Urinary Incontinence

Understanding Urinary Incontinence

Women of all ages can have problems with the muscles or organs in the pelvis that can lead to urinary incontinence. These problems may happen when nerve signals do not function properly from genetic or anatomic factors or because of childbirth, menopause, aging, injuries and medications.

There are different types of incontinence, including:

Functional Incontinence

When your medical or physical condition interferes with getting to the toilet on time, it is called functional incontinence.

Overactive Bladder

Urination eight or more times a day or two or more times at night is considered overactive bladder.

Overflow Incontinence

With overflow incontinence, the bladder does not empty properly when you urinate, causing it to spill over at a later time.

Stress Incontinence

Stress incontinence is when urine leaks during moments of physical stress such as coughing, laughing, sneezing or other movements that put pressure on the bladder.

Urge Incontinence

Urge incontinence is when you lose large amounts of urine after suddenly feeling the need (urge) to urinate, including during sleep.

Diagnosis

Loss of bladder control is very common and relatively easy to treat. Do not hesitate to share your concerns with your gynecologist.

Diagnosis of your urinary incontinence problem begins with a complete physical examination that focuses on the urinary and nervous systems as well as the reproductive organs. You will also give urine samples. In addition, you will likely be referred to an urologist (doctor who specialize in diseases of the urinary tract).

Treatment

IU Health uses a “ladder approach” to care for urinary incontinence problems. This means that you will start with the most comprehensive, least risky treatment option and move up as necessary to achieve results.

In many cases, treatments are more effective when used in combination.

Treatment may include:

Lifestyle Changes

Some lifestyle choices can impact incontinence, such as smoking (chronic cough makes pelvic floor relaxation worse) and weight management (excess weight can exacerbate stress incontinence). Counseling on lifestyle modifications for pelvic floor health can help.

Medicine Therapy

Some medicines can help manage symptoms of urinary incontinence. For example, oxybutynin (Ditropan) may be used if you have bladder irritability.

Physical Therapy

An in-depth evaluation will be completed by a licensed physical therapist specially trained in the area of pelvic floor therapy. Your care plan will be developed with your individual goals in mind. Treatment may include exercise, postural corrections, bladder re-training, biofeedback and soft tissue mobilization among other interventions.

Botulinum (“Botox”) Injections

Botox injections can significantly relax the bladder to relieve an overactive bladder.

Fistula Repair

Surgery can correct an abnormal opening between the urinary tract and vagina (fistula) that leads to urinary incontinence.

Graft Placements

A synthetic or biological mesh can be placed to enhance the effectiveness of pelvic organ surgeries performed to correct prolapse.

Outpatient Surgeries

IU Health surgeons can place a urethral “sling” around your urethra to lift it back into normal position and exert pressure on it to aid urine retention. Another option is collagen injection to reinforce deteriorating muscles that support the urethra.

Pessary Device

A pessary is a silicon device similar to the outer ring of a diaphragm. During a simple procedure, it can be positioned to hold up the bladder, vagina or bowel.

Sacral Neuromodulation

This treatment for bladder dysfunction involves implanting an electrode near the sacral nerve, which helps control bladder function.

Surgery for Pelvic Organ Prolapse

When a pelvic organ, such as the bladder, drops from its normal position and pushes against the sides of your vagina, the condition is called pelvic organ prolapse. Pelvic organ prolapse can be surgically corrected in several ways: vaginally, abdominally, laparoscopically (through a small incision) or robotically using the da Vinci Surgical System®.

Surgery for Pudendal Nerve Entrapment

The pudendal nerve is a nerve in the pelvic region that carries sensation from the external genitalia to various pelvic muscles responsible for bladder control. Minimally invasive surgery can relieve pressure on a pinched (entrapped) pudendal nerve.