Urinary Incontinence

Bladder control problems are estimated to affect more than 13 million Americans every year. Many women are embarrassed by their condition and do not even want to talk to their doctor about it. Bladder control problems are not necessarily a normal part of aging. If the symptoms are significantly affecting your quality of life, then there are treatment options which may be able to help.

There are different types of urinary incontinence. The most common types in women include stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI) in which a patient has both SUI and UUI. Stress Urinary Incontinence (SUI) is defined as urinary leakage associated with laughing, coughing, sneezing, jumping, or physical activity. Urge Urinary Incontinence (UUI) is defined as urinary leakage associated with a feeling of urge to urinate. Many times patient’s leak when they are not able to reach the bathroom quickly. Overactive bladder (OAB) is a common condition affecting 1 in 6 adults. With OAB, the bladder muscle squeezes too often, causing frequent, strong sudden urges to go. As a result, patients experience urinary urgency and frequency and sometimes they can leak urine if they are not able to reach the bathroom quickly. Urodynamic testing is sometimes performed to aid in diagnosis and is recommended prior to any surgery involving the bladder, urinary incontinence or pelvic organ prolapse. We can perform this testing in our office if needed. It involves back filling of the bladder with sterile saline to test the capacity of the bladder, urge symptoms, bladder muscle contractions, and leakage. Patients are also asked to urinate and we check to see if there is any urine left in the bladder post-void.

Stress Urinary Incontinence (SUI) is by far the most common type of urinary incontinence. It accounts for 60% of all urinary incontinence cases occurring mainly in women. Women who suffer from SUI, experience embarrassing accidents of urinary leakage whenever they laugh, cough, sneeze, jump, or engage in physical activity. This constant seepage creates social awkwardness and a hygienic problem. The fear of becoming wet and smelling like urine limits these women in much of their important daily activities. SUI is usually caused by an excessively movable (hypermobile) bladder neck (urethra) whenever stress such as coughing is exerted. A normally functioning bladder neck should move only slightly under strained conditions.

Surgical correction is the only effective treatment to repair the hypermobility of the urethra and to get rid of SUI. Tension free Vaginal Tape placement (TVT) and Transobturator Tape Placement (TOT) are the most effective and successful suburethral sling procedures to eliminate SUI. These procedures involve placing a permanent polypropylene mesh under the bladder neck to support it. The incision sites are very small and heal quickly. The procedure is done in an outpatient surgery center, usually takes about 15 minutes, and can be done either under general or regional anesthesia. Recovery time is short and usually patients can return to work in 1-3 days.

Overactive Bladder (OAB) with or without Urge Urinary Incontinence (UUI) caused by involuntary bladder wall contractions that may happen randomly and at the least convenient times and locations. The first line of treatment consists of a daily anti-cholinergic medication, such as Ditropan, Detrol, Vesicare, Enablex, Oxytrol, etc. These medications effectively “calm” the bladder wall and decrease urinary frequency and leakage. These medications are contraindicated in women with narrow-angle glaucoma. So tell your doctor if you have this condition. The most common side effects are dry mouth and constipation. The higher the dosage, the more effective the medication is. But unfortunately, the side effects may be more severe as well. For patients in whom these medications are contraindicated, not working effectively, and/or the side effects are too bothersome; there is an alternative treatment option. Interstim or Sacral Nerve Stimulator (SNS) is a safe and effective device that once implanted usually helps decrease symptoms from OAB and UUI. Interstim, also known as the “bladder pacemaker”, calms the bladder locally. Thus it avoids the systemic side effects of medications. It is a highly effective 0.5 x 2.0 inch size device installed in the “fat” of the buttocks. A wire runs from the device to the sacrum and stimulates the third sacral nerve. The communication between the device and the sacral nerve helps to control the bladder wall contractions. The surgery is usually performed in a minor surgery center or outpatient surgery center under local and light-sedation IV anesthesia. The procedure usually takes about 1 hour. There is one 3 inch incision in the buttock and one small incision in the midline of the lower back. Recovery is short and normal activity is resumed in 1 day. The procedure is performed in two phases. After the initial procedure, for 1-2 weeks, the patient must work with her temporary SNS device to determine which setting works best for her. She must keep a strict diary of her voiding habits. If the device improves symptoms by more than 50%, the device is implanted permanently in the second phase. The battery lasts between five and ten years.

Patients afflicted with Mixed Urinary Incontinence (MUI) have both SUI and UUI symptoms. We treat both conditions separately as described above. Treatment includes TVT/TOT, medications and/or Sacral Nerve Stimulation.

Learn more about Suburethral Sling Procedures.