What is urinary incontinence?
Millions of women of all ages — one woman out of three — struggle with urinary incontinence, the unintended loss of urine or “leaking.” Embarrassment and uncertainty about what can be done keeps many from acknowledging the problem and asking their doctors for help with their urinary incontinence. Instead, some women significantly change their lifestyles to accommodate urinary incontinence:
- Giving up a favorite sport like golf or tennis
- Limiting social engagements
- Cutting back on travel
- Loss of interest in sex
What are the types of urinary incontinence?
- Stress incontinence: Urinary leakage during coughing, sneezing or exercise
Defined : Urine leakage as the result of a sudden increase in abdominal pressure.
Causes : Weakness in pelvic floor muscles and/or urethral sphincter caused by childbirth or aging changes.
- Urge incontinence: (over active bladder) and frequency
Defined : The urgent need to urinate even if the bladder is not full, frequently followed by loss of urine before you reach the bathroom.
Causes : The cause is unknown in most cases; it is associated with aging. Urinary tract or bladder infections can also cause temporary urge incontinence.
- Overflow incompetence: (incomplete emptying of the bladder)
Defined : The bladder never completely empties or the body produces more urine than it can hold, resulting in leakage without a sense of needing to go
Causes : Underactive bladder muscles (opposite of urge incompetence) which may be the result of a tumor, bladder stone, scar tissue, nerve damage, certain medications, or severe prolapse of the uterus or bladder (when the organ has dropped out of position and causes pressure in the vagina.)
What is pelvic organ prolapse?
Prolapse occurs when the pelvic organs slip out of place and descend, bulging into the vaginal canal or putting pressure on the bladder, urethra or other parts of the pelvis. Prolapse can occur with the uterus (uterine prolapse), rectum (rectocele), or bladder (cystocele). This condition results in feelings of pressure or pulling in the vagina, discomfort, pain and incontinence.
Prolapse is caused by weakness of the pelvic connective tissue and muscle supporting the organs. The following factors are associated with the risk of pelvic organ prolapse:
- Multiple pregnancies and vaginal deliveries. Tissue trauma
during childbirth, especially with large babies or difficult
labor and delivery, often causes muscle weakness.
- Normal aging and reduction of estrogen during menopause contributes
to loss of muscle tone.
- Obesity places additional strain on the supportive muscles
of the pelvis
- Severe or long-standing constipation
- Chronic coughing
- Heavy lifting
What are the treatments for urinary incontinence and pelvic organ prolapse?
The first step is to recognize that urinary incontinence or pelvic organ prolapse are causing problems in your life and to ask for a consultation with an expert. Most of our experts in urogynecology are also obstetricians and gynecologists who treat women at all stages of life: during the childbearing years, pre- and post-menopause, and the elderly.
During your first visit, your Vincent doctor will discuss the details of the urinary incontinence or discomfort you are experiencing and conduct a full physical exam. During a future visit, you may have state-of-the-art urodynamic testing of bladder and urethra function.
Your doctor will then discuss an individualized treatment plan for your urinary incontinence or pelvic prolapse. This might include:
- Pessary or balloon devices placement of a vaginal support ring or urethra balloon device
- Biofeedback to teach you how to strengthen your pelvic floor muscles to reduce incontinence and support your pelvic organs.
- Bladder training for urge and frequency incontinence
- Vaginal weighted cones for urge and stress incontinence
- Medications for various types of incontinence
- Electrical stimulation of the pelvic floor muscles to tighten them
- Physical therapy with an expert who specializes in the muscles of the pelvic floor. Most patients begin with Kegel exercises. Physical therapists also use biofeedback and electrical stimulation to improve bladder control.
Kegel Site: Link to Kegel site
(We do not endorse the products or other recommendations within this site).
- Surgical options including a complete range from minimal intervention to complete reconstruction, depending on what is required. The goal is to intervene surgically only when all other non-surgical options fail. Surgeries are designed to support or provide a “hammock” for the urethra to compress against so it can remain closed during times of “stress.” This can be done by several methods, including repositioning the urethra, inserting a sling of material to hold the urethra and bladder neck in place, or injecting substances such as collagen to firm up the tissues surrounding the urethra.
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