Urinary incontinence is a very common condition in the United States. Approximately 14 million Americans suffer from this condition with women affected twice as often as men. Despite its prevalence, relatively few sufferers seek evaluation and therapy. Many women believe this is a normal consequence of aging and does not require evaluation or therapy. This leads to a poor quality of life. Fortunately, therapy is available and has high cure rates.
Incontinence exists in two forms. Urge incontinence manifests with irritative voiding symptoms. These include feelings of needing to void urgently, frequent urination, and awaking at night to urinate. At its worst, urge incontinence presents with the leaking while running to the bathroom. Urologists believe this is due, in part, to an overactive bladder. Stress incontinence, on the other hand, is leaking urine with activity. It results from incompetence of the urinary sphincter-the muscle controlling urinary continence. Sufferers note leakage of urine with coughing, sneezing and running. It is not uncommon for both conditions to occur in the same patient. This is mixed urinary incontinence. Some experts believe stress incontinence causes a reflex in the bladder. This reflex causes uninhibited squeezing of the bladder muscle which yields urinary urgency.
The incontinence evaluation is relatively easy. A history and physical including a pelvic examination elicits any non-urologic causes of the condition such as neurological disease, gastrointestinal dysfunction, medications or pelvic prolapse (“dropped bladder”). The physician checks a urinalysis to examine for infection or blood in the urine. In patients with significant irritative voiding symptoms, the physician may obtain a 72 hour voiding log in which the patient measures and records his/her urine volumes with each void. This provides an objective measure of the number of voids per day, functional bladder volume, and total daily urine volume. Some patients require a cystoscopy, a test in which the urologist uses a small scope to evaluate the bladder for disease. This is done in the urologist’s office with minimal discomfort.
Treatment of the two conditions is quite different. Urge incontinence is typically treated with medication, and behavioral modifications. The medications are a group of drugs known as anticholinergics. Examples of anticholinergics include oxybutinin, tolterodine, and trospium chloride. These drugs relax the bladder muscle and decrease it’s over activity. There are a large number of ant cholinergic drugs with varying effectiveness and side effect rates. It is not uncommon for patients to require a trial of several different drugs until the most effective drug is found. In addition to medications, patients also perform behavioral modification. This includes urinating on a schedule, avoiding foods which irritate the bladder and even decreasing fluid intake. The physician tailors the behavioral modification regimen to each patient’s needs. Biofeedback and pelvic physical therapy may also provide benefit to urge incontinence sufferers. Urge incontinence treatment is effective. Treatment does not achieve complete relief of symptoms in all patients. Some patients may require lifetime therapy with an urologist for control of symptoms.
Stress incontinence therapy is generally surgical. Most patients with stress incontinence attempt Kegel exercises to strengthen the pelvic floor. There are limited results with these exercises in treating stress incontinence. Fortunately, two surgical options exist. The first is injection of urethral bulking agents. The urologist injects an agent, typically collagen, into the urethra using a scope to add resistance at the urethral sphincter. The procedure can be performed in the clinic or as outpatient surgery. It is up to 90% effective. Patients may require multiple injections to become dry and often require touch up injections every 6 or 12 months. This option is minimally invasive and well tolerated. The other option is a urethral sling. During this procedure the urologist places a sling underneath the urethra through a vaginal incision. This surgical procedure is performed as an outpatient or with an overnight hospital stay. Sling surgery has an approximate 90% success rate and very few adverse side effects. Patients tolerate this procedure well and are pleased with the outcome. The patient’s symptoms, physical exam findings, preference and the surgeon’s comfort with the procedure determine which surgical therapy is optimal.
Urinary incontinence is a very common condition in women. It is under-diagnosed and under-treated. Evaluation and treatment of this condition is easy and safe. Patients who elect treatment note significant improvement in their quality of life and are happy with their choice. Women with incontinence should seek consultation with their local urologist. If we can be of service to you or your family members in the treatment of urinary incontinence or any other urologic disease, please contact us at The Jackson Clinic Department of Urology at 731-422-0333.