are start dating. Unfortunately, we can’t help her in that department!