Overactive bladder
Does it feel like you're always hurrying to the bathroom, afraid that you won't make it on time? Do you have trouble sitting through meetings or social functions without taking a restroom break? If so, you may have an overactive bladder.
Overactive bladder is a problem with bladder function that causes a sudden urge to urinate. The urge may be difficult to suppress, and overactive bladder can even lead to the involuntary loss of urine (incontinence).
If you have overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that after a brief evaluation to determine the cause, you can receive treatments that may greatly alleviate symptoms of overactive bladder and help you manage their impact on your daily life.
Symptoms
Signs and symptoms of overactive bladder may mean you:
Feel a strong, sudden urge to urinate
Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
Urinate frequently, usually eight or more times in 24 hours
Awaken two or more times in the night to urinate (nocturia)
Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and nighttime urination, as well as the need to suddenly "drop everything," can definitely disrupt your life.
When to see a doctor
Fewer than half of women and less than one-quarter of men who experience incontinence ever talk to their doctor about the problem, according to a study in the Journal of Urology.
Although it can sometimes be difficult to discuss such a normally private matter with your doctor, it's important that you do, especially if you experience urge incontinence or if other symptoms of overactive bladder disrupt your work schedule, social interactions and everyday activities.
Don't avoid an evaluation and simply deal with the condition by wearing absorbent undergarments or pads. Treatments are available that might help you. Additionally, it's important to talk to your doctor because an overactive bladder and urge incontinence may occur as a result of a serious underlying problem, such as a cancerous tumor.
Causes
Filling and emptying your bladder is a complex interplay of kidney function, nerve signals and muscle activity. A problem anywhere throughout this system can contribute to overactive bladder and urge incontinence.
Normal bladder function
Your kidneys produce urine, which travels down a pair of long tubes from your kidneys to your bladder. Urine drains from your bladder through an opening at the bottom (neck) and flows out a short tube called the urethra (u-REE-thrah). In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.
Your bladder expands like a balloon to accommodate the flow of urine. When it's reached about half its capacity, nerve signals alert your brain, and you sense that your bladder is "full." By the time it's three-quarters full, you feel the need to urinate (void). When you urinate, nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper portion of the urethra (urinary sphincter muscles). The muscles of the bladder contract, forcing urine out.
Involuntary bladder contractions
The symptoms of overactive bladder occur in most cases because the muscles of the bladder involuntarily contract. This contraction creates the urgent need to urinate. The urinary sphincter may remain constricted and prevent the bladder from leaking. If the sphincter's strength is overwhelmed by the contraction, then a person experiences urge incontinence.
Causal or contributing factors
In many cases doctors can't exactly identify the causes of overactive bladder. Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis, are often associated with an overactive bladder.
Several factors may cause or contribute to symptoms similar to those of overactive bladder, and your doctor will try to rule them out during an evaluation because they require other specialized treatments.
These factors include:
High urine production as might occur with high fluid intake, poor kidney function, or diabetes
Acute urinary tract infections that can cause symptoms very similar to an overactive bladder.
Inflammation of tissues near the urinary tract
Abnormalities in the bladder, such as tumors or bladder stones
Factors that obstruct bladder outflow — enlarged prostate, constipation or previous operations to treat other forms of incontinence
Excess consumption of caffeine or alcohol
Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
Risk factors
As you grow older, you're at increased risk of developing overactive bladder, and you're also more susceptible to diseases and disorders that can contribute to problems with bladder function, such as enlarged prostate and diabetes. Although common among older adults, overactive bladder and urge incontinence shouldn't be considered a normal part of aging.
Complications
As might be expected, urge incontinence can affect your overall quality of life, but frequent urination and nocturia can also be detrimental to your well-being. People with significant disruption from an overactive bladder are more susceptible to:
Depression
Emotional distress
Some people may also have a disorder called mixed incontinence, when both urge incontinence and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stressors or pressure on your bladder, as when you cough or laugh.
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, he or she may refer you to a urologist or a urogynecologist for diagnosis and treatment. When you make your appointment, ask your doctor if you should keep a bladder diary for a few days. You record when, how much and what kind of fluids you consume; when you urinate; whether you feel an urge to urinate; and whether you experience incontinence. Your diary may reveal patterns that help your doctor understand your symptoms and identify contributing factors.
Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all the medications you take, as well as any vitamins or supplements.
Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For overactive bladder, some basic questions to ask your doctor include:
What's the most likely cause of my symptoms?
Are there any other possible causes for my symptoms?
