Urinary Incontinence

Urinary incontinence (UI), or bladder leakage, is the loss of urine control, or the inability to hold your urine until you can reach a restroom. Incontinence can range from the discomfort of slight losses of urine to severe, frequent wetting. Millions of people experience incontinence and it can have a profound impact on their quality of life.  Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that can result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause because of weakened pelvic muscles.

Types of Female Urinary Incontinence

Urge incontinence, the inability to hold urine long enough to reach a restroom, is associated with a sudden, intense desire to urinate that cannot be resisted. It can be caused by neurological conditions such as stroke, dementia, Parkinson’s disease, and multiple sclerosis, but it can also develop in patients without neurological diseases. Problems with bowel movements can also cause urge incontinence.

Stress incontinence involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is one of the most common types of incontinence, particularly in women. In men, surgery on the prostate can cause stress incontinence.

Overflow incontinence is leakage that occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it. This type of incontinence generally develops when a person is unable to empty completely on a regular basis. Patients often complain of persistent dribbling, or urinating small amounts but not feeling empty.

Mixed incontinence usually refers to both stress and urge incontinence, but can refer to any combination of types of incontinence.

Functional incontinence is a medical condition that prevents a person from making it to the bathroom in time to urinate, resulting in incontinence. Common examples include physical impairments such as arthritis, which make it difficult to move quickly enough to reach a restroom in time, or mental impairments such as dementia, which prevent a person from realizing when they need to urinate.

Total incontinence is persistent, continuous incontinence that can occur as a result of anatomic abnormalities or injuries that develop during surgery.

Evaluation for Female Urinary Incontinence

Incontinence is a common condition but one that should not be ignored. Women suffering from incontinence should see a doctor because there are a number of treatment interventions that can dramatically improve their urinary control. Doctors often ask patients to fill out a voiding diary, or a frequency/volume chart, to establish urinary patterns. Our physicians may perform a urinalysis to rule out an infection or other problems.  They may perform a bladder ultrasound or scan after voiding to ensure that the patient is emptying his/her bladder completely. They may perform a cough stress test to investigate whether stress incontinence exists.

More sophisticated testing includes multichannel urodynamic studies, which include complex cystometrograms (CMG), leak point pressures, urethral-pressure profile (UPP), and uroflow, and pressure-flow testing using the Lumax Cystometry System.  This highly sophisticated bladder function evaluation allows the doctor to determine the bladder capacity, whether the bladder is spasming while it is filling, whether incontinence is present, and if so, what type, and whether bladder pressures while it is filling are appropriate.

Incontinence Treatments

Treatment depends on what’s causing the problem and what type of incontinence you have. If your urinary incontinence is caused by a medical problem, the incontinence will go away when the problem is treated. Kegel exercises and bladder training help some types of incontinence through strengthening the pelvic muscles. Medicine and surgery are other options.

In addition to effective drug therapy, Carolina Women’s Aesthetic Surgery Center is equipped with a state of the art operating room where IV sedation may be given for certain procedures. We utilize the services of Certified Registered Nurse Anesthetists who are experienced in both office and hospital environments. The procedure room is equipped with modern monitoring and resuscitation equipment.

Behavior Therapy

Behavior therapies for urge incontinence include bladder training and pelvic floor muscle (Kegel) exercises. Bladder training (i.e., learning to hold urine longer and longer between voids) can be more effective than medications, such as oxybutynin, and improves incontinence in more than 50 percent of patients.

Cystoscopy

This is a procedure which involves inserting a small scope into the bladder for evaluation of blood in the urine, and for evaluation of the inside of the bladder. A flexible fiberoptic scope is used for cystoscopies. This allows us to perform cystoscopies with the patient lying back without being in stirrups. It is also much more comfortable than using the older, rigid cystoscopes.

Urodynamics
urodynamics
In females, urodynamic evaluation is performed to check for bladder sensation, stability, and competence of the internal sphincter. These studies help decide if a surgical bladder suspension is required to treat urinary incontinence or whether medication should be used.

Monarc™ Subfascial Hammock
MonarcHammock
The Monarc Subfascial Hammock treats female stress urinary incontinence by placing a narrow strip of mesh in your body to support the urethra. The Monarc uses what is called a transobturator approach to place the supportive mesh. The transobturator approach avoids the retropubic space, the area of loose connective tissue between the bladder, pubic bone and abdominal wall. With this approach, narrow mesh carriers are passed through an area near the groin at the obturator of the pubic bone. The mesh is then attached and pulled into place under the urethra.

Once placed, the hammock cradles your urethra and gives it a point of support.  Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities within a few days.

The Monarc offers several benefits:
•Patients generally recover quickly and experience immediate continence.
•It is minimally invasive and suitable for a wide variety of patients.
•Incisions in the groin area are small.
•Can be used in patients who have retropubic scarring resulting from prior pelvic surgery.
•The hammock can be loosened or tightened during and immediately after the procedure.

The SPARC Sling System treats female stress urinary incontinence by placing a narrow strip of material—called a “sling”—in your body to support the urethra. The SPARC system uses a suprapubic approach in which narrow sling carriers are passed from above the pubic bone to the vagina. The sling mesh then is attached to the carriers and pulled into place.
sling

A self-fixating polypropylene sling cradles your urethra and gives it support during normal daily activities. Most patients are continent immediately following the procedure and can resume normal, non-strenuous activities within a few days.

The SPARC provides many benefits:
•It is an outpatient treatment suitable for a wide variety of patients and can be performed using a minimally invasive approach.
•The sling can be loosened or tightened during and immediately after the procedure.
•Incisions in the abdomen and vagina are small.
•Patients generally recover quickly and experience immediate continence.

Click here to see an interview with Dr. Lisa Grana about treating urinary incontinence.