Urinary Incontinence and Overactive Bladder
Urinary incontinence, that is, the involuntary loss of urine, is not a medical condition but rather a symptom of a larger bladder and/or pelvic disorder.
Overview and Symptoms
A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection and degenerative changes associated with aging. It can also occur as a result of pregnancy or childbirth.
There are various types of incontinence, including:
Stress urinary incontinence occurs when laughing, sneezing, coughing or exercising, and is caused by weakness in the muscles and ligaments that support the bladder and urethra, or deficient urethral sphincter muscles. Obesity can also put increased pressure on the bladder, causing stress incontinence.
Overactive bladder and urge urinary incontinence result in the need to go to the bathroom frequently, waking up at night to void, feeling strong urges to urinate or the inability to get to the toilet on time. These conditions occur when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited.
Mixed incontinence, a very common condition, refers to the occurrence of both stress and urge incontinence symptoms.
Overflow incontinence refers to the condition of being unable to empty your bladder adequately. As a result, the quantity of urine in the bladder exceeds the bladder's holding capacity, causing unexpectedly leaking or overflowing.
Vesico-vaginal fistula is an abnormal connection between the bladder and the vagina that results in constant leakage of urine into vagina. It can be caused by injury to the urinary tract, which can occur accidentally during surgery, be caused by a tumor, or be due to tissue death (necrosis) caused by radiation therapy or by reduced blood supply from prolonged labor during childbirth.
Functional incontinence describes untimely urination in people who have normal bladder control but are unable to reach the bathroom in time because of physical disability. For example, severe arthritis can interfere with managing zippers and buttons. Another example is mental confusion, such as Alzheimer's disease.
Treatment
According to the American Urogynecologic Society Foundation, 80% - 90% of the women who seek treatment will experience significant improvement. In fact, the majority of patients with urinary incontinence doesn’t need surgery and benefit from a number of effective treatment options including:
- Laser therapy is a new and innovative treatment option that’s ideal for women who have mild to moderate stress urinary incontinence.
- Pelvic floor muscle exercises, also known as Kegel exercises, can help strengthen the muscles that control urine flow and hold the bladder in place; these exercises are effective for both stress urinary incontinence as well as overactive bladder and urge incontinence.
- Timed voiding involves voiding on a regular schedule, every 2 - 4 hours; this technique is frequently recommended for frail elderly, bedridden or Alzheimer's patients.
- Bladder retraining involves gradually lengthening the time in between bathroom trips thereby training the bladder to delay voiding for longer time intervals. It’s especially beneficial for patients with overactive bladder.
- Lifestyle changes can help reduce the symptoms of incontinence. Changes such as maintaining a healthy weight, eating a high-fiber diet, avoiding alcohol and caffeine, quitting smoking and avoiding heavy lifting and repetitive strenuous activities can all help.
- Medications can also be very effective for treating overactive bladder.
- Incontinence devices such as pessaries and urethral inserts can be used to block the flow of urine.
Most surgical treatments for incontinence are minimally invasive, outpatient or overnight procedures, with small incisions to help expedite healing and minimize pain and blood loss.
Obstetrics and Gynecology
The Department of Obstetrics and Gynecology at BIDMC provides outstanding care for all women throughout their lives, in a friendly, comfortable and safe environment.