What is Female Urinary Incontinence?
Urinary Incontinence (UI) is the involuntary loss of urine at a time that is inconvenient and in amounts sufficient enough to be considered a social or health problem. Significant misconceptions about female urinary incontinence are that it is a normal part of aging or an inevitable consequence of childbirth.
Female urinary incontinence is a symptom rather than a specific disease. It can occur in all ages. The urine loss can range from slight losses of urine to severe. This urine loss can also be temporary or permanent. FUI patients frequently feel embarrassed by their incontinence and tend to withdraw from social situations.
The urinary bladder collects and stores the body waste and urine water removed by the kidney. The bladder is connected to urethra or the tube through which urine is ejected out of the body. During urination, the muscles lining the bladder contract’s inner walls purging the urine out of the bladder into the urethra. Simultaneously, the muscles surrounding the urethra, also called the sphincter muscles, relax, allowing the urine to flow out of the body. Incontinence happens when the bladder muscles suddenly contract or the sphincter muscles are not strong enough to restrain the urine your body is about to discharge.
Causes of Urinary Incontinence
Many factors are contributing to the development of urinary incontinence. While some forms are temporary (caused by conditions such as urinary tract infections, vaginal infections, etc.), others are not. Weak or overactive muscles that hold the bladder in place or hold urine in the bladder (such as weak pelvic floor muscles, weak bladders, weak urethral sphincter muscles) can result in long term urinary incontinence. Among all types of FUI, the most common is the stress female urinary incontinence.
Types of Urinary Incotinence In Women
There are several different types of urinary incontinence. The most common types are stress urinary incontinence and overactive bladder.
Stress urinary incontinence is a leakage of urine with activity, physical stress. The stress that most women will experience is coughing, sneezing, exercising, jumping up and down. Doing these activities they will notice leakage of urine. It can be anywhere from drips and splashes to big accidents. And some women will experience this enough that they end up having to wear pads, panty liners or different types of undergarments to help protect themselves from the leakage.
Urge Incontinence (Overactive Bladder)
Overactive bladder is a type of incontinence that comes with urgency. It is a sudden onset of urge where you have to rush to the bathroom. It doesn’t give you very much warning. And some women will feel as if they’ve lost their sensation because that warning is so fast. They may even can’t get their pants down fast enough to make it to the commode in time.
Women of all ages can experience urinary incontinence. Patients from their early teens until their 90s will experience urinary incontinence. It really depends on risk factors that you’ve been exposed to throughout your life.
Overactive bladder, which often presents to women as an inability to control their urge to urinate, often presents with a sudden onset of urgency where they have to rush to get to the bathroom. These patients can often also present with frequency. So they’re going to the bathroom much more frequently than they ever did.
Women can wake up at night, which is called nocturia. Waking up at night approximately one or two times after the age of 60 is fairly normal. But if you’re waking up more than that and it’s disrupting your ability to get a good night’s sleep, then that is an abnormality.
You should speak to your doctor about urinary incontinence when it starts to affect your quality of life. If you find yourself not participating in activities and enjoying every day, then it’s definitely time to speak to your physician. There are lots of some surgical and some non-surgical treatments that will greatly improve your quality of life.
Urinary incontinence is treated in a number of different ways. Initially, we would have to have a thorough history and a physical exam in order to determine what the underlying type of incontinence is. Once we know the type of incontinence, we can come up with a treatment plan. It may include treatment of the urethra if you have stress urinary incontinence. Or it could involve treatment of the bladder itself, if you have overactive bladder.
The treatment of stress incontinence when addressing the urethra usually entails a minor outpatient surgical procedure, which is very well tolerated and has a minimal recovery. Whereas treatment of the overactive bladder usually involves changes in your diet, behavior and medications. If those fail and there are more invasive treatments available. But for most women, they do very well with that.
Symptoms of urinary incontinence
- High urinary frequency: When the frequency crosses the standard limit, the patient urinates more than eight or nine times a day and thrice or four times at night.
- Extreme urinary urgency: The strong yet unpredictable urge to urinate. It might occur right after one has urinated in a large amount.
- Uncontrollable urge: When certain amount of urine just gushes out and the patient has no control over it.
- Nocturia: The necessity to urinate repeatedly at night causing the patient to stay awake.
Behavioral techniques are the first stage of therapies for this disease. A physician may suggest a large number of exercises, which can help to cope with the issue. The most common among them are Kegel exercise. Several bladder exercises and Pelvic Floor Therapy are also among the common options.
Medication for an over-active bladder: Doctors may prescribe few medicines which relax the hyper nervous activity relaxing the signals causing frequent urination.
Surgery. There are many different techniques to solve this problem with varying rates of success. Every woman needs a different bladder support level. Thus, it makes sense to use a re-adjustable sling to adapt the bladder support to every patient.
