Incontinence

Urinary incontinence is defined as the involuntary loss of urine or bladder control.  It affects millions of Americans, both men and women. Unfortunately, many men and women believe incontinence is a natural effect of aging to live with and do not know that multiple treatment options are available. Urinary incontinence is not a disease, but rather is a symptom due to an underlying problem that can almost always be treated. There are many types of urinary incontinence, and different underlying causes for each type. The impact of the problem in one’s life cannot be underestimated. The chance of embarrassment, limitations to travel and social engagement as well as loss of productivity represent only a part of the difficulties patients experience with this problem. Interest in this condition is currently surging and novel incontinence treatment options are always emerging.

At Comprehensive Urology, our team works with our patients in order to create a tailored program to help address their specific problem. To learn more about what incontinence treatments could do for you, call (310) 499-2756 or contact us online today!

Types of Urinary Incontinence

There are different types of urinary incontinence. While some are specific to male and female incontinence some are shared by both genders:

1. Stress Incontinence – Urine leakage occurs with a strong increase in pressure transmitted through the abdomen and pelvis, often from straining, coughing, laughing or sneezing. Most commonly caused by a hypermobile urethra (the tube from the bladder to the outside of the body).
2. Urge Incontinence – Urine leakage occurs due to involuntary contractions of the bladder muscle. It is also termed “overactive bladder.” Individuals with this disorder often times have mishaps, because they cannot hold their urine long enough to make it to the bathroom.
3. Mixed Incontinence – Urine leakage due to a combination of stress and urge incontinence.
4. Overflow Incontinence – Urine leakage occurs due to an overflow of urine from an already full bladder.
5. Mixed incontinence – Leakage due to combination of two of the above causes.

Symptoms & Causes of Urinary Leakage

Bladder problems can sometimes be a sign of a more serious condition. If this becomes frequent for you or you meet any of the below points, it may be a good time to schedule an appointment with one of our urologists to talk about your options for treatment.

• Bladder leakage may indicate a more serious underlying condition, especially if it’s associated with blood in your urine.
• Urinary incontinence may be causing you to restrict your activities and limit your social interactions to avoid embarrassment.
• Bladder control problems may increase the risk of falls in older adults as they rush to make it to the toilet.

There are many causes of this urinary incontinence which include:

• Infection (i.e., urinary tract infections) and inflammation
• Anatomic variations due to childbirth or surgery
• Neuromuscular dysfunction due to stroke, spinal cord injury, diabetes, or other underlying disease
• Benign prostatic hypertrophy (BPH, an enlarged prostate)

If you have urinary incontinence or loss of bladder control, sometimes taking a look at what medications you are taking can help. A lot of medications have side effects that could cause urine leakage and could be contributing factors.

• High Blood Pressure Medication: Alpha blockers work by dilating blood vessels to reduce blood pressure, can relax your muscles allowing urine to flow easier. Women taking an alpha blocker who are experiencing these conditions should also ask their doctor if there is an alternative medication available to treat their high blood pressure.
• Antidepressants: While some antidepressants like Tofranil can help with urinary incontinence, others can impair the bladder’s ability to contract. This could worsen bladder control loss since it would decrease your awareness of when you need to use the restroom.
• Diuretics: Water pills and diuretics work in the kidney by flushing excess water and salt from the body. By doing this, you are making more urine which means more visits to the bathroom.
• Sleeping Pills: A small portion of people who have urinary incontinence actually have a problem with bedwetting. However, sleeping pills can be the cause of bedwetting at night because you simply don’t wake up. As an alternative cut down on caffeine and try not to drink liquids before you go to bed.

At Comprehensive Urology, we believe that a proper and thorough evaluation is the first step to understanding the cause of urinary incontinence.

