Female Urinary Incontinence

URINARY INCONTINENCE

Urinary incontinence is any unintentional leakage of urine.  It can be caused by several underlying conditions including: infections, strokes, pressure from pregnancy, obesity and neurological problems.  It is more common in women than in men.  It affects 10-25% of women under 65 and 15-30% of women older than 60 who do not live in nursing homes.  Incontinence is even more common in nursing home residents - more than half may be affected.

Some women have the false belief that urinary incontinence is a normal part of aging and that nothing can be done to correct it.  Less than half of women seek medical care!  They may feel ashamed and even try to avoid certain social or work events; often wearing dark clothing to avoid embarrassing and visible urine stains.

When you urinate, the muscles of the bladder tighten and squeeze the urine out through the urethra, a tube that leads from the bladder to the outside of your body.  At the same time, sphincter muscles surrounding the urethra loosen, after receiving signals from your brain, allowing urine to pass out.  These muscles also can tighten and squeeze the urethra shut to prevent urine from passing.  If these muscles become weak or damaged, they might not be able to hold urine during stress activities such as sneezing, coughing, laughing or dancing.  The resulting leakage depends on how much urine is in the bladder at the time of the stress event.

TYPES OF INCONTINENCE

There are four types of incontinence:

The most common type of incontinence is urge incontinence. It occurs if the detrusor muscle (the muscle wall of the bladder) is overactive.

Stress Incontinence occurs when the pressure inside the bladder (which moves urine out) is greater than the pressure in the urethra (which keeps urine in).  It causes loss of urine during physical activity such as coughing, laughing or sneezing.  Leakage occurs when the tissues that surround and support the urethra and bladder are weakened.

In overflow incontinence, the bladder does not empty 100% during voiding.  This results in a steady leakage of small amounts of urine.  It occurs when the detrusor muscle is under active.  Overflow incontinence is less common than urge incontinence.

A woman with urinary incontinence also may have other symptoms:

URODYNAMICS STUDY

A Urodynamic study is a series of tests that provides us with a detailed look at the function of your bladder and urethra.  These tests involve measuring the pressure in the bladder while it is being filled with sterile water.  Once we know how much water your bladder can hold, we the check to see whether your bladder empties itself efficiently and completely.

PREPARING FOR THE STUDY

You should wear lose comfortable clothing.  All medications that you are taking for bladder control, including all herbals, should be stopped 7 days before testing.  You should try and keep a diary of voiding habits (how often you go to the bathroom, how often you leak, how much fluids you are drinking, etc) for the week prior to the testing.

TESTS THAT MAY BE DONE

Uroflowmetry: This test measures the amount and speed of urine you release from your bladder.  A computer records your urine flow over time.  We also measure the amount of urine remaining in your bladder after you void.

Cystometry: This test evaluates how much your bladder can hold, how strong the bladder muscle is and how well the signals work that tells you when your bladder is full.  Your bladder is filled with sterile water using a thin catheter.  You will be asked to report when you feel the urge to void and the amount of water needed to create that sensation is measure.  You may be also be asked to cough, sneeze or bear down.

Pressure flow study: This test measure the pressure of the urine stream as it leaves your bladder.

Treatment Options for Female Urinary Incontinence

Pelvic Floor Retraining

BIOFEEDBACK BLADDER REHABILITATION

This is a conservative, non-surgical therapy used to treat incontinence, urgency, frequency and sometimes pelvic pain.  It is a method that can be used to restore bladder health after childbirth and hysterectomy.  One of our specially trained health care professionals will educate, evaluate, and instruct you on proper isolation and exercise of the muscles that support your bladder, also called the "pelvic-floor".

Often people attempt to exercise the pelvic-floor” muscles by performing Kegel exercises. Most people do not realize that they are performing these exercises improperly and therefore are not making good progress. With the guidance of our trained staff biofeedback offers a clear visual reinforcement of the accuracy and effectiveness of the muscle exercises. This personalized approach helps you obtain optimal results.

BIOFEEDBACK “PELVIC-FLOOR” THERAPY

Using biofeedback technology, a computer recorder monitors the strength of your “pelvic-floor” muscles and your progress throughout the therapy session.  This computerized technology allows you to immediately see the results as you contract and relax the correct group of muscles according to a preset pattern of exercises.

Just as you may do in a fitness center, think of this as your personal “pelvic-floor” trainer while you do a circuit of exercises.  You will learn skills that will enable you to continue maintaining pelvic floor health throughout your life.

STIMULATION BIOFEEDBACK THERAPY

Sometimes your “pelvic-floor” muscles are so weak that you may benefit from an extra boost of exercise which can be provided by directly stimulating these muscles with a very mild electrical pulse.  This painless pulse causes the muscles to contract without your direct effort.  Many people report that this offers a sensation that guides them in identifying the correct muscles to contract.  This stimulation often is described as a tingling sensation which is adjusted to your specific comfort.

WHAT TO EXPECT DURING BIOFEEDBACK

With each visit, we will discuss with you your progress and any changes to the therapy regimen. Typically the therapy consists of weekly sessions for six weeks to 10 weeks.  The first session will last about one hour while the remaining sessions will last less than an hour.

A small, sterile medical device called a probe will be inserted vaginally to allow direct assessment of the pelvic muscles.  In addition, painless computer attached adhesive electrodes may be placed on your abdominal muscles to further help you master the techniques in contracting only the “pelvic-floor” muscles.

Renessa for Stress Urinary Incontinence

What is Stress Urinary Incontinence (SUI)?

SUI is a medical condition that affects millions of women worldwide.  It involves the involuntary leakage of urine during routine activities such as laughing, coughing, sneezing, sex, or recreational activities.  SUI often develops after childbirth.  It occurs when body tissues do not provide enough support to vent the bladder from opening.

Many women don’t want to undergo surgery to treat Sui.  Others mistakenly accept SUI as a natural part of aging or childbirth.  But now women have another alternative: RENESSA.

Renessa: A Non-surgical Treatment Option

Renessa is a non-surgical treatment that uses a small device for controlled heating of microscopic tissue sites at the base of your bladder, causing natural collagen in the tissue to become firmer and decreasing leaks.  Treatment can be performed in the comfort of our office.  There are bandages or dressings to change.  Renessa is performed in a 45-minute to 1-hour office visit, after which you can safely resume virtually all activities the next day.  Your recovery is rapid and comfortable, with minimal limitations.  The treatment effect is typically seen within 60 to 90 days.

In two large US clinical trials, women continued to experience improvement in SUI symptoms 12 months after treatment with Renessa.  In these studies:

Most side effects are typically mild and resolve within a few weeks after treatment.  Side effects can include pain on urination, blood tinged urine, urinary tract infection, urinary retention or worsening incontinence.