Female Incontinence

More than 33 million Americans experience some form of urinary incontinence or bladder condition, according to the National Association for Continence. It occurs in men and women of all ages, though chances increase with age.

There are three basic forms of incontinence:

• Stress incontinence: Leakage that occurs when physical stress, including sneezing, coughing or athletic activities, puts pressure on the bladder.
• Urge incontinence: A sudden need to urinate because the bladder contracts involuntarily, forcing urine out.
• Overflow incontinence: The bladder doesn’t empty as it should and later leaks urine as a result. For men, this commonly happens when the urethra is blocked by an enlarged prostate.

Urinary incontinence caused by muscle weakness in the bladder or pelvic floor, or problems in the nerves that control urination. In general, it occurs when the muscle (sphincter) that holds the bladder’s outlet closed is not strong enough to hold back the urine. This may happen if the sphincter is too weak, if the bladder muscles contract too strongly, or if the bladder is overfull.

Smoking, previous pregnancies, obesity, diabetes, bladder disease, certain medications, or constipation can contribute to incontinence. Congenital problems or neurologic disease such as stroke, Parkinson’s disease, multiple sclerosis, or a spinal cord injury can also contribute to incontinence.

The main symptom of incontinence is the accidental release of urine.

• Stress incontinence: Urine leaks when coughing, laughing, exercising or sudden movements.
• Urge incontinence: An immediate need to urinate, even small amounts. Patients urinate frequently and have trouble reaching the toilet in time.
• Overflow incontinence: A constant urge to urinate, but urine just dribbles continuously.

A urologist will perform a detailed history and physical exam, so it is helpful if the patient keeps a bladder diary for a few days beforehand to record times of urination, the amount of urine, leakage, and foods and beverages consumed. The physician may also perform one or more tests:

• Stress test: The patient relaxes and then coughs hard as the physician watches for urine loss.
• Postvoid residual volume: A measure of the amount of urine left in the bladder after urination.
• Urinalysis: An examination of the composition of the patient’s urine.
• Bladder scan: An ultrasound of the kidneys, bladder, and urethra, to see if the bladder empties completely.
• Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.
• Urodynamics: A technique that measures the pressure in the bladder and urine flow.

It is helpful if the patient keeps a diary for a few days beforehand to record times of urination, the amount of urine, the leakage, and the foods and beverages consumed.

Lifestyle changes, including modifications to the diet and Kegel (pelvic squeezing) exercises, can help manage both stress incontinence and urge incontinence. The physician may also recommend the following treatments:

• Medications: Anticholinergics (which block neurotransmitters) can help suppress involuntary contractions by the muscle surrounding the bladder. Other medications include estrogens, antidepressants, or alpha-adrenergic (nerve-stimulating) drugs.
• Injection therapy: This therapy injects collagen, body fat, or synthetic compounds around the urethra to bulk up or improve the function of the urethral sphincter and compress the urethra near the bladder outlet.
• Posterior Tibial Nerve Stimulation (PTNS): A periodic stimulation of the posterior tibial nerve (near the ankle) as regular, outpatient therapy.
• Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.
• Surgery:

• • Urethral or mid-urethral slings: Mesh tape placed under the urethra acts like a hammock to keep it in its normal position. The tape provides support for a sagging urethra, so it remains closed during a cough or vigorous or sudden movement. At times, non-mesh or autologous fascia options can be used. This usually treats stress or mixed incontinence.
  • Tension-free vaginal tape (TVT): Mesh tape placed under the urethra acts like a hammock to keep it in its normal position. The tape provides support for a sagging urethra so it remains closed during a cough or vigorous or sudden movement. This usually treats stress or mixed incontinence.
  • Sacral nerve stimulation: A pacemaker-like device for the bladder is implanted through a tiny incision near the tailbone to calm the nerves that control bladder function. This usually treats urge incontinence.