Comprehensive Care for Urinary Incontinence

Incontinence: What is it and How to Treat It?

Napa Valley Urology has all of the resources to serve as a comprehensive center for patients with urinary symptoms. Often therapy can simply involve behavioral modification and/ or physical therapy. There are also multiple medications that can be very effectively used. We also offer Urodynamic Evaluation in the office; a very effective diagnostic tool to determine the exact nature of urinary symptoms.

Napa Valley Urology Associates offers all modalities for diagnosing and treating these often debilitating urinary symptoms. Treatment is tailored to the individual needs and symptoms of each patient in a compassionate setting.


Urinary Incontinence

Urinary incontinence or unintentional loss of urine is generally more common in women compared to men. There are a few types of urinary incontinence that include urge incontinence and stress incontinence. A person may be suffering from as urge incontinence when uncontrollable urinary urgency, frequency or leakage becomes a troublesome pattern. Overactive bladder (OAB), also a form of urinary incontinence, is also referred to as urge incontinence.

However, if urine leaks out when stress or pressure is put on the bladder such as a sneeze or cough, this type of incontinence is referred to as stress incontinence. This is caused by anatomic weakness in the urinary system that normally should prevent the bladder from leaking.

Diagnosis/Symptoms

Urge Incontinence, or Overactive Bladder (or OAB) can include a number of symptoms such as:

  1. Sudden, intense urge to urinate (urinary urgency)
  2. Sometimes this sudden urgency is followed by urine leakage from a few drops to the entire contents of the bladder (urge incontinence)
  3. Urinating more than 8 times daily or twice at night (urinary frequency). The norm is about 5-7 times per day, or every 3-5 hours.
  4. Nocturia or the need to urinate 1+ times at night. A person should be able to sleep 6+ hours without the need to urinate.

Symptoms of Stress Incontinence may occur in females when they cough, sneeze, laugh, exercise, does physical activity, lifts heavy objects or when getting up and down.

It is not uncommon to have symptoms of both Stress and Urge Incontinence. There are other types of incontinence as well such as Overflow Incontinence where the bladder does not empty normally and become very full. Your Urologist will conduct a Bladder Control Assessment to determine the problem.

Causes/Risk Factors

Bladder muscles that are overly sensitive or overactive generally are the causes of Urge Incontinence or OAB. If there has been damage or trauma to the nervous system or to the nerves/muscles connected to the bladder, overactivity of the bladder can be present. The cause of nerve damage is not always identified so it should be discussed with your Urologist. Bladder irritation, infection, or certain medications could also cause bladder to keep contracting and leaking urine.

Certain factors like age or weight can put a person at risk for urinary problems. Some of these factors can cause temporary Urge Incontinence symptoms which can improve if treated accordingly. The following are some factors that may put a person at risk for Urge Incontinence:

  • Advancing age
  • Declining Estrogen Levels
  • Pregnancy and Childbirth
  • Multiple medications
  • Nervous system diseases (such as Parkinson’s, Multiple Sclerosis, Diabetes, or strokes)
  • Pelvic surgery or radiation
  • Benign Prostatic Hyperplasia (BPH)
  • UTI’s
  • Bladder cancer
  • Obesity and certain occupations that require a person to be on their feet throughout the day without taking necessary bathroom breaks.

Typically stress incontinence can be caused by or aggravated by vaginal childbirth, hormone changes such as menopause, radical pelvic surgery, damaged bladder muscles/nerves, dropped bladder with dropped urethra, obesity, smoking, aging, or certain medications.

Diagnosing Problem

A Bladder Control Assessment helps your Urologist find the type of incontinence you may have, and be able to rule out other possible problems. It would also be helpful for you to take the patient quiz “Is Your Bladder Acting Up?” Certain tests may be done in your Urologist’s office, lab or at a hospital such as a Urinalysis and culture, Cystoscopy, Cystography and Urodynamics. Napa Valley Urology Associates is able to conduct these tests in-office (except for a Cystography), and will send in cultures to a lab.

Treatment

The best treatment for you will depend on several factors such as the type of incontinence you have, your age, symptoms and any other underlying issues.

