Incontinence

When Ya Gotta Go, Ya Gotta Figure Out Why

Health Guides: Incontinence
 

Incontinence is not a disease. It’s a common problem that may be linked to other conditions.

If you accidentally release urine, you’re not alone—more than 16 million American women experience some degree of incontinence. Things such as childbirth or being overweight stretch the pelvic floor and make bladder control, shall we say, more challenging. This release of urine can be triggered by coughing, sneezing, walking, jumping, even a funny joke or the sound of running water. It’s estimated that 1 in 3 American women over the age of 45 have some form of incontinence. After age 60, that number jumps to 1 in 2; however, only 15% of these women choose to seek treatment.

Patients are diagnosed with one of two types of incontinence. Stress incontinence is generally caused by trauma to the pelvic floor, which can happen in childbirth but also have a hereditary component. It can also be associated with pelvic prolapse. Meanwhile, urge incontinence is that sudden need to “go,” that may or may not have a specific trigger. This condition is commonly referred to as Overactive Bladder (OAB). For the majority of women, there is no known cause.

Non-surgical treatments range from medication to simple exercises. Pelvic floor therapy is a series of exercises, including Kegels, designed to strengthen the pelvic floor muscles. Medications may also be given, or a pessary can be inserted. A pessary is designed to hold the bladder in place and is used when incontinence is caused by pelvic prolapse.  

There are also several surgical options:

  • Urethral bulking injections are similar to collagen injections, are done as an outpatient procedure and may need to be periodically repeated.
  • The “sling” procedure typically generates 85%-90% improvement in the symptoms of stress incontinence. The sling is designed to create enough urethral compression to achieve bladder control when coughing, sneezing or exercising.
  • Neurostimulator Implantation near the sacrum may be an effective option for urge incontinence that has not been controlled effectively with medications or other conservative options. It’s basically a pacemaker for the bladder. 

Symptoms

  • A strong, sudden urge to “go,” followed by a leaking or gushing of urine
  • Accidents during exercise or sexual activity
  • Frequent bladder infections
  • “Going” much more often than is normal for you
  • Pain involved with filling bladder and urination
  • Sudden need to urinate, regardless of how long it’s been since your last trip to the bathroom
  • Incontinence can be managed or cured at all ages.
  • Urinary incontinence is common in women.
  • Incontinence isn’t an inevitability of aging.  

Types

  • Stress Incontinence is caused by trauma to the pelvic floor, but it can also be hereditary.
  • Urge Incontinence refers to the sudden need to “go,” and is also known as OAB.

Treatments

  • Non-surgical options, such as Kegel exercises and medications, are often tried first. A pessary may also be used in patients who are not candidates for surgery.
  • Surgical options include injection, “sling” procedures and implantation of a neurostimulator.