Types, causes and treatment of urinary incontinence in women.
Urinary incontinence (UI), or involuntary loss of urine, can be an embarrassing problem that restricts a woman’s life. Urinary incontinence, contrary to popular belief, is not a natural part of aging that must be tolerated. The two most common types of incontinence are stress and urge incontinence.
Stress incontinence is the most common type of incontinence in women. Stress incontinence refers to the loss of urine with exertion of pressure —or stress— on the bladder, namely through coughing, laughing, sneezing, exercising, or heavy lifting. Urine loss occurs when the sphincter muscle at the bladder neck is weakened. Physical changes from pregnancy, childbirth, and menopause can cause stress incontinence. Treatment for stress incontinence involves improvement in sphincter tone through exercise or support of the bladder neck through surgery.
Urge incontinence is often also called an overactive bladder. Urge incontinence is a sudden, intense urge to urinate followed by loss of urine. The bladder muscle contracts before there is time to reach the toilet. It is not uncommon to experience an increase in frequency of urination or the need to get up to urinate at night. Urge incontinence is best treated with behavior modification or through medicines that can help relax the bladder as it fills.
Treatments for urinary incontinence
Women experiencing urinary incontinence have a number of treatment options. However, because proper treatment depends upon the type of urinary incontinence, accurate diagnosis is crucial. Therefore, a careful history and physical exam, urinalysis, and a voiding diary are important. Urodynamic testing to evaluate bladder function may also be needed, particularly when surgical treatment is being considered. Urodynamic testing involves measuring pressure in the bladder and urethra and flow of urine. It takes about 45 minutes and is performed in the office.
We start with the most conservative approach to the treatment of urinary incontinence. Behavioral changes alone can often be helpful. Urinary incontinence can be addressed through pelvic floor or Kegel exercises help to strengthen muscles. A physical therapist who works on pelvic disorders can teach these exercises and use techniques such as biofeedback to improve their effectiveness. We can help you in behavior or exercise techniques and can refer you for additional help as necessary.
If surgery is needed for stress incontinence, we perform the tension free vaginal sling. The tension free vaginal sling is a minimally invasive, outpatient procedure that allows for a quick recovery with high success rates and durable results.