Risk Factors & Complications of Urinary Leakage

Some factors can increase the possibility of you having trouble with bladder leakage. Risk factors include:

• Obesity: Obese people have increased pressure on their bladder and surrounding muscles, compared to people of normal weight. This weakens the muscles and makes it more likely that for bladder leakage to occur when the person sneezes or coughs.
• Smoking: Regular smokers are more likely to develop a chronic cough, which may result in episodes of urinary incontinence. A chronic cough (coughing a lot over the long term) places undue stress on the urinary sphincter, leading to stress incontinence. A regular smoker is also more susceptible to having an overactive bladder and bladder control issues.
• Sex: Women have a significantly higher chance of experiencing stress incontinence than men. Certain aspects of a female’s life, such as childbirth and menopause, make urinary leakage more likely. A man’s risk is higher if he has prostate gland problems.
• Aging: The muscles in the bladder and urethra weaken during old age. This means the bladder cannot hold as much liquid as before, raising the risk of involuntary bladder leakage. This does not mean that people will necessarily become incontinent when they are old; it just means the risk is higher.
  Certain diseases and conditions: People with diabetes and some kidney diseases are more likely to suffer from bladder leakage.
• Certain diseases and conditions: People with diabetes and some kidney diseases are more likely to suffer from bladder leakage.

Complications of Urine Leakage

Often times, loss of bladder control comes along with complications that could affect the treatment. Sores, rashes, and urinary tract infections are a direct result of bladder control problems and can become a serious issue if left untreated.

• Skin problems: A person with urinary leakage has an increased chance to develop skin sores, rashes and infections. This is because the skin is wet most of the time.
• Urinary tract infections: People with urinary leakage are more susceptible to urinary tract infections. Long-term use of a urinary catheter significantly increases the risk of infection.
• Impact on personal and social life: Which may have a serious negative impact on the quality of life and also mental health of the patient

Urinary Incontinence Diagnosis

Prior to performing urinary incontinence treatment, your urologist will perform a general exam at our Beverly Hills health center. Your surgeon will carefully walk though your history in order to pinpoint the cause of urinary leakage. He or she will look for any signs of medical conditions that would have leakage as a symptom, such as tumors that may block the urinary tract, stool impaction, and poor sensations, which may be evidence of a nerve related cause. A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles. Other tests for incontinence treatment include:

• Stress test: The patient relaxes, then coughs vigorously as the doctor watches for loss of urine.
• Urinalysis: Urine is tested for evidence of infection, urinary stones, or other contributing causes.
• Blood tests: Blood is taken, sent to a laboratory, and examined for substances related to causes of leakage. Treatment can then be provided.
• Ultrasound imaging: Sound waves are used to visualize the kidneys, ureters, bladder, and urethra.
• Cystoscopy: A thin tube with a tiny camera is inserted in the urethra and used to see inside the urethra and bladder.
• Urodynamics: Various sophisticated techniques are used to the measure pressure in the bladder during filling and also the flow of urine during urination.

Treatments for Incontinence

Urinary incontinence treatment depends on the type of incontinence, its severity, and the underlying cause. Fortunately, there are many therapies available for the treatment of urinary leakage. Our physicians work with each patient to help determine their optimal personalized incontinence treatment program. These therapies include medications, non-pharmacologic (non-medication) approaches, as well as surgical procedures. Your doctor will recommend the approaches best suited to your condition. Sometimes a combination of treatments may be needed. Treatments for bladder control issues include:

• Behavioral modification such as scheduled toilet trips and fluid management help to control a bladder that tends to overflow.
• Physical therapy can be used to strengthen your sphincter and pelvic floor muscles which will help you control your bladder in the end.
• Medications are often used in combination of behavioral techniques.
• Non-surgical treatments can help women who struggle with urinary leakage. Treatments include urethral inserts, pessaries, and more.
• Surgery can also be used for urinary incontinence treatment. Depending on your case, there are many surgical options available to you which may include slings, bulking agent injections, nerve stimulator implants, etc.

Urinary Incontinence Medications

Multiple medications are available to help manage different types of incontinence and associated symptoms (i.e., urinary urgency and frequency and “bedwetting” (nocturnal enuresis). These urinary leakage treatment options must be balanced against the risk of side effects or interactions with other necessary medications. With careful consideration of each individual’s need, an appropriate incontinence treatment medicine can be selected and implemented with scheduled follow up to evaluate results.

