My name is Yaser Bassel, I’m a board certified urologist with Advanced Urology Institute. We see a lot of women, in particular for issues with incontinence or involuntary loss of urine. And there are multiple reasons for having that
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The loss of bladder control known as Urinary Incontinence is a normal problem that is more common in women than men. The effects of urinary incontinence range from barely noticeable to severe. As Dr. Amar Raval from the Advance Urology Institute says, “It is a big issue for women out in public.” Incontinence can cause difficult and embarrassing situations.
There are many causes of urinary incontinence. To understand these causes, it is important to remember that urinary incontinence is a symptom, not a disease. Lifestyle choices that can exacerbate the problem include consuming alcohol, caffeine, spicy foods and certain medications. For women, life events that affect women’s bodies in a way that can cause incontinence include pregnancy, childbirth, menopause and aging. Other causes can be found in weight, family history and health.
The different types of urinary incontinence can exhibit a variety of symptoms. Stress incontinence is characterized by small leaks of urine due to pressure on the bladder while laughing, coughing, sneezing or exerting oneself. The small leaks of overflow incontinence happen when the bladder has not fully emptied during urination. Urge incontinence is the sudden and intense urge to urinate, sometimes resulting in an involuntary loss of urine. Having to urinate frequently through the night is another symptom experienced by women with urge incontinence. It is also common for women to be affected by more than one of these types of incontinence.
Fortunately, a wide range of treatment options is available. Women can work with their urologist to find the best treatment option for their individual situation. In some cases, treatment can be as easy as making slight lifestyle changes or taking an oral medication. Botox and acupuncture can help relieve stress incontinence. For more advanced cases, urethral slings can ease symptoms by lifting the urethra into a normal position, and robotic surgeries can lift the bladder in cases of incontinence caused by a prolapse.
The loss of bladder control can be a lifestyle limiting problem for women when it affects their ability to leave the house and maintain normal activities. The urologists at the Advance Urology Institute work closely with each patient to ensure they can live with freedom and confidence, and without the worries of incontinence. For more information, visit the Advanced Urology Institute website.
Urinary incontinence happens when the bladder becomes weak and urination happens by accident. Although they seldom want to talk about it, urinary incontinence affects women twice as often as men. The cause may be related to childbirth or menopause, and the structure of the female urinary tract plays a role as well.
If you suffer from this problem, it’s important to realize you are not alone. More than 33 million Americans deal with urinary incontinence or a bladder condition. Unwanted urinary activity occurs in both men and women and increasing age can be a partial cause. Is is estimated that one out of three women in the United States has a bladder problem.
Bladder control problems can vary, from occasional urine leakage that happens when you cough or sneeze, to having sudden urges to urinate so strong you do not make it to the toilet in time. There are several basic forms of incontinence and you can have more than one condition. There is urge incontinence, where you will feel a need to urinate all of a sudden as the bladder involuntarily contracts, compelling you to urinate immediately. Another form is stress incontinence. This is caused when physical stress from coughing or sneezing, or athletic activity, puts pressure on the bladder and causes leakage.
Some women experience overflow incontinence, which happens when you leak urine because your bladder does not empty all the way.
When you make an appointment, your doctor or a physician assistant will ask for a thorough history of the problem, followed by a physical exam. Some simple and painless tests may be taken. Urinalysis is a test in which a urine sample is checked for traces of blood, signs of infection, nitrates, or other indications of a medical problem. You may be asked to create a bladder diary, keeping a record for a few days to track the amount of fluids you drink and the frequency and amount of urine, as well as details of urgency or leakage.
Another test may be a post-void residual measurement. You will urinate into a container, and then your doctor uses ultrasound to measure the amount of urine left in your bladder.
It is best to make an appointment with a urologist if you are experiencing bladder control problems. Our doctors at Advanced Urology Institute have years of experience with treating bladder problems and working with patients to find the best solutions. For more information, visit the Advanced Urology Institute website.
