There are many different types of urinary incontinence. This affects both genders but women more commonly than men and will be the focus of this blog. Two of the more common types of incontinence are "urge incontinence" and "stress incontinence". Very effective treatment options exist for both although it is critically important to first arrive at the correct diagnosis. I recommend consulting your local Urologist. Depending on your presentation, there may be very limited testing needed. In other cases we may need to perform diagnostic tests such as cystoscopy (looking in the bladder with a small flexible camera scope) or urodynamics (a test of how well or poorly the bladder is functioning).
Stress incontinence is when there is a loss of urine with an increase of abdominal force. This can occur with laughing, coughing, sneezing, exercising, picking up heavy objects, or just moving from a sitting to a standing position. It can range from a very small loss of urine to nearly continual leakage. For mild cases, treatment options can include physical therapy and pelvic floor rehabilitation. Surgical intervention most commonly consists of intra-urethral bulking agents or a mid-urethral sling. These procedures are worthy of a detailed discussion with your treating Urologist.
Urge incontinence occurs when there is an unintended bladder contraction resulting in a sudden urge to urinate. This can occur without any type of activity, in one's sleep, and often has triggers such as running water. Typical first line treatment options will consist of dietary and behavioral modifications. There are an array of medications specifically designed to help this condition which can be quite effective for many patients. If these medications are not successful or you are suffering side effects, there are now several more advanced options such as:
- Percutaneous tibial nerve stimulation (PTNS): an in-office procedure done once a week for 12 weeks. Minimal risk of side effects and effective in over half of patients. Results are not permanent but can last up to 12 months.
- Sacral nerve modulation (Interstim): a surgical procedure to directly stimulate the S3 nerve that controls bladder function. Effective in over half of patients and is a durable treatment option (if successful, it connects to an internal battery supply similar to a pacemaker).
- Botox: yes, the same stuff used for wrinkles! It can be injected (in the office or surgical suite) into the bladder wall.
Please also be aware that incontinence can be a sign or manifestation of other problems such as an underlying bladder tumor, bladder stones, interstitial cystitis, and others. Consult your Urologist for a complete evaluation and discussion of management options.