Below you can find a surgical treatment description that uses a re-adjustable sling to reconstruct the bladder support level you had before the incontinence appeared. For example, the Remeex system gives your doctor the ability to regulate the bladder support level to your particular need, not only in surgery but also whenever needed, during the rest of your life. The Remeex System may avoid reinterventions, eliminate post-operative retention and assure long term continence control.
Stress Incontinence Treatment Options
Stress urinary incontinence or the leakage of urine with any activity tends to be quite a common problem for many women. With exercise, coughing, and sneezing, many people seem to think that it’s part of growing older. Or, they just chalk it up to having kids, which is certainly true. The onset of menopause, having children, or being pregnant can worsen the problem. But we have many treatments now that are very minimally invasive.
Many patients always tell that they’ve been doing Kegel exercises for years, and they haven’t helped. However, even though they think they’re doing Kegel exercises, they’re often squeezing their abdominal muscles or their cheeks and not the right types of muscles.
Also, it takes a lot of commitment to stick with a regiment or to do them correctly and often enough. That is why we sometimes recommend seeing a physical therapist. We always tell our patients to feel the difference between getting a six-pack on your own or working with a personal trainer.
Urethral Sling Procedure
If Kegel exercises don’t work for patients, the next step from there would be surgery. Fortunately, we can fix stress urinary incontinence with an incision about one centimeter long right in the vagina underneath the urethra.
From there, we insert a small sling about the size of a finger that sits underneath the urethra. When you cough, sneeze, or exercise, the urethra has something to support itself against. And then you don’t get the urinary leakage.
Urethral Bulking Agents
This option is for postmenopausal people or patients who have had a sling before, and it hasn’t worked for them. Often, when a woman becomes postmenopausal, her urethra walls become thin, and the urethra’s lumen is open.
What we do is we go in through a scope into the urethra and put some filler into the walls so that it bulks them up, and the urethra lumen closes up. It gives a little bit more resistance for the urine to pass through.
Urge Incontinence Treatment Options
Urge incontinence or urine leakage that comes with a strong sense of urgency is a widespread problem. Many of our patients seem to just chalk it up to growing older or being part of what it means to be a woman. However, it doesn’t have to be true. We have so many minimally invasive options for treatment with very few side effects.
Behavioral changes. In terms of management, we start with behavioral changes. Many women think that they have to drink six to eight glasses a day. However, even though it’s always healthier to drink, some people don’t need that much fluid. They don’t notice that all the liquid that they’re taking in has to go somewhere. And it might be associated with some sense of urgency.
From there, other options include either physical therapy to try to retrain the bladder or medicines. Some people even try both.
There are two types of medication for the overactive bladder: anticholinergic and the beta-agonists.
The anticholinergics are very popular, including the following drugs:
- atropine (Atropen)
- belladonna alkaloids
- benztropine mesylate (Cogentin)
- cyclopentolate (Cyclogyl)
- darifenacin (Enablex)
- fesoterodine (Toviaz)
These are just some of these medications that are meant to help calm the bladder down.
There is only one beta-agonist that exists in the market – Myrbetriq. Again, the concept here is to try to calm the bladder down.
Furthermore, a newer drug called Mirabegron is in a different group of drugs than the previously available ones. It does not have those side effects and could be a good option for people.
Some of the common side effects we see in anticholinergics are constipation and dry mouth. Myrbetriq can increase your blood pressure slightly. However, these medications work very well, and these can be game-changers for these patients’ quality of life.
Peripheral tibial nerve stimulation (PTNS)
The next option is something called peripheral tibial nerve stimulation or PTNS. A patient comes in once a week for a series of 12 weeks for the treatment. We put a tiny acupuncture-like needle into the ankle area, and it gets stimulated. You can sit and enjoy reading a book during that time.
Many of our patients find it therapeutic and like the minimally invasive nature of it. PTNS has about 70 to 80% success rate. After completing 12 weeks, a patient can come in 3, 6 months, or other terms. This maintenance rate is specific in any individual case.
It is an implantable device that goes into the back area. A wire runs alongside the nerve that controls the entire pelvic region. What’s nice about this device is you get to try it out before you actually have it implanted. The trialing tails are coming down, and we inject a little bit of local anesthetic into your lower back. Then pass a wire that runs along the nerve on either side. You get to wear this device for a few days on one side and for a few days on the other side to see which side works best for you.
After a week for the trial, you come back and let us know that this worked great or didn’t work at all. You can also tell which side worked best for you. We’re looking for at least a 50% improvement to make it worthwhile to have the implant.
Botulinum Toxin Injections
Finally, we have something called Botox. Unfortunately, it does not remove the wrinkles from the bladder. What it does is it paralyzes some of the muscles inside the bladder, so it’s not so trigger-happy and squeezing when it’s not supposed to. Botox helps to reduce urinary frequency and incontinence.