What kinds of tests do I need? Do I need to do any special preparation for these tests?
Is my condition likely temporary or chronic?
What treatments are available?
Which do you recommend?
Are there any dietary restrictions that I need to follow?
Do I need to see a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Are there any brochures or other printed material that I can take home with me?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor may use an overactive bladder screening questionnaire to make a preliminary assessment of your symptoms. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
Do you ever unexpectedly leak urine?
Do you ever leak urine when you cough, laugh or sneeze?
Do you ever leak urine on your way to the bathroom?
Do you need to use pads or extra cloth in your underwear to catch urine?
When did you first begin experiencing symptoms?
Have your symptoms been continuous, or occasional?
What activities do your symptoms keep you from doing?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Your doctor will also want to know if your bladder symptoms are causing problems in your daily life, such as interfering with work or social interactions.
Tests and diagnosis
In a basic diagnostic workup, your doctor will look for clues that may also indicate contributing factors.
The exam will likely include:
A medical history
A physical examination with particular focus on your abdomen and genitals
A urine sample to test for infection, traces of blood or other abnormalities
A focused neurological exam that may identify sensory problems
Specialized tests
Your doctor may order urodynamic tests, which are used to assess the function of your bladder and its ability to empty itself steadily and completely. These tests usually require a referral to a specialist in urinary disorders in men and women (urologist) or urinary disorders in women (urogynecologist). Tests include:
Measurements of postvoid residual urine. When you urinate or experience urinary incontinence, your bladder may not empty completely. The remaining urine volume (postvoid residual urine) may cause symptoms identical to an overactive bladder. To measure residual urine after you have voided, a thin tube (catheter) is passed through the urethra and into your bladder. The catheter drains the remaining urine, which can then be measured. Alternatively, a specialist may use an ultrasound scan, which translates sound waves into an image of your bladder and its contents.
Uroflowmetry. A uroflowmeter is a device into which you urinate to measure the volume and speed of your voiding. This device translates the data into a graph of changes in your flow rate.
Cystometry and pressure-flow studies. Cystometry measures bladder pressure during filling. Pressure-flow studies measure the amount of pressure needed to urinate and the speed of the urine flow. A catheter is used to fill your bladder slowly with water. Another catheter with a pressure-measuring sensor device will be placed in your rectum or for women, in your vagina. This procedure can identify any involuntary muscle contractions, indicate the level of pressure at which you feel an urge or experience leakage, and measure pressure needed to empty your bladder.
Electromyography. Electromyography assesses the coordination of nerve impulses in the muscles of the bladder and the urinary sphincter. Sensors are placed either on or in the skin in your pelvic floor.
Video urodynamics. These procedures use either X-ray or ultrasound waves to create pictures of your bladder in combination with cystometry and a pressure-flow study as your bladder is filling and emptying. Your bladder is filled with the use of a catheter, and you urinate to empty your bladder. The fluid will contain a special dye that's detected by X-ray technology.
Cystoscopy. A cystoscope, a thin tube with a tiny lens, enables your doctor to see the inside of your urethra and bladder. With the aid of this device, your doctor can check for abnormalities in your lower urinary tract, such as bladder stones or tumors.
Your doctor will review the results of these tests with you and suggest a treatment strategy.
Treatments and drugs
Your doctor is likely to recommend a combination of treatment strategies to alleviate your symptoms.
Behavioral interventions
Behavioral interventions can help you manage overactive bladder. If you experience urge incontinence, these interventions alone aren't likely to result in complete dryness, but they will likely reduce the number of incontinence episodes. The interventions your doctor will recommend may cover the following areas:
Fluid consumption. Your doctor may recommend the amount and timing of your fluid consumption. If caffeinated and alcoholic beverages worsen your symptoms, it might be wise to avoid these.
Fiber intake. Eat a diet rich in fiber, or take fiber supplements if instructed by your doctor, as constipation is commonly associated with bladder problems.
Bladder training. Occasionally, your doctor may recommend a strategy to train yourself to delay voiding when you feel an urge to urinate. You'll begin with very small delays, such as 10 minutes, and gradually work your way up to urinating every three to five hours.
Double voiding. Some people have problems with emptying their bladder. This is diagnosed by significant elevations of residual urine volumes and may be helped by double voiding. After urinating, you wait a few minutes and then try again to empty your bladder completely. Your doctor will let you know if this is something that might help you.
