Incontinence / Bladder Leakage
Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom. Incontinence can range from the discomfort of slight losses of urine to severe, frequent wetting. Millions of people experience incontinence and it can have a profound impact on their quality of life. Approximately 17 million women in the U.S. encounter urinary incontinence in their lifetime. This condition can occur in women between the ages of 18 and 60 and beyond and is usually a result of the urethra not being closed tightly enough to keep urine in the bladder or spasms of the urinary bladder that overwhelm the ability of the urethra to prevent leakage.
Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that can result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.
There are different types of female urinary incontinence:
Stress Incontinence:
Stress Urinary Incontinence (SUI) is a when a woman leaks urine while she is laughing, coughing, or exercising. Female SUI is caused by an improperly functioning urethra, or bladder neck. Normally the urethra should provide a tight seal to prevent embarrassing and unexpected leakage of urine. When there is loss of support to the muscles and ligaments that support the urethra urine funnels down into the bladder next and will escape as pressure is exerted on the bladder – such as when a woman is coughing, sneezing, or laughing. Stress incontinence involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is one of the most common types of incontinence, particularly in women.
Unstable Bladder / Overactive Bladder Detrusor Instability (DI)
Otherwise known as the Unstable Bladder or Overactive Bladder is caused by an overstimulation of the muscle that surrounds the bladder. Normally this muscle, called the Detrusor Muscle, should remain calm until you decide it is time to go to urinate. When we are toddlers we are training ourselves to control the bladder. An overactive bladder is embarrassing, and can control your life, as you are afraid to wander too far from the nearest bathroom.
Urge Incontinence:
Sudden onset of the strong desire to urinate and subsequent loss of urine the inability to hold urine long enough to reach a restroom, is associated with a sudden, intense desire to urinate that cannot be resisted. It can be caused by neurological conditions such as stroke, dementia, Parkinson’s disease, and multiple sclerosis, but it can also develop in patients without neurological diseases. Problems with bowel movements can also cause urge incontinence.
Mixed Incontinence:
Combination of STRESS and URGE incontinence. Mixed incontinence usually refers to both stress and urge incontinence, but can refer to any combination of types of incontinence
Overflow / Enuresis:
Involuntary loss of urine without any associated urge to urinate or physical activity. For example, wetting the bed while sleeping. Overflow incontinence is leakage that occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it. This type of incontinence generally develops when a person is unable to empty completely on a regular basis. Patients often complain of persistent dribbling, or urinating small amounts but not feeling empty.
Functional Incontinence:
Is a medical condition that prevents a person from making it to the bathroom in time to urinate, resulting in incontinence. Common examples include physical impairments such as arthritis, which make it difficult to move quickly enough to reach a restroom in time, or mental impairments such as dementia, which prevent a person from realizing when they need to urinate.
Total Incontinence:
Is persistent, continuous incontinence that can occur as a result of anatomic abnormalities or injuries that develop during surgery.
Our comprehensive URODYNAMIC TESTING can help make the diagnosis! We can offer real solutions that will allow you to RECLAIM your life! Real choices! Real Results!
Causes of female urinary incontinence
Following are some of the many causes of Urinary Incontinence.
Blocked urethra – from prolapse of the vaginal walls (often described as a bulge from the vagina creating vaginal pressure). The urethra may also be blocked from having previous vaginal or incontinence surgery.
Constipation.
Hormones imbalanced in women.
Being immobile (not being able to move around).
Overactive bladder muscles.
Some medicines.
Urinary tract infection.
Vaginal infection.
Weakness of the bladder or the muscles that hold it in place.
Weakness of the muscles that keep the urethra closed.
Signs and Symptoms:
The symptoms of Urinary Incontinence are different depending on which type of Urinary Incontinence that you have. Please review the various bladder problems or make an appointment with Dr Lisa Erhard today!
Evaluation for Female Urinary Incontinence
Incontinence is a common condition but one that should not be ignored. Women suffering from incontinence should see Dr Erhard because there are a number of treatment interventions that can dramatically improve their urinary control. Dr Erhard will often ask patients to fill out a voiding diary, or a frequency/volume chart, to establish urinary patterns. She may perform a urinalysis to rule out an infection or other problems, a bladder ultrasound or scan after voiding to ensure that the patient is emptying her bladder completely, and a cough stress test to investigate whether stress incontinence exists. Dr Erhard will have you schedule urodynamics test (also called a bladder function test). This evaluation allows Dr Erhard to determine the bladder capacity, whether the bladder is spamming while it is filling, whether incontinence is present, and if so, what type, and whether bladder pressures while it is filling are appropriate. She can also analyze the voiding pattern analyzed with this test, and get an X-ray of the bladder.
