Urinary Incontinence

Stress urinary incontinence (SUI) occurs when there is pressure on the bladder that it can’t resist. The pressure could come from heavy lifting, exercising, coughing or laughing. For some, just standing up is too much pressure.

Regardless of whether the stress is mild or severe, you might lose a dribble of urine or a significant amount. You might not feel an urge to go to the bathroom before it happens.

Risk factors include:

• Gender. Women are more likely to experience stress incontinence than men because of the physical difference in the urethra, the tube that brings urine outside of the body. Women have a shorter urethra, which can undergo trauma during pregnancy and childbirth.
• being overweight
• smoking
• conditions that lead to chronic coughing
• constipation, which results in straining
• Genetic factors. Stress incontinence can run in families.

If you are overweight, losing weight can make a difference. Pelvic floor exercises, known as Kegel exercises, can strengthen the pelvic floor. You need to squeeze and relax the muscles repetitively daily. Talk to your health care provider to make sure you’re doing Kegel exercises correctly.

Nonsurgical treatments include:

• A pessary, a small silicone device inserted into the vagina to support the urethra.
• The Poise Impressa, an over-the-counter product that supports the urethra. Getting the right fit is imperative.

Surgical treatments are typically minimally-invasive outpatient procedures with little downtime.

Options include:

• A sling, a hammock-like support for the urethra made of mesh or the patient’s own connective tissue. The tension is critical. The sling must prevent leakage yet allow the normal flow of urine. Although rare, the mesh sling can lead to side effects, such as urinary tract infections. The American Urogynecologic Society (AUGS) has a handout with more information on slings.
• An adjustable sling, which can be adjusted after its insertion.
• Bulking, which might work for a select number of patients. During the outpatient procedures, the surgeon will inject the walls of the urethra to narrow it.

ChristianaCare Center for Urogynecology and Pelvic Surgery provides all of these treatments.

Often referred to as an overactive bladder (OAB), urge urinary incontinence happens when your brain tells your bladder that you have to go, but your bladder isn’t full. Or, the bladder muscles are contracting too frequently. In either case, you feel as though you need to continually go to the bathroom.

About 33 million Americans have OAB, according to the Urology Care Foundation. The risk of developing OAB rises with age, but that doesn’t mean it should be an accepted part of the aging process.

Your health care provider will first look for an underlying cause, such as a urinary tract infection (UTI). If you do not have a UTI, you might find relief with lifestyle and behavioral changes, such as:

• Avoiding certain dietary triggers, such as caffeine, which can stimulate the bladder.
• losing weight
• Practicing Kegel exercises to strengthen the muscles in the pelvic floor.
• “Retraining” your bladder. For instance, if you routinely head to the bathroom after coming home—regardless of whether you need to use it—you might try waiting to recondition your bladder.
• Medications for overactive bladder include:
• Anticholinergic medications, such as Oxytrol and Vesicare. Common side effects include a dry mouth and constipation. This group of medications can cause memory issues in older patients.
• Myrbetriq, which has fewer side effects

Your doctor may recommend several tests and procedures, including:

• A cystoscopy, during which the doctor inserts a hollow tube with a camera lens into the urethra and up to the bladder to look for any abnormalities.
• Urodynamic studies (UDS) test, which evaluates how well the bladder works.

At the ChristianaCare Center for Urogynecology and Pelvic Surgery, the physicians will then discuss the possible treatment options, which might include:

• Botox. Using a cystoscope, the doctor will inject a section of the bladder to paralyze the muscle and reduce the strength of the contraction. It will wear off in six to 12 months. Side effects include an increased risk of developing a UTI. In rare instances, the Botox completely paralyzes the bladder, necessitating self-catheterization.
• Sacral nerve stimulation. An implanted device—much like a pacemaker—sends a signal to a wire near the sacral nerves so you can better sense when you need to urinate to prevent leakage. ChristianaCare Center for Urogynecology and Pelvic Surgery offers the procedure.
• Tibial nerve stimulation. In an office procedure, the doctor will insert an acupuncture needle next to the tibial nerve behind your ankle, which runs to the same spot in the spinal cord as the bladder nerve. There is no implant, but you need to undergo the 30-minutes procedure once a week for 12 weeks. After that, you will need periodic boosters.

You and your physician will make your choice based on your medical history, lifestyle and your personal preferences.