Incontinence

You do not have to live with incontinence – there are effective treatments.

What is incontinence?

Incontinence is the leakage of urine, feces, or flatus.
Women of all ages can be affected.
Aside from the physical effects, there are significant emotional, social, and financial impacts.

Types of Incontinence

The two most common types of urine leakage in women are urge and stress incontinence. People with both stress and urge incontinence are said to have mixed incontinence.

Urge incontinence

Urge incontinence is the leakage of urine associated with a strong urge to urinate, or not making it to the bathroom in time. When leakage of urine is accompanied by a sensation of the need to urinate, or the impending sense that a large leak is going to happen, this is often what is known as urge incontinence. Unlike stress incontinence, this usually represents a bladder “squeeze” or contraction, occurring at an unwelcome time. Often people with urge incontinence also have increased urinary frequency, have to rush to the bathroom frequently, or wake up more than once or twice at night to urinate. They may also notice severe urgency and leakage when driving into the driveway, placing the key in the front door, running water or with temperature changes.

Stress incontinence

Stress urinary incontinence is loss of urine that occurs at the same time as physical activities that increase abdominal pressure (such as sneezing, coughing, laughing, and exercising). These activities can increase the pressure within the bladder, which behaves like a balloon filled with liquid. The rise in pressure can push urine out through the urethra, especially when the support to the urethra has been weakened. This is what we call stress urinary incontinence. Often the stretching of pelvic muscles during pregnancy and childbirth can cause urinary incontinence in new mothers, which may or may not resolve within a few months after delivery.

Mixed incontinence

Mixed incontinence is the combination of two or more causes, such as the presence of both stress and urge incontinence.

Overactive bladder

People with overactive bladder have a sudden, overwhelming urge to urinate, but may or may not leak urine before getting to the toilet. People with overactive bladder often have urgency to go to the bathroom during the day and/or night.

Evaluation & Diagnosis

The first step to getting help with incontinence is to talk to your healthcare provider. Even though it can be an embarrassing problem, many patients are surprised to learn how many women - of all ages - are affected, and that it IS a treatable, curable problem.

First Visit Tips

These are some tips to get the conversation started on your first visit – knowing this information will help your provider form an accurate diagnosis and treatment plan options:

Date of your last pelvic exam
Number of children you have birthed and how they were delivered (vaginally, or cesarean section)
Symptoms you may have in your pelvic region: bulging, trouble urinating or passing a bowel movement, leaking, needing to use the bathroom frequently, pain during urination
When your symptoms started
How often you have these symptoms
Any medicines you may be taking or allergies you may have

Voiding diary

A voiding diary (or bladder diary) helps you record how much fluid you drink, activities that cause leakage and when you have urge sensations. Recording this data will provide important information about the cause and potential treatment of your leakage.

Bladder Tests

Simple tests, such as a cough test, may be done during an office visit to determine the type of leakage you are experiencing. A test of your urine (urinalysis) is usually done to rule out infection or blood in the urine. Blood tests may also be ordered.

Learn more about Urodynamics

Treatment Options

Depending on the severity and extent of your symptoms and your goals, you and your healthcare practitioner can discuss the various treatment options.

Stress Incontinence

Pelvic floor muscle rehabilitation – pelvic muscle exercises, also known as Kegel exercise, can help reduce or eliminate urine leakage. Just like other exercises, technique and dedication to regularly performing the exercises will yield the best results. Pelvic floor strengthening can involve physical therapy, the use of phone apps, or biofeedback devices that can help maximize your pelvic floor strength. Your provider can discuss the options with you in greater detail.
Surgical treatments – a number of minimally invasive surgical procedures may be performed, and surgery has the highest cure rate, even in elderly women.
Bulking agents – Injectable urethral bulking agents are used for treatment of stress urinary incontinence. Improvement is achieved by increasing the tissue bulk around the urethra and thereby increasing resistance to the outflow of urine.
Vaginal Pessaries – A pessary is a plastic device that can be fitted to help support prolapsed pelvic organs and may help with incontinence. When fitted properly, it should be comfortable and allow you to urinate and have bowel movements without any difficulty. Many women will use a pessary if they want to delay surgery, or avoid having surgery.

Urge Incontinence

Dietary modifications – certain foods and drinks can cause women to go to the bathroom more frequently. Working with your healthcare provider, you may be able to identify bladder irritants (like caffeine, alcohol, artificial sweeteners). Constipation can also make urgency and frequency worse, so increased dietary fiber can help.
Bladder training – By retraining your bladder to hold more urine, urges can be better controlled. This is done by learning to go to the bathroom at specific intervals, and also learning strategies to control urges.
Medications – Medication provides the best results when it is combined with bladder training and dietary modifications.
Neuromodulation – Nerves located in the lower back affect your bladder. We can perform a simple test to see if your symptoms are affected by these nerves. Evaluations can be performed in the hospital or practitioner’s office. Following evaluation, treatment involves placing a small nerve stimulation device; this can be performed in a minor daystay procedure.

Common Incontinence Terminology

Incontinence is the leakage of urine, feces, or flatus. OAB is associated with frequency, urgency and sometimes the loss of urine. Incontinence and OAB can affect people of all ages. Aside from the physical effects, there are significant emotional, social, and financial impacts on the lives of those who are affected. We invite you to tour our comprehensive online suite devoted to Incontinence and Overactive Bladder.

Common Incontinence Terminology

Fecal Incontinence – Accidental loss of solid stool, liquid stool, or gas
Constipation – Variously defined as infrequent bowel movements (< 3 bowel movements per week), incomplete emptying of bowel contents, need to excessively strain to effect a bowel movement, passage of small, hard stools, or need to place your fingers in the vagina or the space between the vagina and anus to effect a bowel movement.
Urinary incontinence – leakage of urine
Stress incontinence – involuntary loss of urine during activities that put “stress” on the bladder such as laughing, coughing, sneezing, lifting, etc.
Urge incontinence – an involuntary loss of urine preceded by a strong urge (also known as “overactive bladder”)Dysuria – Painful urination
Urgency – A powerful need to urinate immediately
Frequency – The need to urinate more often than normal (more than every 2 hours or more than 7 times a day)
Nocturia – Waking up frequently (more than once) during the night to urinate

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