Urinary incontinence is defined as the involuntary loss of urine. It is a very common problem in both women and men. In women, it is most commonly seen in those who have had several children and it typically worsens following menopause. Historically, incontinence was treated with the use of urinary pads. However, now that we are able to determine the cause of urinary incontinence in many cases, we can often cure or significantly improve it, so that the need for urinary pads is relatively small.

There are three types of urinary incontinence.

1. Urgency urinary incontinence (overactive bladder). This occurs in individuals who, upon getting an urge to urinate, leak urine before they have a chance to make it to the bathroom. These patients typically often have urinary frequency as well. These patients typically need to know the location of restrooms whenever they are shopping, and are often afraid to leave their homes for fear that they will not find a bathroom on time. Caffeine-containing beverages such as coffee, tea, and soft drinks may exacerbate these types of symptoms. Drinking a lot of fluids can also result in these symptoms. Therefore, as part of the evaluation, we will ask about your fluid intake and suggest changes if we feel that it could result in an improvement in symptoms. There are no surgical procedures which cure this type of urinary incontinence.

   The most common cause of urinary urgency incontinence and frequency is an "unstable" bladder. This means that the bladder is inappropriately squeezing urine out before a bathroom becomes available. This is treated with medications that relax the bladder, giving the patient longer periods of time between urination. In addition, the treatment also consists of "timed voiding" where the patient urinates on a regular schedule and thus voids filling the bladder up to that volume which triggers the sensation of urinary urgency. For patients with severe urge incontinence not helped by medications, Interstim Continence Control Therapy can help. The Interstim system involves the use of a mild electrical pulse to stimulate the nerves in the lower spine that control urination.

2. Stress Urinary Incontinence (SUI). This occurs where there is the involuntary loss of urine with activities such as coughing, sneezing, laughing or sitting up from a chair. Stress urinary incontinence typically occurs because of weakness in the pelvic muscles. Based on the degree of incontinence, the treatment can vary from conservative measures such as Kegel exercises, medication, collagen injections, and surgery. Kegel exercises are pelvic tightening exercises designed to strengthen the pelvic muscles, and are appropriate for women with mild stress urinary incontinence. Collagen injections involve the injection of collagen around the urethra resulting in a tightening of the opening between the bladder and the urethra. This procedure is done as an outpatient with virtually no restrictions postoperatively. Surgical procedures such as PV sling for stress urinary incontinence are generally quite successful. These procedures typically require a one or two night stay in the hospital and can be done in combination with gynecological surgery. The appropriate treatment for stress urinary incontinence is best determined following urodynamic evaluation.
3. Overflow Urinary Incontinence. This occurs when the bladder does not empty adequately. This results in the bladder retaining large volumes of urine despite multiple attempts to empty. The effect is that of an overflowing bucket of water. The goal of treatment is to improve bladder emptying through voiding on a more frequent basis. Sometimes self-catheterization may be needed. This is a process whereby a small tube is inserted into the bladder through the urethra to empty it. Many patients will often have a combination of these types of incontinence. Besides physical examination and a urinalysis, the correct diagnosis often requires urodynamic testing. Urodynamic testing involves placement of a catherer with pressure sensors within the bladder in order to observe how your bladder reacts to filling, stress (coughing/bearing down), and emptying. In addition, examination of your bladder with a small scope (cystoscopy) may be performed.