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Urinary incontinence is any involuntary leakage of urine. It can be leakage of a large amount of urine or just a few drops. The four most common types of female urinary incontinence are stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and overflow incontinence. Stress urinary incontinence is leakage of urine with physical activity. Urge urinary incontinence, also called "wet overactive bladder", is unintentional leakage of urine preceded by a sudden urge to urinate. Mixed urinary incontinence is a combination of both stress and urge incontinence. Overflow incontinence is leakage of urine due to a bladder that is always too full.
38% of women in the United States experience urinary incontinence. It is estimated that 49% of these women have stress urinary incontinence, 22% have urge urinary incontinence, and 29% have mixed urinary incontinence. Overflow incontinence tends to be rare in women. The incidence of urinary incontinence increases with age but is never considered normal. It can interfere with work, socializing, exercise, and sexual functioning. Treatment options are available for all types of urinary incontinence.
Women with stress urinary incontinence experience leakage of a small to moderate amount of urine with activity. This includes coughing, sneezing, laughing, running, walking, bending over, lifting, or just changing positions.
Symptoms of urge urinary incontinence include a moderate to large loss of urine immediately preceded by a sudden, strong urge to urinate. Women with urge urinary incontinence are often not able to make it to the bathroom in time. Some women experience urge urinary incontinence when they hear running water or get close to a bathroom. Certain foods and beverages can worsen urge urinary incontinence.
Women with mixed urinary incontinence suffer from symptoms of both stress and urge urinary incontinence. Often one type seems worse than the other.
Symptoms of overflow incontinence include the continual loss of urine without a sense that the bladder is full. Other symptoms associated with overflow incontinence are a incomplete emptying of the bladder, a slow urine stream, difficulty starting urination, or dribbling of urine after urination is complete.
Stress urinary incontinence is caused by a urethra that does not compress tightly enough to prevent leakage with physical activity. It is associated with childbirth and menopause.
Urge urinary incontinence occurs when an overactive bladder muscle contracts in an attempt to empty the bladder when it is not supposed to. The exact cause of urge urinary incontinence is unknown but is believed to be a result of malfunctioning bladder nerves. Risk factors for the development of urge urinary incontinence are age, obesity, pelvic surgery, and the presence of neurological conditions such as diabetes, stroke, Parkinson's disease, or multiple sclerosis. Urinary tract (bladder) infections, certain medications, bladder stones, and bladder tumors can also cause urge urinary incontinence.
The cause of mixed urinary incontinence is a combination of those listed above for stress and urge urinary incontinence.
Urinary retention is the cause of overflow incontinence. Click here for more information on urinary retention.
Click here for information on diagnostic testing.
NON-SURGICAL TREATMENT OPTIONS FOR STRESS URINARY INCONTINENCE
Kegel exercises strengthen the pelvic floor muscles that surround the urethra to reduce stress urinary incontinence. Kegel exercises must be done correctly and regularly to work.
Pelvic Floor Therapy
Pelvic floor therapy consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor disorders. The physical therapist uses techniques to help women contract their pelvic floor muscles correctly to prevent leakage of urine. Click here for more information on pelvic floor therapy.
Low-Dose Vaginal Estrogen
Low-dose vaginal estrogen replaces declining estrogen in urethral tissues which may thicken the lining of the urethra. Low-dose vaginal estrogen comes in a cream (Estrace™ or Premarin™), suppository (Vagifem™), or a ring (Estring™).
A vaginal pessary is a removable, diaphragm-like device worn in the vagina to support vaginal prolapse and/or decrease stress urinary incontinence. There are a variety of types and sizes of pessaries available. A pessary fitting includes two or more office visits to find a type and size of pessary that will work for you. Click here for more information on vaginal pessaries.
The Colpexin™ Sphere Intravaginal Device
The Colpexin™ Sphere is a device that is worn in the vagina to enhance the performance of Kegel exercises. Click here for more information on the Colpexin™ Sphere.
The urethral insert is a small disposable device worn in the urethra to temporarily block leakage of urine due to stress incontinence. The device is removed for urination. Click here for more information on urethral inserts.
SURGICAL TREATMENT OPTIONS FOR STRESS URINARY INCONTINENCE
A suburethral sling is a small strip of material that is inserted through an incision in the vagina and placed beneath the urethra. It provides a firm surface against which the urethra can be compressed during physical activity to prevent stress urinary incontinence. There are a variety of types of suburethral slings.
Tension-free Vaginal Tape™ (TVT)
The TVT is a brand of suburethral sling made of synthetic material that can be placed on an outpatient basis using local anesthesia. Click here for more information on the TVT.
A transurethral or periurethral injection is a simple outpatient procedure in which a substance is injected to narrow the urethra and prevent leakage. Click here for more information on urethral injections.
NON-SURGICAL TREATMENT OF URGE URINARY INCONTINENCE
Kegel exercises are contractions of the pelvic floor muscles. Pelvic floor muscle contraction at the appropriate time can inhibit bladder overactivity controlling urinary urgency and urge incontinence. Kegel exercises must be done correctly and regularly to work.
Pelvic Floor Therapy
Pelvic floor therapy for urge urinary incontinence consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor and bladder problems. The physical therapist uses techniques such as biofeedback, functional electrical stimulation, and bladder training to help women develop better control over urge urinary incontinence. Click here for more information on pelvic floor therapy.
Low-Dose Vaginal Estrogen
Low-dose vaginal estrogen replaces declining estrogen in urethral tissues and has been shown to decrease symptoms of urinary urgency and frequency. Low-dose vaginal estrogen comes in a cream (Estrace™ or Premarin™), suppository (Vagifem™), or a ring (Estring™).
Overactive Bladder Medications
There are several brands of overactive bladder medications on the market to treat urge urinary incontinence. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness or drowsiness. Changing the brand or dose of medication can decrease side effects. To learn about the different brands of overactive bladder medications, click on the links below:
SURGICAL TREATMENT OPTIONS FOR URGE URINARY INCONTINENCE
InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence, and retention. The InterStim™ is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally. Click here for more information on InterStim™ Therapy.
Studies are currently underway to evaluate the effectiveness of injecting botulinum toxin into the bladder muscle to control urinary urgency, frequency, and urge incontinence. We do not currently use botox to treat these conditions at Aguirre Specialty Care.
SURGICAL TREATMENT OPTIONS FOR MIXED URINARY INCONTINENCE
Treatment options for mixed urinary incontinence are a combination of those listed above for stress and urge incontinence.
SURGICAL TREATMENT OPTIONS FOR OVERFLOW INCONTINENCE
Treatment for overflow incontinence depends on the underlying cause of the urinary retention contributing to this problem. Click here for more information on urinary retention.