- Bladder control problems affect 30 to 50% of women.
- Although the rates go up with age, urinary leakage among young women is common.
- Though common, urinary incontinence is NOT “normal” at any age.
Urine leakage (urinary incontinence) is a medical issue and can be categorized into different types:
- Loss of urine that occurs at the same time as physical activities that increase abdominal pressure such as sneezing, coughing, laughing, and exercising (stress incontinence).
- Inability to hold urine long enough to reach the restroom (urinary urge incontinence).
- Frequent urination – more than seven times a day (urge frequency).
- Urinating at night (nocturia).
- A combination of stress and urge incontinence (mixed urinary incontinence).
Am I at Risk?
Certain events or conditions may make a woman more likely to experience urinary incontinence. Sometimes, very clear-cut events such as pregnancy, vaginal delivery, surgery, radiation or accidental injury can lead to urinary incontinence. Other times, causes may be much less well-defined. And, in many cases, there is no obvious underlying reason for why bladder control problems occur.
Some women are born with a weaker pelvic floor. If your mother or sister have bladder control problems, you are at increased risk.
Some medicines, such as diuretics, put you at greater risk for urinary incontinence. Also, certain health conditions increase your chances of developing incontinence:
- Chronic constipation
- Lung conditions
- Neurological conditions
- Kidney or bladder conditions
The Female Pelvic and Reconstructive Surgery clinic is a part of CLS Health. CLS Health is a multi-specialty group with over ninety providers providing comprehensive inpatient and outpatient care in Baytown, Friendswood, Webster, Pasadena, League City, and surrounding areas. For more information, or to schedule an appointment with Dr. Danny Mounir, call 281-993-9817
Urgency Incontinenace/Overactive Bladder
Overactive bladder (OAB) is a complex condition affecting about 15 percent of women across all ages. Symptoms of overactive bladder include urinary frequency, urgency (a strong sensation of the need to urinate), nocturia (waking up with the need to urinate at night), and often leakage of urine accompanied by urgency. See below for more detail about these symptoms:
- Frequency – more than 8 voids in each 24 hours.
- Urgency – that gotta-go now sensation, a powerful urge to urinate, which is difficult to put off.
- Nocturia – waking up one or more at night to urinate.
You may notice severe urgency and leakage when driving into the driveway, placing the key in the front door, running water, or with temperature changes. OAB is a very common condition.
As a first step, talk to your medical provider or bladder specialist, like a urogynecologist or urologist. Discuss when and how often you experience urgency or leakage of urine. A physical exam helps identify other conditions that influence the bladder, such as prolapse.
Diagnosis of Overactive bladder/Urgency Urinary Incontinence will start with a thorough medical history. Your doctor will obtain a history of how often you urinate during the day and night and if you have an abnormal strong urge to urinate. Other important information is if you are leaking with urgency, at night and/or without any sensation. Documentation of pad use is also recorded.
A physical exam will be performed with attention to the abdomen and genital areas for assessment of anatomy and signs of possible pelvic organ prolapse.
A urine sample is important to rule out a bladder infection. Your doctor may also check to make sure you are emptying your bladder. This can be done by either an ultrasound scan of the bladder or by passing a small catheter into the bladder to drain the remaining urine after voiding
Your doctor may request a bladder diary or special tests after your visit.
A urodynamic test is the most common test to understand the function of your bladder and why you may be experiencing these bothersome urinary symptoms.
Based on your history, your doctor may also want to perform a Cystoscopy which is a test that looks inside the bladder see the lining to rule out any bladder stone or cancer.
Medicines for bladder control help to treat an overactive bladder (OAB). The medicines generally work by blocking signals that may cause muscle spasms in the bladder. If you have tried conservative treatments (such as cutting back on common bladder irritants, bladder retraining, and other lifestyle changes) but are still having bothersome bladder symptoms (such as urinary frequency, urinary urgency, or urinary leakage associated with urgency), you may consider starting a medicine to help with bladder control. Talk with your doctor about how your OAB medicine is working. If your symptoms are not improving, ask about the possibility of changing medications or if you might be a candidate for other treatments.
Refractory Overactive Bladder/Advanced Therapies
If lifestyle and behavioral treatments and medicines don’t help to control your symptoms of overactive bladder (OAB), there are additional therapies available. These therapies include: botulinum injections into the bladder and nerve stimulation therapies.