Scheduled toilet trips. Your doctor may recommend a schedule for toileting so that you urinate at the same time every day — every two to three hours as recommended — rather than when you feel the urge to urinate.
Pelvic floor muscle exercises. Exercises called Kegel exercises strengthen your pelvic floor muscles and urinary sphincter — muscles that are critical for holding urine even if your bladder muscles involuntarily contract. These strengthened muscles are then contracted when you feel urge so that you can successfully suppress the bladder's involuntary contractions. Your doctor or a physical therapist can help you learn how to do these exercises correctly. It may take as long as eight weeks before you notice a difference in your symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases.
Intermittent catheterization. You can learn how to empty your bladder by passing a catheter periodically to empty it completely. This is a very safe and comfortable procedure. It does not make the bladder lazy; contrary to that old tale, it simply helps the bladder do what it can't do itself. Your doctor will let you know if this is right for you.
Absorbent pads. You can wear absorbent pads or undergarments to protect your clothing and avoid embarrassing incidents if you do experience incontinence.
Maintaining a healthy weight. If you're overweight, losing weight may ease your symptoms because extra weight is associated with more urge incontinence. Heavier people are also at greater risk of stress urinary incontinence.
Surgery
Surgery to treat overactive bladder is reserved for people with severe cases who don't respond to other treatments. The goal is to improve the bladder's storing ability and reduce pressure in the bladder. Surgical interventions include:
Sacral nerve stimulation. The sacral nerves are a primary link between the spinal cord and nerves in the bladder's tissues. Modulation of these nerve impulses can improve overactive bladder symptoms. In this procedure, a thin wire is placed near the sacral nerves as they pass near your tailbone. Your doctor will then use a device to deliver electrical impulses to your bladder, similar to what a pacemaker does for the heart. If successful at reducing your symptoms, the wire is eventually connected to a small battery device that's placed under your skin.
Augmentation cystoplasty. This major surgical procedure, intended to increase the capacity of your bladder, uses pieces of your bowel to replace a portion of your bladder. If you undergo this procedure, you may need to use a catheter intermittently for the rest of your life to empty your bladder. Because this is a major surgical procedure with the potential for serious side effects, this surgery is reserved for people with severe overactive bladder that hasn't improved despite other treatments.
Coping and support
Living with overactive bladder can be difficult. Organizations such as the National Association for Continence can provide you with resources and information about joining a support group of people who experience overactive bladder and urge incontinence. Support groups offer a venue for voicing concerns and learning new coping strategies and often provide motivation to maintain self-care strategies. Educating your friends and co-workers about overactive bladder and your experiences with it may help you establish your own support network and alleviate some of the embarrassment you may feel.
Prevention
Healthy lifestyle choices that may reduce your risk of overactive bladder include a regular exercise routine, a high-fiber diet, and limited consumption of caffeine and alcohol.
Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running or coughing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.
Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.
Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.
Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine—water and wastes removed by the kidneys—in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.
During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder. Obesity, which is associated with increased abdominal pressure, can worsen incontinence. Fortunately, weight loss can reduce its severity.
What are the types of incontinence?
Stress Incontinence
If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. This type of incontinence is common in women and, in many cases, can be treated.
Childbirth and other events can injure the scaffolding that helps support the bladder in women. Pelvic floor muscles, the vagina, and ligaments support your bladder (see figure 2). If these structures weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the squeezing muscles weaken.
Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.
Urge Incontinence
If you lose urine for no apparent reason after suddenly feeling the need or urge to urinate, you may have urge incontinence. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.
Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower). Certain fluids and medications such as diuretics or emotional states such as anxiety can worsen this condition. Some medical conditions, such as hyperthyroidism and uncontrolled diabetes, can also lead to or worsen urge incontinence.
Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, and injury—including injury that occurs during surgery—all can harm bladder nerves or muscles.
Overactive Bladder
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.
Specifically, the symptoms of overactive bladder include
urinary frequency—bothersome urination eight or more times a day or two or more times at night
urinary urgency—the sudden, strong need to urinate immediately
urge incontinence—leakage or gushing of urine that follows a sudden, strong urge
nocturia—awaking at night to urinate
Functional Incontinence
People with medical problems that interfere with thinking, moving, or communicating may have trouble reaching a toilet. A person with Alzheimer’s disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may have a hard time getting to a toilet in time. Functional incontinence is the result of these physical and medical conditions. Conditions such as arthritis often develop with age and account for some of the incontinence of elderly women in nursing homes.
