Incontinence - Diagnosis and Treatment

Female Urology p3

Millions of women experience involuntary loss of urine called urinary incontinence (UI). UI can be anything from a few drops of urine to a large amount. It can be slightly bothersome or totally debilitating. It may keep you from enjoying activities with family and friends and cause anxiety, depression and isolation. Urine loss also can occur during sexual activity and cause tremendous emotional distress.

Older women experience UI more often than younger women, but incontinence is not inevitable with age. UI is a treatable medical problem. We can help you find a solution and get your life back.

Treatment for any kind of UI begins with a thorough evaluation. We generally begin with conservative measures such as medications, physical therapy and lifestyle changes. Medical devices and surgery also may be options. Comprehensive care for UI is provided by our physicians and staff including Drs. Susan Tarry, Tia Schellato and Melanie Amster. All three are board-certified urologist who specialize in minimally invasive surgical procedures. Additionally, Dr. Tarry is fellowship trained in advanced reconstruction surgery.

Preparing for Your Visit

Keeping track of what you drink and how often and how much you urinate will help us evaluate your problem. Keep a diary for three days. Be sure to note any incidents of leakage--when and how much--as well as any other concerns.

We will begin with a thorough medical history and physical exam to look for medical conditions that can cause incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the pelvic organs begin to protrude out of your body.

Depending on your problem, we may measure your bladder capacity or the residual urine left after you've voided for evidence of poorly functioning bladder muscles. Other tests that may guide diagnosis and treatment include:

  • Bladder stress test--measures urine loss as you cough vigorously
  • Urinalysis and urine culture--laboratory tests for evidence of infection, urinary stones or other contributing causes
  • Ultrasound--images of the kidneys and bladder
  • Cystoscopy--a thin tube with a tiny camera that shows the inside of the urethra and bladder
  • Urodynamics--a functional test of the bladder and urinary sphincter

Types of Urinary Incontinence

Stress Incontinence

Stress incontinence is characterized by leakage of small amounts of urine during physical movements such as coughing, sneezing, exercising or picking up a heavy object. It may occur after childbirth or a hysterectomy, or as women age. It can occur during the week before your menstrual period and after menopause. Alcohol and caffeine can worsen stress incontinence.

Avoiding alcohol and caffeine and losing extra weight can help lessen stress incontinence. We may refer you to a nutritionist for assistance. Pelvic floor physical therapy, possibly in conjunction with biofeedback, can strengthen muscles around the bladder, urethra and sphincter. Another option is injection of a bulking material around the urethra to close the bladder opening. Sometimes a procedure to position a sling to support the urethra has the best success.

Urge Incontinence

This is characterized by a sudden urge to urinate and subsequent leakage when you can't make it to a bathroom in time. It results from an overactive bladder. Inappropriate bladder contractions from abnormal nerve signals can cause your bladder to suddenly empty, often during sleep. It also can occur after drinking a small amount of water or when you touch water or hear it running. Medications such as diuretics can worsen this condition. Medical conditions such as hyperthyroidism, uncontrolled diabetes, multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke and other neurologic injuries also can lead to or worsen urge incontinence.

Alcohol, caffeine and acidic bladder irritants such as tomatoes and citrus make this condition worse. Also, being dehydrated causes the urine to become more concentrated and irritating. You may think you should drink less when you are experiencing overactive bladder, but drinking water actually dilutes the urine and makes it less irritating. Urinary tract infection and constipation also contribute to the problem.

Treatment begins with evaluation to rule out a neurologic problem, stones, bladder tumors or infections, as well as any medications that could contribute to the problem. Anticholinergic medications can help relax bladder muscles and prevent bladder spasms. Botox has been shown to reduce bladder contractions. Botox can be injected in to the wall of the bladder to reduce bladder contractions and provide short-term improvement. Pelvic floor physical therapy, sometimes with biofeedback, can help you learn to control muscles. InterStim is an implantable device that controls bladder impulses. If these more conservative measures don't work, bladder augmentation may be an option.

Mixed Incontinence

Stress and urge incontinence often occur together in women. Each needs to be managed individually. When a woman is experiencing both stress and urge incontinence, a good history and physical is crucial in the evaluation, and often urodynamic studies are employed. In some cases, only the more bothersome component need be treated, but in a certain number of women, stress incontinence actually causes urge incontinence, and in these women, fixing the stress incontinence will cure the urge problem.

Overflow Incontinence

Overflow incontinence happens when the bladder doesn't empty properly, causing it to spill over. It may be caused by weak bladder muscles or a blocked urethra. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Other risk factors include pelvic surgery, recent anesthetic, constipation and narcotic use. A cystoscopy, bladder stress test and urodynamic tests can check for bladder muscle function and obstruction.

Treatment may include catheterization, medications, surgery or InterStim, an implantable device to control bladder impulses.

Functional Incontinence

Functional incontinence occurs when people cannot get to a toilet because of medical problems that interfere with thinking, moving or communicating. These include Alzheimer's disease, arthritis and being confined to a wheelchair. Treatment options include wearing protective undergarments or using a bedside commode. It's very important to maintain proper hygiene and skin care to avoid skin breakdown, ulcers and infections.

Fast appointments - same or next business day for urgent care

Bala Cynwyd 610.667.3020   *  Jeanes Hospital 215.745.4130  *  Hahnemann Hospital 215.762.3200