The main types of medications that help urinary bladder leakage are:

Anticholinergics

These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Anticholinergic drugs also block the action of a chemical messenger — acetylcholine that sends the signals that trigger these contractions.  Examples of anticholinergics are: oxybutynin [Ditropan], tolterodine (Detrol), and solifenacin (Vesicare).

Topical estrogen

Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce the symptoms of urine leakage. Oral estrogen replacement also is not the same as topical estrogen, and it may actually worsen incontinence symptoms.

Imipramine

Imipramine (Tofranil) is a tricyclic antidepressant treatment for mixed — urge and stress — incontinence. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. Usually this is best for children and not a good fit for older patients.

Duloxetine

The antidepressant medication duloxetine (Cymbalta) is sometimes used to treat stress incontinence.

Other medications include: tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil), alpha blockers such as prazosin (Minipress), and even botulinum toxin A (Botox).

Medications used for urinary incontinence are usually also combined with behavioral treatment. Usually after you have tried giving up certain drinks, tried timed bathroom visits, and pelvic floor exercises, if you are still having bladder control trouble, talking to your urologist about medication options could help. Effective medications are available for people with overactive bladder and urge incontinence. However there are fewer options for stress incontinence which is urine leakage prompted by a physical movement or activity, such as coughing, sneezing or heavy lifting.

Non-Pharmacologic Approaches to Manage Incontinence

For some patients, incontinence medications may not be the right solution due to intolerable side effects or interactions with other medications, or they may need the addition of further medications to assist with their incontinence symptoms.

There are a significant number of non-pharmacologic approaches that can be used only or in conjunction with other incontinence treatment options such as medications and surgery.

• Behavioral modification such as scheduled toilet trips and fluid management help to control a bladder that tends to overflow.
• Physical therapy can be used to strengthen your sphincter and pelvic floor muscles which will help you control your bladder in the end.
• Medications are often used in combination of behavioral techniques.

A first consideration are absorbent products (disposable and reusable), such as pads and other garments, to reduce wetness and odor, providing some modicum of comfort and function.

Behavioral techniques, such as bladder training (to delay urination), double voiding (to more efficiently/completely empty the bladder), and scheduled toilet trips, can be utilized to treat incontinence. Pelvic floor muscle exercises (also known as Kegel’s exercises) may be recommended for incontinence treatment. Dietary modifications such as avoidance of spicy foods, citrus fruits, and chocolate and other caffeine containing substances may be helpful to some with this condition.

One of the specialized programs that we offer at Comprehensive Urology is pelvic floor rehabilitation therapy, which incorporates modalities such as pelvic floor muscle exercises, vaginal cones, biofeedback, and electrical stimulation therapy. Regular sessions with our doctors and therapists have yielded excellent results, often in urine leakage patients who have not benefited from other types of therapy. We monitor the progress of each patient during their sessions, and often the therapies can be taught to patients to perform themselves outside the office.

Another specialized leakage treatment that our experts at Comprehensive Urology utilize is peripheral nerve stimulation. This new and novel incontinence therapy is painless, has no side effects, and has been extremely effective in managing irritative urinary symptoms in patients who have often not been able to find relief with other incontinence treatment options.

Surgical Treatments for Incontinence

Many men and women who suffer from urine leakage may benefit from minimally invasive surgical treatments to assist with their symptoms. Our physicians perform a variety of pelvic and urethral support procedures (that are customized to each patient) designed to treat urinary incontinence. For women with urinary bladder leakage, a variety of slings (e.g., transvaginal or transobturator) can be placed in an outpatient setting (no hospitalization required). For men experiencing incontinence difficulties after prostate surgeries or radiation, several male sling options exist or an artificial urinary sphincter may be implanted.

Sling Procedures

Sling procedures are used to treat stress incontinence in women. Most of the time, this procedure is performed on an outpatient basis and only takes a couple of hours. Doctors usually suggest having about two to six weeks of healing time before resuming normal activities, although recovery varies from patient to patient.