Treatment for Female Urinary Incontinence
Dr Erhard will tailor treatment for incontinence to the type of incontinence that is diagnosed. Treatment approaches include:
Behavioral Therapies
Behavioral therapies to help people regain control of their bladder. Therapies include bladder retraining to teach people to resist the urge to void and to gradually expand the intervals between voiding; and routine or scheduled toileting, habit training schedules, and prompted voiding to help people empty their bladders regularly to prevent leaking. Pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage), including Kegel exercises. If done regularly, these exercises of the pelvic muscles can improve, and even prevent, urinary incontinence. Biofeedback used in conjunction with Kegel exercises helps people gain awareness and control of their pelvic muscles. Pelvic floor electrical stimulation is electrical stimulation using mild pulses to spur muscle contractions. This should be performed in conjunction with Kegel exercises. Medication including antimuscarinic agents to treat urge incontinence (Detrol LA, Ditropan XL, Enablex, Oxytrol, Sanctura, and Vesicare), and estrogen to help control urge incontinence in postmenopausal women.
Conditions treated by pelvic rehabilitation are:
Urinary incontinence
Urinary urgency, frequency
Urinary retention
Overactive bladder (Urge incontinence)
Pelvic floor muscle spasm (Levator ani spasm)
Interstitial cystitis
Chronic pelvic pain
Chronic constipation
Fecal incontinence
Pelvic floor relaxation ( muscle weakness)
Postpartum muscle weakness
Dyspareunia (Pain with intercourse)
Pelvic Prolapse Repair
Pelvic organ prolapse occurs when one or more pelvic organs prolapse or drops from its normal location and pushes against the walls of the vagina. It is called a rectocele when it involves the rectum and a cystocele when it involves the bladder. It happens frequently when the muscles in the area are weakened from childbirth or surgery. Symptoms of pelvic organ prolapse include feeling pressure in the vagina from the pelvic organs, feeling very full, feeling a pull or stretch in the groin and having incontinence urine leakage problems. While this condition may be painful, it is often not serious and can even sometimes get better with time.
For pelvic organ prolapse that does not improve on its own or results in severe symptoms, surgery may be necessary to repair the problem. Pelvic prolapse repair surgery includes many different procedures, depending on which organ is affected. These surgeries can include repair of the bladder or urethra, repair of the vaginal wall, closure of the vagina or a hysterectomy. While pelvic organ prolapse can affect as many as 30% of women at some point in their life, it is important to treat it properly and do what you can to prevent future recurrences.
Urinary Incontinence Repair
Surgical treatment of stress incontinence may be an option for women who have failed medical or behavioral therapy. We will run a urodynamic test to determine your severity of urine leakage which helps us decide the best treatment for you. Depending on your circumstance, an abdominal approach or vaginal approach may be utilized. Both options have a very good success rate. The vaginal approach utilizes a sling and typically can be done as an outpatient procedure at the west health facility. Many women choose to combine the sling procedure with vaginal rejuvenation
Stress Incontinence Surgery
Surgery, including vaginal sling procedures to support the urethra and bladder and treat stress incontinence; implantation of bulking agents to support the bladder for stress incontinence; implantation of InterStim–a pacemaker-like device to control the bladder – for urge incontinence. The SLING is a vaginal procedure used to correct (stress urinary incontinence) loss of urine during physical activity – running, jumping, coughing, sneezing, lifting etc. Through a small vaginal incision a (sling) permanent mesh-like material (Prolene) is placed underneath the mid portion of the urethra. The mesh-like material remains as a permanent sling under the urethra. The Sling causes the urethra to close when the patient puts pressure on the bladder (strains, laughs, coughs, etc.). As a result, episodes of stress incontinence are prevented or improved.
Tension Gree Transvaginal Tape (TVT Sling)
The GYNECARE TVT Tension-free support for incontinence primarily consists of a mesh-like tape that is surgically inserted through the vagina to support the bladder neck and urethra. Ordinarily, the urethra maintains a tight seal to prevent loss of urine. For women with stress urinary incontinence, weakened pelvic floor muscles and ligaments cannot support the urethra in its correct position. If you undergo TVT surgery, your surgeon will restore the normal position of the urethra placing a “sling” or mesh tape beneath the urethra. Uniquely, TVT provides support at the middle of the urethra, the section that is under the most strain during normal activities. This restores the urethra to a more natural position, thus correcting the leakage. Unlike other procedures, no bone anchors or sutures are necessary.
Transobturator Tape (TOT)
Transobturator Tape (TOT) is a small sling that is placed below the bladder neck or the urethra in an outpatient surgery that will correct most stress incontinence or bladder leakage. The procedure is very simple and performed in a Same Day Surgery Center. Most patients return to work or normal activities the next day!
Benefits of Surgery Include:
Minimally invasive outpatient procedure (approx 30 to 40 minute procedure) performed through Small vaginal incision.
Dr Erhard’ has a high success rate in treating stress incontinence- 80 to 90% success rate.
50% chance of improving symptoms of overactive bladder (OAB) – sudden urge to urinate, frequent trips to the bathroom to urinate.
Return to work quickly (1 week) – No heavy lifting, straining or sex for 4 to 6 weeks.
Dietary
Dietary modifications including eliminating caffeine in coffee, soda, and tea, and/or eliminating alcohol.
RECLAIM YOUR LIFE!
We offer choices and solutions with Real RESULTS!! Our simple sling procedures will take you from wet to dry in less than 30 minutes!
No more embarrassing leakage or unexpected change of clothes!