Overflow Incontinence
Overflow incontinence happens when the bladder doesn’t empty properly, causing it to spill over. Your doctor can check for this problem. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.
Other Types of Incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence—and this combination in particular—are sometimes referred to as mixed incontinence. Most women don’t have pure stress or urge incontinence, and many studies show that mixed incontinence is the most common type of urine loss in women.
Transient incontinence is a temporary version of incontinence. Medications, urinary tract infections, mental impairment, and restricted mobility can all trigger transient incontinence. Severe constipation can cause transient incontinence when the impacted stool pushes against the urinary tract and obstructs outflow. A cold can trigger incontinence, which resolves once the coughing spells cease.
The Types of Urinary Incontinence
Stress Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
Urge Leakage of large amounts of urine at unexpected times, including during sleep.
Overactive Bladder Urinary frequency and urgency, with or without urge incontinence.
Functional Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
Overflow Unexpected leakage of small amounts of urine because of a full bladder.
Mixed Usually the occurrence of stress and urge incontinence together.
Transient Leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing).
How is incontinence evaluated?
The first step toward relief is to see a doctor who has experience treating incontinence to learn what type you have. A urologist specializes in the urinary tract, and some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary and associated pelvic problems in women. Family practitioners and internists see patients for all kinds of health conditions. Any of these doctors may be able to help you. In addition, some nurses and other health care providers often provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.
To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem—including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often you can begin treatment at the first medical visit.
Your doctor may instruct you to keep a diary for a day or more—sometimes up to a week—to record when you void. This diary should note the times you urinate and the amounts of urine you produce. To measure your urine, you can use a special pan that fits over the toilet rim. You can also use the bladder diary to record your fluid intake, episodes of urine leakage, and estimated amounts of leakage.
If your diary and medical history do not define the problem, they will at least suggest which tests you need.
Your doctor will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. This condition is also important to diagnose at the time of an evaluation.
Your doctor may measure your bladder capacity. The doctor may also measure the residual urine for evidence of poorly functioning bladder muscles. To do this, you will urinate into a measuring pan, after which the nurse or doctor will measure any urine remaining in the bladder. Your doctor may also recommend other tests:
Bladder stress test—You cough vigorously as the doctor watches for loss of urine from the urinary opening.
Urinalysis and urine culture—Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
Ultrasound—This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.
Cystoscopy—The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.
Urodynamics—Various techniques measure pressure in the bladder and the flow of urine.
How is incontinence treated?
Behavioral Remedies: Bladder Retraining and Kegel Exercises
By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercisedevice to strengthen the muscles that help hold in urine.
How do you do Kegel exercises?
The first step is to find the right muscles. One way to find them is to imagine that you are sitting on a marble and want to pick up the marble with your vagina. Imagine sucking or drawing the marble into your vagina.
Try not to squeeze other muscles at the same time. Be careful not to tighten your stomach, legs, or buttocks. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Just squeeze the pelvic muscles. Don’t hold your breath. Do not practice while urinating.
Repeat, but don’t overdo it. At first, find a quiet spot to practice—your bathroom or bedroom—so you can concentrate. Pull in the pelvic muscles and hold for a count of three. Then relax for a count of three. Work up to three sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest position to do them in because the muscles do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.
Be patient. Don’t give up. It takes just 5 minutes a day. You may not feel your bladder control improve for 3 to 6 weeks. Still, most people do notice an improvement after a few weeks.
Some people with nerve damage cannot tell whether they are doing Kegel exercises correctly. If you are not sure, ask your doctor or nurse to examine you while you try to do them. If it turns out that you are not squeezing the right muscles, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both.
Several medicines from a class of drugs called anticholinergics can help relax bladder muscles and prevent bladder spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, and flushing. Other side effects include drowsiness, confusion, or memory loss. If you have glaucoma, ask your ophthalmologist if these drugs are safe for you.
Some medicines can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling (edema) or high blood pressure may increase your urine output and contribute to bladder control problems. Talk with your doctor; you may find that taking an alternative to a medicine you already take may solve the problem without adding another prescription.
Scientists are studying other drugs and injections that have not yet received U.S. Food and Drug Administration (FDA) approval for incontinence to see if they are effective treatments for people who were unsuccessful with behavioral therapy or pills.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your body’s functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
Neuromodulation
For urge incontinence not responding to behavioral treatments or drugs, stimulation of nerves to the bladder leaving the spine can be effective in some patients. Neuromodulation is the name of this therapy. The FDA has approved a device called InterStim for this purpose. Your doctor will need to test to determine if this device would be helpful to you. The doctor applies an external stimulator to determine if neuromodulation works in you. If you have a 50 percent reduction in symptoms, a surgeon will implant the device. Although neuromodulation can be effective, it is not for everyone. The therapy is expensive, involving surgery with possible surgical revisions and replacement.
