Urinary Incontinence

Approximately 30-65% of women in the United States experience urinary incontinence (involuntary loss of urine). Possible causes include injuries from childbirth, aging, certain vaginal surgeries, radiation therapy, and medications that interfere with muscle, nerve, and bladder function. More than 90% of the urinary incontinence is caused by stress, urge, or mixed incontinence.

Stress incontinence is the most common cause of involuntary urine loss in premenopausal women. It refers to accidental urine loss when a woman coughs, sneezes, jumps, jogs, dances, or lifts a heavy object. Women with stress incontinence frequently have co-existing cystocele (the anterior vaginal wall has fallen down).

Non-surgical treatments for this condition include Kegel exercise with biofeedback to strengthen the pelvic floor muscle, medication to increase the tone of the muscle around the urethra, collagen injection to increase the resistance of the urethra.

Surgical treatments to restore continence include Burch colposuspension, Marshall-Marchetti- Krantz procedure, suburethral sling procedure, anterior repair (usually in conjunction with another procedure), paravaginal repair (usually in conjunction with another procedure), needle suspension (this procedure is rarely performed), and tension free vaginal tape (TVT – for selected patients). Most surgical repairs require 1-2 days of hospitalization.

The choice between non-surgical and surgical treatment depends on the severity of the incontinence, the patient’s general health, how much the incontinence is affecting the quality of patient’s life, and most importantly, the patient’s ultimate goal.

Urge incontinence is involuntary urine loss shortly after a person experiences a sudden and an uncontrollable urge to urinate. Urine loss often occurs before the person can get to the bathroom. The amount of urine loss is often sufficient to soak underwear, pad, and clothing. In addition, women with this type of incontinence often have to go to the bathroom constantly, day and night. These women may have co-existing cystocele (the anterior vaginal wall has fallen down).

Treatment for urge incontinence is primarily non-surgical. These include bladder training (going to the bathroom at specific time only), Kegel exercise, medication (to relax the bladder muscle), functional electrical stimulation (run a mild electric current through the bladder using a vaginal probe for approximately 20-30 minutes each week for 4-6 weeks), and neurostimulator implant (place a permanent implant to stimulate nerve to the bladder. This treatment is rarely used).

Surgical treatment usually involves repairing the co-existing cystocele. This is usually done if a patient failed to response to non-surgical treatments.Mixed Incontinence is when a woman has both stress and urge incontinence. Women with this type of incontinence usually require treatment for both conditions. Frequently, treatment for one condition may markedly improve both types of incontinence. The initial therapy is usually non-surgical.

The initial evaluation for urinary incontinence involves a detailed history and physical examination, and a simple cystometry. During simple cystometry, the nurse will put a small catheter into your bladder to make sure that you are emptying your bladder completely and then fill your bladder with water. During the examination, the doctor will ask you to cough and bear down to see if and how much you leak from your bladder. This initial evaluation process takes approximately one hour.

If your incontinence requires surgical correction, then you would need a multichannel Urodynamic study. The study involves putting one small catheter (approximately _ cm in diameter) in your bladder and another small catheter in your vagina. This study will allow us to accurately determine what is causing your incontinence and what is the best surgical procedure to repair your condition. The entire study takes approximately 30 minutes.