Bladder Neck Suspension

The bladder neck is where your muscle connects to the urethra. During a bladder neck suspension procedure, your surgeon will secure cartilage (or sometimes bone) to the neck of the bladder to reinforce it and keeping it from sagging. This bladder control treatment involves stitches and an abdominal incision. It is usually done under anesthesia on an outpatient basis. Recovery is different from case to case, but may be two to six weeks. During that time, you may need to use a catheter to urinate.

Bulking agents

Bulking agents are another way to treat urinary incontinence. Bulking agents use material that is injected into the tissue around the urethra to help reduce urine leakage. This procedure is usually done on an outpatient basis and sometimes may need repeat injections down the line.

Types of materials used are in bulking agents include:

• Collagen
• Carbon-coated zirconium beads
• A component of bones and teeth
• Silicone implant

Bulking agents are a very successful treatment for bladder control loss. Types of materials used in bulking agents can be different for everyone; one is not more effective than the other. However, if a bulking agent urinary leakage treatment is not working for you, you may want to try another type.

Pessary

Sometimes a vaginal or anal pessary is used to treat urinary incontinence as well. A pessary is a removable device placed in the vagina or anus to support areas of pelvic organ prolapse. This can happen when a woman’s organ, such as her uterus, is in the wrong position. Pessaries are made of either silicone, rubber, or plastic, and can be inflatable, doughnut shaped, or the Gellhorn. Pessaries help strengthen the pelvic floor muscles as these muscles support the bladder and urinary functions.

Endoscopic injections of synthetic urethral bulking agents can serve to curb urinary leakage in many settings of incontinence and are very well tolerated with a local anesthetic and a sedative. In certain cases, sacral neuromodulation or nerve stimulator implants can be used to electrically stimulate the bladder nerve roots and improve voiding or stop leakage.

What to Expect At Your Urinary Incontinence Appointment

1. First we will conduct an evaluation of frequent urination. Our team of incontinence specialists first begins with a thorough history and physical examination to help determine the specific type of urinary incontinence with which you suffer. Even with all of our advanced diagnostic techniques, this time honored tradition often is the most important step in identifying the cause of our patient’s urinary symptoms. When we take the time to listen to your story, the nature of the problem and sometimes, more importantly, the personal context becomes obvious. Established risk factors for the development of urinary incontinence include advancing age, gender (women more likely to have than men), being overweight, smoking, family history, and having other diseases (e.g., nerve disease [neuropathy] or diabetes mellitus). A voiding diary is often employed to document the extent of incontinence and the context in which it occurs. In this “diary,” patients typically are asked to record fluid intake, fluid output, and any episodes of leakage.
2. Then, we will use diagnostic studies to help determine the underlying cause. A careful examination of the urine and laboratory values are used to help assist with the diagnosis of the underlying cause of incontinence. An analysis of the urine (urinalysis) under the microscope (to check for things such as blood, white blood cells/pus, and protein) culture to rule out infection. Other studies that can assist with the diagnosis may include pelvic ultrasound (a non-invasive exam utilizing sound waves to assess pelvic structures, such as the bladder), post-void residual (PVR) volume (quantity of urine left in bladder after voiding), cystoscopy (visual examination of the inside of the bladder), and urodynamic studies (to assess urine pressure and flow rate). These studies can help our physicians better understand the relationships between the urinary bladder and surrounding tissues, giving better insight into the origins and treatment of urinary leakage.
3. Next, we will determine the best treatment for your urinary incontinence.

Frequently Asked Questions

Contact Our Los Angeles Specialists in Urology

Urinary incontinence is a very common but treatable condition in both males and females.  If you’d like to learn more about treatments for the different types of incontinence, schedule your initial consultation with an expert Los Angeles urologist by calling (310) 499-2756.

Incontinence is one of the most common urological problems worldwide. Although it tends to be more common in older people, especially women, the condition can happen to any age group, male or female. Fortunately, urinary incontinence is generally a very treatable condition and symptoms can be relieved after the type of incontinence is identified and proper, individualized treatment ensues.

Next, read Vaginal Reconstruction and Pelvic Prolapse.