Incontinence

Urinary incontinence in women can be troublesome and not easy to talk about, but luckily, there are treatment options available. There are several types of female incontinence, but the most common of these are urinary urge incontinence, stress incontinence, and in some cases, a combination of both. Incontinence is a common condition in women and is more likely to develop as the woman ages.

Diagnosis

The diagnosis of urinary incontinence in women includes a detailed history and physical including when the patient began to experience the symptoms and how frequently they occurred. Your doctor may also choose to evaluate your urethra with a variety of office tests that may include:

• Post-void residual volume: this determines how well you empty your bladder
• Urinary flow rate: the strength of your urinary stream
• Retrograde urethrogram: an x-ray performed while instilling dye into urethra
• Cystoscopy: using a small telescope to examine the urethra and bladder

Female Urinary Urge Incontinence

Urinary urge incontinence involves the involuntary loss of urine usually associated with a sudden urge that cannot be suppressed. Some of the causes may be related to infection, hormone status, childbirth, or previous pelvic surgeries. A thorough history and comprehensive pelvic floor exam are vital to determining the root cause of this condition. Not only is it important that the physician knows all of the medications that the patient is taking, but it is equally important to know the toilet and dietary habits of the patient as well.

Urinary Urge Incontinence can become a serious issue by certain types of foods and beverages. A urinalysis should be performed so that the physician can rule out an infection as the cause. Further testing either with urodynamics or cystoscopy or, in some cases, both may be needed in order to make an informed conclusion.

Treatments for Urge Incontinence

Non-Invasive

• Behavioral Changes- Weight loss, if you have stopped smoking, and pelvic floor muscle therapy
• Botox- An in-office treatment that uses Botox to calm the nerves that trigger the overactive bladder muscles, that cause incontinence
• Dietary Changes
• Pharmacological- This involves a trial of medications that are known as anticholinergics. It is important that the patient is aware of the side effects of medications. If the medications are not helpful or cannot be taken, then other surgical modalities are investigated
• Physical Therapy- Pelvic floor muscle therapy

Minimally Invasive

• Axonics Therapy – Axonics® Therapy is a clinically proven solution that provides gentle stimulation to the nerves that control the bowel and bladder. This type of stimulation can restore normal communication between the brain, the bladder, and the bowel, which can result in an improvement of symptoms related to an overactive bladder, fecal incontinence, or urinary retention. The Axonics® therapy system is designed to work for up to 15 years in regular therapeutic treatments.
• InterStim – This therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms. InterStim therapy does not treat symptoms of stress incontinence.

Female Stress Urinary Incontinence

Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors, some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence at some point in their life. As with urinary urgency incontinence, a thorough history and physical exam is crucial in determining the cause and a treatment plan moving forward.

Treatments for Stress Incontinence

Non-Surgical

• Kegal Exercises to strengthen the pelvic floor
• Dietary Modification / Times Voiding

Surgical

• Sling- Safe and effective with a high, long-term success rate, and is usually done in an outpatient setting
• Bulking Agents- Injected into the urethra, which can be done in the office

Small fistulas may sometimes resolve with a Foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort and recovery time.