Incontinence in Women—The Critical Basics
Antoinette Berkeley, MD
What is incontinence, and what are the various types?
Incontinence is a sudden, uncontrolled, involuntary loss of urine.
There are basically 3 types:
Urge incontinence is a sudden, strong urgency to urinate and inability to control or get to the bathroom in time.
Stress incontinence is a sudden loss of urine with any increase in abdominal pressure—for example, coughing, laughing, or exercising. The sphincter—a little valve in your urethra that’s connected to your bladder—loses its ability to close, causing urine to leak.
Combination of both stress and urge.
What are the most common causes in women, and when should you seek a doctor’s attention?
Many issues can cause urine leakage, including:
- Pregnancy and childbirth (especially with large babies and multiple births)
- Pelvic surgery
- Pelvic radiation
- Pelvic floor prolapse—the dropping of the bladder and/or uterus
- Certain medications, including diuretics, muscle relaxers, some blood pressure medicines and sedatives
- Bladder cancer
- Urinary retention
- Certain neurological disorders—for example, Parkinson’s and multiple sclerosis
Seek input from a qualified doctor sooner than later, especially when the leaking starts acutely or occurs for an extended period of time. Don’t fear interventions! There are many potential solutions, including noninvasive, simple ones, such as changing dietary habits; switching medications or the timing of medications; and simple pelvic floor exercises. It is also very important to rule out serious causes.
What diagnostic tools do you use in your practice?
We usually start with a comprehensive medical history and physical exam, which includes cataloguing your medications and evaluating the urgency and frequency of leakage. Tools we use to assess include:
- A pelvic ultrasound to check for signs of urinary retention/pelvic uterine or ovarian masses and/or bladder masses that are large.
- A simple voiding log which tracks your intake and output anywhere from 3-5 days.
If the pelvic ultrasound and sonogram are normal, and if your log shows just simple urge incontinence, oral medication can be started. Typically, you will be seen back in 6-8 weeks for reevaluation. If there is improvement, medications can be increased or decreased. If there is no improvement, then additional testing may be needed, including urodynamics and cystoscopy. (The cystoscopy is a simple in-office procedure that allows the doctor to look at the lining of the bladder and urethra. A scope is inserted into the urethra painlessly, without general anesthesia; the process typically takes less than 15 minutes.)
What are some treatment options and protocols for incontinence?
Basic treatment protocols include:
- Timed voiding
- Limiting fluids two hours prior to bed
- Changing fluid intake to avoid caffeine, sodas, carbonation, and acidic foods and drinks
- Weight loss
- Medication changes
- Oral medication to treat the overactive bladder and/or incontinence
For pure stress incontinence, treatment options include:
- TVT O—a transvaginal obturator tape sling, which takes under an hour in the operating room;
- Urethral bulking agents that can be injected into the urethra;
- Biofeedback pelvic floor therapy;
- Kegel exercises.
If oral medications don’t work, possible solutions include:
- Neuro modulation—which consists of implanting a surgical device in the lower back
- Chemo denervation--which is typically performed in the office and which can be repeated and can be performed in the office. For example, Botox is often used.
- Percutaneous tibial nerve stimulation (PTNS)—an office treatment with an ankle electrode at some ankle electrode that is done in the office to stimulate the tibial nerve to help stop bladder muscle contraction
- Surgery on the pelvic sling or bladder neck
NewYork-Presbyterian Medical Group Hudson Valley
1985 Crompond Road
Cortlandt Manor, NY 10567