When you complain to us about urinary incontinence, we will take quick vital steps to help you. For instance, if you are able to immediately provide a clean-catch urine sample, we will do a urinalysis to rule out urinary tract infection. We also will ask you to keep a three-day voiding diary to enable us to classify and identify the cause and severity of your incontinence. Then we will schedule a follow-up visit before we begin treatment to review the timing, quantity, severity and circumstances of your typical episodes of urine leakage, particularly those that you find most troubling.
The treatment approach we adopt for each case depends on the type of incontinence and severity of symptoms. In women, the most common types are stress or urge incontinence, but some women may have mixed incontinence, where urge and stress incontinence occur simultaneously. When episodes of urine leakage occur following a physical act like sneezing, coughing, heavy lifting or bending over, that is stress incontinence. On the other hand, urine loss associated with a strong uncontrollable need to void is urge incontinence. So we will use the three-day voiding diary, medical history, physical exam and any necessary tests to determine what type of incontinence you have in order to administer the right treatment.
Once the type of incontinence is determined, we will embark on appropriate treatment for your condition. For example, if we find that you have early-stage incontinence with rare or less troubling symptoms, we will reassure you that your condition is not that bad and recommend a number of lifestyle changes to improve your situation. We are good at building close and abiding relationships with our patients, so we will explain the diagnosis caringly and instruct you compassionately on what lifestyle changes we want you to make. For instance, since timed voiding is quite helpful with nocturnal urge incontinence, we may instruct that you set an alarm every night an hour before the usual time you wake up with a deep sense of urgency and empty your bladder before it gets full to the point of leakage. We also may advise that you reduce your overall fluid intake, avoid caffeine, spicy foods or carbonated drinks.
We often recommend Kegel (pelvic floor) exercises for women with stress incontinence. Well-timed, regular Kegel and bladder retraining exercises help to relieve symptoms and treat the condition. We will instruct you on the right technique for these exercises and work with you on a plan to help you practice them until they become second nature. We recommend that you begin by exercising the pelvic floor muscles 4 times a day and gradually increase this to 8 times a day, making sure also to use bladder retraining exercises to increase the interval of time you take between your bathroom visits. We will guide you all the way, checking on you to find out if there is any relief from the symptoms as you implement the exercise regimen.
In case of a severe, debilitating urinary incontinence with very bothersome and embarrassing symptoms, we may give anticholinergic (anti-muscarinic) medications to eliminate bladder spasms and relieve the symptoms of incontinence. Some common medications we may recommend include Detrol, Vesicare, Ditropan XL, Enablex, Urispas and Oxytrol, with Oxytrol being available even without prescription. Apart from medications, we may advise you to use absorbent pads, panty liners or similar products, to prevent urine leakage or possible embarrassment from a potential leakage. A good example is the pessary, a plastic insert into the vagina, which we may recommend for supporting your bladder’s neck and preventing urine leakage associated with stress incontinence.
If these treatments fail to give enough relief, we may opt for surgery. For instance, we may surgically implant small nerve stimulators just beneath your skin to stimulate the nerves controlling the pelvic floor area and manipulate the contraction of the muscles within your pelvic floor. Or we may opt for the sling procedure, a surgical intervention in which a strap of natural tissue or synthetic mesh is added to support the urethra. We also may conduct procedures to restore your bladder to its original position.
Are you worried about urine loss when you sneeze or cough? Do you always have to stop what you are doing and rush to the bathroom whenever your bladder is full? Or do you fear going out with your friends because of a possible urine leakage? Do not suffer in silence. At Advanced Urology Institute, we have been treating urinary incontinence in women for many years and have the tools and personnel to solve your problem. Whether you just started having urine leaks recently or have had the problem for so long that you have decided to avoid the social activities you used to love, we will give you the right treatment to help you recover. For more information on treating urinary incontinence in women, visit the “Advanced Urology Institute” site.
TRANSCRIPTION:
Hi, I’m Dr. Nicole Szell, I’m a board certified urologist with Advanced Urology Institute.
I think the first thing that’s really important to understand when a patient comes in with these issues is how debilitating is it for them?
Are they in the early stages, it doesn’t bother them that much, they just need to be reassured that it’s something that happens to a lot of women, it could get worse, or it could remain the same, or is it become so debilitating to them that they are willing to have surgery or other invasive maneuvers in order to help prevent it.
