Urinary incontinence is defined as the loss of bladder control. It is a very common and often embarrassing problem. The severity of urinary incontinence can range from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you cannot get to the restroom in time.
Even today, incontinence is an underreported condition. About 20 million women in the US are afflicted with some form of incontinence. Due to embarrassment, low expectations of efficacy and treatment, and a poor awareness of treatment options, the condition is often never diagnosed, or if diagnosed, remains untreated. Typical causes of incontinence include family history, childbirth and aging.
There are two main categories of incontinence. Straining-related Urinary Incontinence (SUI) is defined as involuntary leakage associated with exertion, coughing, sneezing or laughing. Whereas Urge Incontinence (UI) is defined as involuntary leakage that occurs in association with a sudden, strong urge to urinate and is often associated with Overactive Bladder Syndrome (OAB). Some women can even suffer from both.
Evaluation of incontinence relies upon proper assessment of bladder function and anatomy. This includes a physical examination, and ideally, Urodynamics, a computerized bladder function study and Cystoscopy, which allows a look into the bladder endoscopically. The findings ultimately help to properly direct treatment as follows:
Straining-related Urinary Incontinence (SUI) – Treatment
Non-surgical treatment of SUI is based around treatments and lifestyle alterations such as weight loss, smoking cessation, and pelvic floor strengthening. Treatments include Kegel exercises that strengthen the pelvic floor muscles by tightening and relaxing. Magnetic therapy can also be employed as an in-office, non-invasive pelvic floor strengthening therapy.
Minimally invasive treatments are also available. These treatments are administered in the doctor’s office with minimal discomfort and women can safely resume activities the same or next day. They include application of bulking agents around the urethra that can increase resistance at the bladder neck, and radiofrequency heat therapy, which can firm up the natural collagen at the bladder neck.
Surgical treatment of more severe SUI includes bladder neck and mid-urethral slings using biological tissue or synthetic mesh. These are vaginal procedures that can be performed in Outpatient Surgical Centers.
Urge Incontinence (UI) / Overactive Bladder Syndrome (OAB)– Treatment
Non-surgical treatment of UI involves the use of pelvic floor strengthening and/or medications, and in some instances, vaginal estrogen therapy. A newer, non-medication approach to treating UI is Percutaneous Tibial Nerve Stimulation (PTNS). This in-office procedure is delivered through intermittent stimulation of the tibial nerve over twelve bi-monthly sessions each of a 30 minute duration.
Surgical management of UI includes two options that increase bladder capacity and decrease urinary incontinence and frequency. Performed in the office, Bo-Tox injections directly into the bladder muscle can provide relief for up to 6 months. And on an outpatient basis, surgical implantation of a sacral nerve stimulator resulted in long-term decreases in leakage episodes and improvement in quality of life.
In summary, urinary incontinence does not have to go untreated. These numerous options allow for development of patient-specific strategies, successful treatments and overall improvement in quality of life.
Dr. Loisides completed his undergraduate education at UCLA with a BS in Microbiology and his medical school education at the University of Pittsburgh School of Medicine. He then went on to complete his General Surgery Internship and Urology Residency at Loma Linda University Medical Center. He is Board Certified from the American Board of Urology. Dr. Loisides has served as President of the Los Angeles County Urological Society and is currently the Chairman of Urology at Saint John's Health Center in Santa Monica, California. He has been an instructor and lecturer, and has published various articles addressing different areas of Urology. He is currently in private practice in Santa Monica, CA.