Possible Treatment Options

URGE INCONTINENCE OPTIONS

STRESS INCONTINENCE TREATMENT OPTIONS

Behavioral Methods: scheduled toileting, bladder training, dietary changes

Behavioral Methods: Dietary changes, plan for weight loss, cease smoking

Exercise: Kegels and other floor exercises, biofeedback

Exercise: Kegels and other pelvic floor exercises, biofeedback

Medications or hormone therapy

Medications or hormone therapy

Interventional Therapies: Nerve stimulation, Sacral Neuromodulation, Botulinum injection

Interventional Therapies: Urethral Bulking Agents

 

Female surgery: Female Sling
Male surgery: Artificial Sphincter, Male Sling

  1. Behavioral methods
    1. Scheduled toileting is when you are prompted to use the bathroom every 2-4 hours.
    2. Bladder training is vital to training your body know when to use the bathroom. It involves scheduled toileting where the length of time between bathroom visits is gradually increased.
    3. Diet. Certain foods and drinks can irritate the bladder. Reducing caffeine, spicy foods, alcohol as well as timing fluid intake can sometimes alleviate OAB symptoms dramatically.
  2. Exercise
    1. Physical Therapy: Pelvic floor exercises such as Kegel exercises can be helpful. Kegel exercises are performed by squeezing the urinary sphincter for 3 seconds, then relaxing it for 3 seconds. Repeat this 10 times in various positions such as sitting, lying down, etc. Three sets of 10 Kegel exercises take about 3 minutes which can be performed 2-3 times a day. If done correctly and consistently for 3 months, the pelvic floor muscles can become thicker and stronger thereby reducing leakage.
    2. Biofeedback: If there is difficulty for you in finding or managing your pelvic floor muscles, small sensors can be placed in the vagina or rectum and abdomen. When you tighten the correct muscles, the graphs, lights or beeping sounds will provide feedback if you are doing the exercises accurately.
  3. Medications
    1. You should not expect drug therapy to have an instant curing effect. Urinary Incontinence symptoms can get worse over the years, so treatment can also take some time to help resolve the issues. The most commonly prescribed class of drugs are anticholinergics or antimuscarinics. These have the effect of relaxing the bladder. These medications may reduce the number of bathroom breaks and accidental leaks. However, as with most drugs, OAB drugs may cause some unwanted side effects such as dry mouth and eyes, constipation and urinary retention. Your Urologist can provide strategies to control these side effects.
    2. Hormone therapy, such as estrogen creams, could possibly be effective in helping to improve pelvic floor muscle function.
  4. Interventional Therapies and Surgery
    1. Nerve Stimulation (PTNS Treatment with Urgent PC): A minimally way to improve bladder control, Urgent PC uses percutaneous tibial nerve stimulation (PTNS) to treat OAB and associated symptoms of urinary urgency, frequency and urge incontinence. The Urgent PC Neuromodulation System is a combination of a stimulator and a lead set. The stimulator generates electrical impulses that are delivered to the patient through the lead set. There are generally 12 initial treatments with each other about 30 minutes in length.
    2. Urethral Bulking Agent: This is a less invasive treatment option with a specific type of stress urinary incontinence called intrinsic sphincter deficiency. In women, for instance, the muscles surrounding the urethra can no longer close properly to hold the urine in the bladder. The bulking agent is injected into the tissues surrounding the urethra. The increased “bulk” allows the urethra to close more effectively and prevents urine from leaking. http://www.uroplasty.com/files/html/urethralbulking.html
    3. Sacral Neuromodulation: Learn more about sacral neuromodulation.
    4. Botulinum Injection: Learn more about botulinum injection.
    5. graphic-female-slingFemale Sling: When medications and other therapies are ineffective for stress incontinence, many patients opt for surgery which may help control urine leakage. Surgery may restore support of the bladder and urethra by securing them in place.
      1. To treat stress urinary incontinence with the MiniArc system, your Urologist would surgically place a narrow strip of mesh material–called a sling–under the urethra to give it a point of support. This procedure is minimally invasive with only one small incision.
    6. AdVance_ImplantedMale patients may undergo an artificial urinary sphincter or a male sling.
      1. In a sling procedure, your Urologist creates a support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the strip to the pelvic bone. The sling keeps constant pressure on the urethra so that it does not open until the patient consciously releases the urine. 
      2. Some men may eliminate urine leakage with an artificial sphincter, an implanted device that keeps the urethra closed until you are ready to urinate. This device can help if you suffer from incontinence because of weak sphincter muscles or because of nerve damage that interferes with sphincter muscle function. It does not solve incontinence caused by uncontrolled bladder contractions.
  5. If you elect not to undergo any medical therapies such as interventional therapies, medications, etc. then you always have the option to use absorbent pads, bed pads, external catheters for men, or having portable toilets accessible (near bedside) if urinating cannot wait. Maintaining a healthy weight and diet can also improve OAB symptoms. You may even elect to take natural herbs formulated to control OAB symptoms although there are no proven remedies to date. You can also see an Herbalist, Naturopath, Physical Therapist or Acupuncturist for other treatment options.