Urine leakage is inconvenient and embarrassing, and can prevent us from doing the activities that we enjoy. In past generations women were taught that is was part of life and simply had to put up with it. Thank goodness advances in medicine have made treatment options more effective and less invasive, so that we no longer have to tolerate this difficult problem.
There are two common types of urinary incontinence and many of us have a little of both.
STRESS URINARY INCONTINENCE or SUI applies to urine leakage that occurs when the abdominal pressure is increased, such as with coughing, laughing, or exercise. Typically this occurs after childbirth due to weakening of the supportive tissue under the bladder and urethra (the tube that carries urine from the bladder to the outside world). With loss of support, when we push down with our abdomen the pressure inside the bladder is higher than that in the urethra, which causes a leak. When adequately supported the urethra should sit inside the abdominal cavity, so that the pressure is exerted equally on the bladder and urethra and there won’t be a leak.
Treatment approaches center on strengthening the support under the urethra so that it does not shift downward with increasing abdominal pressure. Non surgical approaches include Kegel exercises, which involve voluntarily tightening the vaginal muscles in many repetitious sets to strengthen the tissue. Other methods involve electrical stimulation of the muscular tissue with the same goal. When non-surgical approaches are not sufficient, replacing the support with a synthetic piece of material called a “sling” can be very successful. Slings are placed through a small vaginal incision beneath the urethra . The surgery takes about 20 minutes in an outpatient setting and has a quick recovery. Slings should not be confused with other “vaginal mesh” procedures which have received negative attention in the media. Generally slings are very safe and straightforward and the success rate for SUI is very high and is generally permanent.
URGE INCONTINENCE or “overactive bladder” (OAB) is a problem many women experience as an uncontrollable urge to urinate when on the way to the bathroom, perhaps when the keys are in the door or unbuttoning the pants. The problem happens when the brain sends a message to the bladder to contract, which is normal when it is time to urinate, but the message is sent too early and is difficult to control voluntarily. Treatments for OAB center on bladder relaxing medications which prevent the overactive muscle contractions. The downside of these treatments is that they do have to be taken daily, and may cause mild side effects such as dry mouth, dry eyes and constipation. Often dietary changes can help as well, with common culprits being acidic foods, alcohol and caffeine.
Other less common causes of incontinence occur from neurologic damage due to diabetes or other diseases, physical damage from surgery or radiation causing a hole on the bladder (a fistula) and damage to the sphincter mechanism between the urethra and bladder.
Before treatment is started we generally recommend testing the bladder to see which of these problems is present. The test involves placing a catheter in the bladder and filling the bladder with fluid to simulate fullness. A pressure sensor on the catheter can detect OAB since the muscle will contract involuntarily. Coughing and bearing down will illustrate when SUI occurs and will measure how much pressure it takes to leak. Bladder emptying is then observed to make sure it occurs normally. This test is a but uncomfortable but not painful and takes about 45 minutes.
Let us know if we can help you with urinary incontinence, life is too short to leak!
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