The bladder may be injected with OnabotulinumtoxinA, a powerful neurotoxin. It works by helping to relax the bladder muscle. Bladder injections are usually an outpatient procedure performed in a doctor’s office.
Percutaneous tibial nerve stimulation (PTNS) is an outpatient office procedure in which a slim needle is temporarily inserted in your ankle near the tibial nerve and connected to a battery-powered stimulator. This is like a combination of acupuncture and a TENS unit .Each treatment lasts for approximately 30 minutes and the recommended treatment course is weekly for 12 weeks, followed by a period of tapered therapy that is typically monthly. Sacral nerve modulation (SNM) is an implantable system using a lead and battery (similar to a heart pacemaker) that sends continuous mild electrical impulses to the sacral pelvic nerves. It typically involves a test either in the office with or a one- to two-week trial with placement to confirm success prior to the full placement of the stimulator (battery). The device is reversible, and some devices are not safe for MRIs after insertion.
Stress Urinary Incontinence (SUI)
Stress urinary incontinence (SUI) is loss of urine that occurs at the same time as physical activities that increase abdominal pressure (such as sneezing, coughing, laughing, and exercising).
For women with stress incontinence activities can increase the pressure within the bladder, which acts like a balloon filled with liquid.
Some women leak occasionally. For example, when they exercise aggressively, have colds or allergies, or their bladder is very full. Other women have a great deal of leakage with simple activities such as getting up out of a chair, or casual walking. Although the severity may vary, many women find that these symptoms begin to limit their physical or social activities and can have a serious impact on quality of life.
The good news is that stress urinary incontinence is very treatable! Learn more about treatment options.
Link to Pregnancy
With the joys of childbirth also comes increased weight pushing on your pelvic floor. This added pressure can lead to urine leakage. Pregnancy incontinence is not an official type of incontinence, and often, incontinence related to pregnancy resolves in the first few months after delivery. Pregnancy-related incontinence can be stress incontinence or another form of incontinence. Vaginal delivery can increase the risk of future urinary incontinence. That said, overall the risks of vaginal birth are generally significantly less than Cesareans.
Stress urinary incontinence is both a symptom (urine leakage with activities that increase pressure on the bladder) and a diagnosis (made by a doctor when the leakage is demonstrated on exam or testing). The diagnosis can reliably be made in most cases simply from the symptoms that patients experience! Examination and testing are used to look for unusual causes of incontinence and contributing co-existing conditions.
There are safe and effective treatments available for SUI that you can even try before seeing a doctor. These include exercises and over-the-counter inserts to prevent leakage. See the treatments page for more details.
If you aren’t sure if you have SUI or you have other symptoms too, a physician who specializes in urine leakage can help. Locate a provider near you using our Find a Provider tool.
Depending on your situation, a bladder diary, examination, and possibly additional testing can be helpful. More information on what to expect at the doctor’s office can be found here.
Do you have stress urinary incontinence? If you answer yes to the questions below, it may be time to talk to a doctor about your symptoms:
Do you leak urine (even small drops), wet yourself, or wet your pads or undergarments…
- When you cough or sneeze? (none, rarely, once in awhile, often, most of the time, all of the time)
- When you bend down or lift something up?
- When walking quickly, jogging or exercising?
The good news is that most women (80 to 90%) who seek help find that their symptoms improve. There is a wide array of treatment options, ranging from lifestyle and behavioral changes to surgical options. With treatment, you can recover parts of your life that you may have let go. Depending upon the extent of your symptoms and treatment goals, there may be one or more options for your bladder control problem:
Effective Non-surgical Options
- Lifestyle & Behavior
- Diet and fitness
- Pelvic floor muscle exercise
- Bladder retraining
- Physical therapy for the pelvic floor
- Vaginal Devices (Pessary)
Doctors may suggest surgery to improve bladder control if other treatments for incontinence have failed.
Surgery helps stress urinary incontinence. The best surgical procedures improve or cure the incontinence associated with coughing, laughing, sneezing, and exercise in about 85% of women.
Experts recommend you consider surgery for urinary incontinence only if:
- Incontinence symptoms are bothersome.
- Your doctor confirmed the diagnosis of stress incontinence
- Non-surgical treatments for incontinence failed to provide relief of symptoms.
- The benefits of surgery are expected to be greater than the possible risks.