Vaginal Devices for Stress Incontinence
One of the reasons for stress incontinence may be weak pelvic muscles, the muscles that hold the bladder in place and hold urine inside. A pessary is a stiff ring that a doctor or nurse inserts into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.
Injections for Stress Incontinence
A variety of bulking agents, such as collagen and carbon spheres, are available for injection near the urinary sphincter. The doctor injects the bulking agent into tissues around the bladder neck and urethra to make the tissues thicker and close the bladder opening to reduce stress incontinence. After using local anesthesia or sedation, a doctor can inject the material in about half an hour. Over time, the body may slowly eliminate certain bulking agents, so you will need repeat injections. Before you receive an injection, a doctor may perform a skin test to determine whether you could have an allergic reaction to the material. Scientists are testing newer agents, including your own muscle cells, to see if they are effective in treating stress incontinence. Your doctor will discuss which bulking agent may be best for you.
Surgery for Stress Incontinence
In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position. The three main types of surgery are retropubic suspension and two types of sling procedures.
Retropubic suspension uses surgical threads called sutures to support the bladder neck. The most common retropubic suspension procedure is called the Burch procedure. In this operation, the surgeon makes an incision in the abdomen a few inches below the navel and then secures the threads to strong ligaments within the pelvis to support the urethral sphincter. This common procedure is often done at the time of an abdominal procedure such as a hysterectomy.
Sling procedures are performed through a vaginal incision. The traditional sling procedure uses a strip of your own tissue called fascia to cradle the bladder neck. Some slings may consist of natural tissue or man-made material. The surgeon attaches both ends of the sling to the pubic bone or ties them in front of the abdomen just above the pubic bone.
Midurethral slings are newer procedures that you can have on an outpatient basis. These procedures use synthetic mesh materials that the surgeon places midway along the urethra. The two general types of midurethral slings are retropubic slings, such as the transvaginal tapes (TVT), and transobturator slings (TOT). The surgeon makes small incisions behind the pubic bone or just by the sides of the vaginal opening as well as a small incision in the vagina. The surgeon uses specially designed needles to position a synthetic tape under the urethra. The surgeon pulls the ends of the tape through the incisions and adjusts them to provide the right amount of support to the urethra.
If you have pelvic prolapse, your surgeon may recommend an anti-incontinence procedure with a prolapse repair and possibly a hysterectomy.
Supporting sutures in place following retropubic or transvaginal suspension. Sling in place, secured to the pubic bone. The ends of the transobturator tape supporting the urethra are pulled through incisions in the groin to achieve the right amount of support. The tape ends are removed when the incisions are closed.
Recent women’s health studies performed with the Urinary Incontinence Treatment Network (UITN) compared the suspension and sling procedures and found that, 2 years after surgery, about two-thirds of women with a sling and about half of women with a suspension were cured of stress incontinence. Women with a sling, however, had more urinary tract infections, voiding problems, and urge incontinence than women with a suspension. Overall, 86 percent of women with a sling and 78 percent of women with a suspension said they were satisfied with their results.
Talk with your doctor about whether surgery will help your condition and what type of surgery is best for you. The procedure you choose may depend on your own preferences or on your surgeon’s experience. Ask what you should expect after the procedure. You may also wish to talk with someone who has recently had the procedure. Surgeons have described more than 200 procedures for stress incontinence, so no single surgery stands out as best.
Catheterization
If you are incontinent because your bladder never empties completely—overflow incontinence—or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use an indwelling—long-term—catheter, you should watch for possible urinary tract infections.
Other Helpful Hints
Many women manage urinary incontinence with menstrual pads that catch slight leakage during activities such as exercising. Also, many people find they can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many women are afraid to mention their problem. They may have urinary incontinence that can improve with treatment but remain silent sufferers and resort to wearing absorbent undergarments, or diapers. This practice is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are relying on diapers to manage your incontinence, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding and pelvic muscle exercises.
Points to Remember
Urinary incontinence is common in women.
All types of urinary incontinence are treatable.
Incontinence is treatable at all ages.
You need not be embarrassed by incontinence.
Diet and exercise go
