Urinary incontinence is the involuntary loss of urine. It is a very common problem affecting an estimated 13 million adults in the United States and the vast majority of them are women. There are two main types of urinary incontinence. Stress incontinence occurs with any activity that can put pressure on the bladder such as sneezing, coughing, laughing, intercourse, lifting and exercise. It is the most common type of incontinence. Urge incontinence is a strong or sudden urge to urinate with the inability to reach the bathroom in time. This can happen even when your bladder is holding only a small amount of urine. Patients with urge loss can also struggle with voiding more frequently during during the day and at night. Mixed incontinence is when patients have some combination of both stress and urge urine loss. It’s very important to carefully discern the cause of leakage for any individual patient to know how to treat them effectively.
Stress incontinence is caused by weakening of the pelvic floor tissues and disruption of their usual anatomic position and/or function. For women there is a strong correlation with their number of vaginal deliveries and larger birth weights. Other factors include repetitive heavy lifting or chronic cough and less likely neurologic injury to the lower back or pelvic floor. Urge incontinence is caused by involuntary detrusor or bladder muscle contractions when it’s not expected or wanted. Needing to void more frequently in small amounts is common. Causes of urgency include dietary irritants such as excessive caffeine and/or high acid foods, certain medications like diuretics and medical conditions like interstitial cystitis. Urgency and frequency are generally progressively worse as we age and that’s also when mobility issues can make physically getting to the restroom in a timely fashion more difficult.
While urinary incontinence is very common among women, unfortunately less than half of women tell their provider. This is commonly due to embarrassment but women may also underreport because symptoms have very slowly progressed over time and to some degree they have “become used to it”. Women also tend to minimize symptoms by adjusting behavior and activities. They tend to restrict oral fluids and reduce the physical activities that either make them leak or restrict their access to a restroom. They may also empty frequently to preemptively avoid urine loss. Unfortunately, it’s common for patients to start making an “I used to” list and keep adding to it. It’s very sad to hear “I used to jog, bowl, and jazzercise” or, “I would never dream of hiking that far from a restroom”. The good news is that with proper evaluation and treatment the vast majority of incontinence can be cured or significantly improved!
The best treatment for urinary loss depends on the type of incontinence, the severity of the problem, and the underlying cause. If urgency incontinenceis part of the problem it needs to be dealt with first to understand exactly what stress loss symptoms remain. A urinalysis should be done to rule out something as simple as a UTI. Thankfully, treatments for urgency are highly successful and simple dietary education and adjustments may be all that’s needed. Restricting irritants such as caffeine and high acid foods can have a significant impact. Several medications are also available to help treat bladder contractions and urgency. In years past they had significant side effects but now there are several good options.
Stress urinary incontinence is usually from too much mobility of the urethra tube which drains the urine from the bladder to the outside. If the stress loss is minimal, simply exercising the pelvic floor muscles with Kegels done correctly may have satisfactory results. Avoiding constipation, smoking cessation, and losing weight are also helpful. In menopausal women vaginal estrogen may be indicated. Definitive treatment for moderate to severe stress loss frequently requires surgical correction. In years past surgery usually involved a moderate abdominal incision with a MMK or Burch procedure and 2-3 days of hospitalization.
Surgical options have been revolutionized by a minimally invasive surgery called a Pubovaginal Sling or Tension Free Vaginal Tape (TVT). The TVT utilizes a soft mesh band about ½ inches in width to create a backstop of sorts. When the urethra drops down with a cough or sneeze instead of the urethra bulging down and leaking it compresses against the sling and urine is obstructed from leaking. Dr. Kratz was the first gynecologist to offer this procedure in Springfield about 13 years ago and his patients have appreciated dramatic results with well over 95% being completely dry in over 500 patients treated. The actual surgery lasts only 20-30 minutes. Patients go home usually within 2-3 hours and are back to work on Monday after surgery on a Friday.
We know it’s very embarrassing but please talk to us about your urine loss. It is incredibly common and we help several patients every day address their issues. It’s likely we start with a detailed history, exam and urinalysis. Most patients can make dramatic improvements without needing surgery but if genuine stress loss persists we will perform Urodynamic Studies to confirm the exact nature of loss. We measure voided volume when full, residual volume, bladder and urethral pressures, bladder capacity, and bladder contractions. This information validates the exact nature of the bladder dysfunction and that the problem should be amenable to surgical correction. The surgical options are minimally invasive and in most cases are done on an outpatient basis with great results. Please call the Woman’s Clinic with questions or to schedule your appointment.