Types of Stress Urinary Incontinence Surgery
The most commonly performed incontinence surgeries with the highest success rates are:
- Mid-urethral Mesh Slings (also called Vaginal Tape, TVT, TOT, Transobturator Slings, Mini-Slings)
- Pubovaginal/Fascial Bladder Neck Slings
- Burch Colposuspension Procedures
- Urethral Bulking Agent Injections
Mid-Urethral Mesh Slings
Mid-urethral sling (MUS) procedures are the most commonly performed SUI operation. They are safe, effective, and improve quality of life for many women. These procedures involve placing a small piece of mesh underneath the middle part of the urethra (mid-urethra) to provide support. The graft material in this type of sling is most often made of polypropylene mesh. These procedures have been done for over 20 years with excellent results.
Mid-urethral slings are the best-studied incontinence surgery in history. The Food and Drug Administration (FDA) supports the safety and effectiveness of this surgery. The permanent mesh used in this surgery does not cause the high rates of complications that have been in the news related to mesh used for other types of vaginal surgery.
Read interviews with real women who have gone through surgery for stress urinary incontinence. Learn about their stress incontinence surgery recovery time, how long it took to get back to everyday activities, and the effectiveness of receiving the sling as a stress urinary incontinence treatment.
Pubovaginal/Fascial Bladder Neck Slings
Physicians have been performing this operation for stress urinary incontinence since 1947. In this operation, the surgeon uses strong tissue called fascia underneath the urethra with the ends sutured to the tissue covering the abdominal muscles. There is a small incision in the vagina and another just above the pubic bone with this procedure.
The tissue can come from the patient herself or from donated tissue. This procedure does not utilize mesh.
In Burch colposuspensions, the surgeon places stitches into the vaginal wall alongside the urethra and then secures to ligaments nearby in the pelvis. The stitches lift the vaginal wall that the urethra rests upon and provides support.
This procedure does not utilize mesh. It is sometimes performed through small incisions (laparoscopicaly) and sometimes through a larger incision on the abdomen.
Urethral Bulking Agent
In this procedure, a long acting or permanent substance is injected into the muscular wall of the urethra using a cystoscope. This injection causes the tube of the urethral to narrow which results in less urine leakage. Although this is a less effective procedure than other surgeries for stress urinary incontinence (SUI), this procedure:
- Is much less invasive.
- Does not require incisions.
- Has a low complication rate and can be performed in an office or on an outpatient basis.
This is not considered a permanent treatment and likely will require multiple injections over time.
Doctors frequently recommend this procedure for women in poor health, for whom more invasive surgery or anesthesia is not safe; in women with intrinsic sphincteric deficiency; for those women who continue to leak after other incontinence surgery; or for women who desire future pregnancies.
GOOD NEWS! There are certain things that can reduce the likelihood or severity of incontinence.
- Eat healthy with plenty of fiber and fluids
- Decrease caffeine intake
- Move – exercise your body and your pelvic muscles
- Lose weight if you are overweight or obese
- Quit smoking
Something to Talk About
Many women who have bladder control problems are reluctant to discuss them with anyone. They are embarrassed to acknowledge that they have a problem, even to themselves.
The truth is that urinary incontinence can have a very significant impact:
- It can undermine your sense of well-being and self-worth
- It impacts exercise, physical, and social activities
- It impacts work activities, travel, and intimacy
The good news is that 80 to 90% of women who seek treatment experience significant improvement. Providers, like urogynecologists or female urologists, work with women on treatments, ranging from lifestyle and diet changes to nerve stimulation and surgery, and help women recover parts of their lives they may have lost.
Learn more, get evaluated and review treatment options appropriate for your urinary incontinence. The more you know, the more confident you will be in choosing the direction of treatment.
History and Physical Exam
During the initial appointment, your provider will perform a detailed medical history and physical exam and try to diagnose the type of urinary incontinence you have. Your provider also will perform a detailed pelvic exam to evaluate your pelvic support, anatomy, and muscle strength.
In order to evaluate your urinary incontinence and risk factors, you may be asked about your pregnancy history, bowel habits, medications and supplements, and any difficulties with sexual relations.
In addition, diaries and other exams or studies may help your doctor assess your urinary incontinence symptoms
Bladder diary: Your provider may have you fill out a bladder diary to better understand how often and how much you urinate and what leads to urinary leakage.
Urodynamic testing: This test can be helpful to figure out what parts of the bladder and urethra are functioning correctly, and which parts are not.
Cystoscopy: Cystoscopy is a procedure that uses a camera to look inside of the bladder and urethra to see if there are any stones, tumors, inflammation or other problems that might be contributing to the bladder not working properly.