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Bladder control problems are common for many women. They are characterized by urine leakage, a progressively weaker urine stream, inability to empty the bladder or the frequent urge to urinate and rush to a bathroom. Bladder issues often restrict a woman’s range of physical activities and may cause withdrawal from social interactions, resulting in a diminished quality of life. Causes may include weakness of the pelvic fascio-muscular supports, nerve damage, various medications for neurologic conditions and underlying medical disorders like kidney disease and diabetes. While these problems differ according to cause and contributing factors, urologists can help women regain bladder control by identifying the type of bladder problem and administering the right treatment.
The 7 most common types of bladder control problems in women are:
1. Temporary or transient incontinence
This is a short-lived episode of loss of bladder control that commonly affects more than half of hospitalized women and at least a third of community-dwelling elderly women. It is often a side effect of medications (such as sleeping pills and diuretics) that lower cortical control over the urinary bladder or stimulate overproduction of urine. They may also be caused by surgery, pregnancy, urinary infections, severe constipation, or an inflamed or irritated bladder, vagina or urethra. In all cases, temporary incontinence will resolve on its own as soon as causative factors are identified and corrected.
2. Stress incontinence
This is the involuntary loss of bladder control associated with activities that increase physical pressure and stress in the abdomen and bladder. Affected women report having urine escapes when they laugh, cough, sneeze, have sex, exercise or engage in heavy lifting. It is the most common type of incontinence among women, occurring at any stage of life due to the physical changes of pregnancy, childbirth or menopause, all of which weaken the pelvic floor and reduce the effectiveness of bladder supporting ligaments.
3.Urge incontinence
Urge incontinence is the loss of bladder control commonly resulting from abnormal nerve signals or nerve damage due to a cerebrovascular accident, an infection or diabetes mellitus. It is characterized by a strong, abrupt and urgent need to urinate without prior warning, followed by the escape of a considerable amount of urine almost at once. Women affected by this bladder problem report leaking urine on their way to the restroom, urinate more than eight times per day and usually have to get to the bathroom more than two times overnight.
4. Mixed incontinence
This type of incontinence represents a combination of the characteristics of both urge and stress incontinence, with affected women experiencing episodes of sudden, urgent and uncontrollable urge to urinate together with urine leakage after a sudden cough, sneeze or laughter. All the factors that trigger urge and stress incontinence also cause mixed incontinence, including abnormal nerve signals, nerve damage, weakened pelvic floor muscles and connective tissue abnormalities.
5. Functional incontinence
Unlike the other types of incontinence, functional incontinence is not caused by abnormalities in the urinary system, nerves or muscles, but it occurs when a woman is unable to reach the bathroom in time to void because of mental and physical limitations. For example, a woman who is handicapped (such as having arthritis, a broken leg, Parkinson’s disease or Alzheimer’s disease) may not be able to move to the bathroom to urinate as soon as her bladder capacity is far exceeded, urinating where she is. Therefore, functional incontinence is a side effect of a mental or medical health issue.
6. Overflow incontinence
Characterized by the involuntary leakage of small amounts of urine when the amount of urine in the bladder exceeds the bladder’s maximum capacity, overflow incontinence occurs in women with weak bladder muscles, blocked urethra, kidney stones, scar tissue, pelvic organ prolapse, diabetes and multiple sclerosis. In overflow incontinence, the bladder has a substantial amount of residual urine and tends to overfill rapidly, resulting in the overflow of urine within a very short time. When not promptly treated, overflow incontinence can lead to bladder infection.
7. Overactive bladder
In some women, the inability to control the bladder is characterized by a sudden and unstoppable need to urinate, passing urine eight or more times per day and having to wake up two or more times every night to pass urine. In women with overactive bladder, detrusor muscles contract unpredictably and the inability to control the bladder can be so embarrassing that the affected person may want to isolate herself and limit her work and social life.
For women having bladder control problems, the good news is that a brief evaluation by an experienced urologist can quickly identify the type of bladder problem and pave the way for immediate treatment. If you have bladder control problems, inform your doctor and ask for help. Do not let your embarrassment keep you from getting the help you need. For more information, visit the site Advanced Urology Institute.
