Procedures

Urinary incontinence is defined as the involuntary leakage of urine. Many women have the misconception that this is a “normal” part of aging, but this is far from the truth. While urinary incontinence may be common, it is certainly not something a woman should have to live with. The two most common types are stress urinary incontinence and urge urinary incontinence.

Stress incontinence

Loss of urine when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress urinary incontinence occurs when the sphincter muscle at the bladder is weakened. The problem is especially noticeable when you let your bladder get too full. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence.

Urge incontinence

This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a restroom. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. The bladder becomes “overactive”, or it contracts even when your bladder is not full. Urge incontinence is often called an overactive bladder.

Overflow incontinence

If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, which leads to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra. Nerve damage from diabetes also can lead to overflow incontinence.

Mixed incontinence

If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence. Usually one type is more bothersome than the other is.

To learn of the treatment options for urinary incontinence, please click on any of the following tabs.

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{magictabs} Behavioral Modifications::

Some patients are able to make behavioral changes in their day-to-day life to alleviate bladder control problems. Typically, we recommend each patient suffering from urinary incontinence attempt behavioral modifications first to avoid medications or surgery. The first step in behavioral modification is to keep a voiding diary, which will help us get a better understanding of your voiding patterns. We will give you a voiding diary during your first visit to our specialty center.

The voiding diary will allow you to record over a 3 day period the time you voided along with the type of fluid intake, severity of urge, severity of leakage, and the activity that caused you to leak.

Excessive Fluid Intake

Your voiding diary may tell us that you tend to leak after you consume a high volume of fluids. Drinking too much fluid of any kind makes you urinate more often. Drinking too much fluid over a short period of time can overwhelm your bladder and create a strong sense of urgency.

Lifestyle Changes

Diet

Some foods and fluids can irritate your bladder. Examples would be caffeine and alcohol, which act as diuretics thus increasing urine production. If your bladder diary shows an increase in urine leakage after consuming caffeine, then we may have you cut caffeine out of your diet for a period of time to see if you stop leaking. Often, simply cutting down on your intake may help you.

Bladder Training

Bladder training or timed voiding involves adjusting your voiding habits by going on a set schedule even if you do not have the urge to urinate gradually increasing the time between urination. This allows your bladder to fill more fully and gives you more control over the urge to urinate. We will use the results of your voiding diary to come up with a schedule for your bladder training.

Extending the time between your urination intervals involves using your bladder diary to come up with an approximate amount of time that goes by in between the time that you void. The point of this exercise is to extend that interval by 10 minutes, so if you go to the restroom every 80 minutes then you must go every 90 minutes instead. If you ever feel like you are going to have an accident, do not wait for your scheduled voiding time.

The next step is to gradually increase the interval of time between your trips to the restroom. Your goal is to continue lengthening this interval until you reach intervals of two to four hours. Please be patient as it may take some time to reach these goals.

|||| Medical Therapy::

For some patients conservative treatment in the form of behavioral modification does not help with urinary leakage. The major types of medications used to manage urinary incontinence are called anticholinergics. Often, these drugs are only effective in patients that have urge incontinence caused by overactive bladder or a bladder control problem marked by sudden, intense urinary urges and urine leakage. There are fewer options for patients with stress urinary incontinence or leakage of urine that occurs with coughing, sneezing, laughing, exercising, or lifting something heavy.

Anticholinergics

Overactive bladder as one of the causes of urge incontinence is characterized by abnormal bladder contractions, which make you want to urinate even when your bladder is not full. Anticholinergic medications block the action of a chemical messenger (acetylcholine) that sends the signals that trigger these contractions. Examples of anticholinergic drugs includes but is not limited to Ditropan, Gelniqe, Detrol, Enablex, Vesicare, Sanctura, and Toviaz.

The most common side effects of taking anticholinergics is dry mouth. Other less common side effects include constipation, heartburn, blurry vision, rapid heartbeat, flushed skin, and urinary retention.|||| Physical Therapy::Patients who desire physical therapy are typically referred to a practitioner who is experienced in female pelvic floor disorders. With a physical therapist, patients learn how to recruit the correct muscle groups and build adequate strength to improve their symptoms. This may require one to two months of sessions with a physical therapist as well as a long-term commitment to continuing pelvic floor exercises.

|||| Surgery::

Stress urinary incontinence is treated either with a mid-urethral sling or peri-urethral bulking. Both procedures are minimally invasive and are typically done in our surgery center at our main location in Fresno. However, prior to undergoing surgery, patients undergo urodynamic testing to not only confirm urinary incontinence, but also to evaluate the bladder in both storage and voiding phases. This test provides valuable information that will help to determine the appropriate course of treatment.

Mid-Urethral Sling

A small, one-centimeter wide portion of mesh is placed underneath the urethra. As patients return to physical exertion, such as coughing, sneezing, running or lifting, the urethra compresses on the sling, which in turn prevents the leakage of urine.

Peri-Urethral Bulking

Using a cystoscope (scope allowing your physician to assess the lining of the bladder) a synthetic bulking agent is injected on each side of the urethra at the level of the bladder neck to narrow the urethral opening to prevent leakage.

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