The involuntary loss of urine
Urinary incontinence in women can be troublesome and embarrassing, but it is treatable. There are several types of incontinence, but the most common are urinary urge incontinence, stress incontinence, and a combination of both. Incontinence is a very common condition and the prevalence does increase as one ages.
Urinary urge incontinence involves the involuntary loss of urine usually associated with a sudden urge that cannot be suppressed. Some of the causes may be related to infection, hormone status, childbirth, or previous pelvic surgeries. It can be exacerbated by certain types of foods/beverages. As with any medical problem, a thorough history is vital. The physician needs to know all the medications that the patient uses as well as toilet habits. Avoiding diary can be extremely useful. Physical exam involves assessing the vaginal area and pelvic floor. It is important to rule out infection, and other inflammatory causes. (If the incontinence is not straight forward, further testing called urodynamics is performed to assess bladder filling and emptying.)
Treatment involves both behavior and pharmacological changes. Behavior changes may include weight loss, smoking cessation, dietary changes, and pelvic floor muscle therapy. The pharmacologic therapy for urinary urge incontinence involves a trial of medications that are known as anticholinergics. It is important that the patient is aware of the side effects of medications. If the medications are not helpful or cannot be taken, then other surgical modalties are investigated. These may include sacral nerve stimulation, posterior tibial nerve stimulation or botulinum toxin injections for refractory UUI. These treatment options are minimally invasive and patient friendly.
Stress incontinence is the involuntary loss of urine usually associated with physical activity, for example, coughing, sneezing, and exercising. It can develop as a result of childbirth and pelvic surgeries. As with the UUI, a thorough history is crucial. Nonsurgical treatment options include pelvic floor strengthening (Kegel exercises). Surgical options include bulking agents injected into the urethra, which can be done in the office. The minimally invasive “sling” or “tape” procedure is safe and effective with a high, long-term success rate, and is usually done in an outpatient setting.
Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:
Various treatment options exist, each with their own advantages and disadvantages.
Urethral dilationgently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
Endoscopic Incisionthe stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.