Obstetrics Gynecology Conditions & Treatments - row of books

Urinary Incontinence

What is urinary incontinence?

Most women experience recurring mild urinary leakage at some point in their lives. It can be caused by certain physical activities or conditions. Some women may experience leakage when they hear running water, or when a part of their body comes into contact with water. Others simply cannot control the urge to urinate. When urinary leakage becomes frequent or severe, the condition is called urinary incontinence. This condition affects about one in every 10 women.
There are five types of urinary incontinence:

  • Stress incontinence, the most common type in younger women, occurs when the tissues that support the bladder or the muscles of the urethra get weak. Leaks may result from coughing, laughing, or sneezing, or from activities such as walking, running, or aerobics.
  • Urge incontinence occurs when a woman has a sudden urge to urinate and leaks urine before she can get to the bathroom. This condition may occur when the bladder muscles are too active and contract too often. It also can be related to problems with the nerves that send signals to the bladder.
  • Mixed incontinence occurs when a woman experiences stress and urge incontinence.
  • Overflow incontinence occurs when the bladder does not empty completely during voiding. It usually happens when the urethra is blocked or the bladder muscle is not active enough.
  • Functional incontinence is caused by various health problems such as arthritis, stroke, mobility problems or nervous system disorders.

Many women believe that loss of bladder control is a normal and unavoidable part of aging, but this is not the case. Urinary incontinence usually can be treated medically.

What causes urinary incontinence?

Urinary incontinence can be caused by a number of conditions, including the following:

  • urinary tract infection
  • urinary tract growths or abnormalities, such as an opening, or fistula, between the urinary tract and the vagina (fistulas may occur following pelvic surgery, childbirth, radiation treatment, or cancer of the pelvis)
  • pelvic support problems (these may occur when pelvic tissues and muscles are stretched or weakened by pregnancy, childbirth, or aging)
  • neuromuscular disorders (abnormal conditions relating to nerves and muscles, sometimes related to other conditions, such as diabetes, stroke, or multiple sclerosis)
  • side effects from certain medications, such as diuretics

How is urinary incontinence diagnosed?

Firstly, the circumstances or triggers for urinary loss need to be identified. This is usually done with what we call the “history”, and is greatly facilitated by the completion of a bladder diary and a validated urinary questionnaire (see document below).  The history is supplemented by an exam to determine the degree of urethral mobility and amount of retained urine.

In many cases, Dr. Garofalo will recommend a special test called urodynamics for more precise diagnosis, especially when surgery is being considered.

How is urinary incontinence treated?

Urinary incontinence can be treated without surgery in a variety of  ways, including the following:

  • behavioral changes such as losing weight, quitting smoking, cutting back on caffeinated drinks, and avoiding constipation or heavy lifting
  • bladder training, including learning to urinate at set times or before exercise
  • physical therapy such as Kegel exercises or biofeedback to strengthen the pelvic muscles
  • medication to control muscle spasms or strengthen the muscle of the urethra
  • antibiotics may be used to treat a urinary tract infection
  • Botox injections into the bladder wall can be effective for urgency incontinence.
  • Urethral bulking injections injecting a bulking agent around the urethra can help prevent leakage; this is usually effective for about a year and the procedure can be repeated.

Surgery for urinary incontinence

Dr. Garofalo often treats urinary incontinence using a procedure called the suburethral sling. The sling is a doctor-applied ribbon-like strip that stops urine leakage by supporting the urethra.

The suburethral sling procedure can be performed using local, spinal or general anesthesia and usually takes about 30 minutes. The recovery period is short, patients generally experience few complications and minimal scarring, and it’s covered by most insurance plans.

Dr. Garofalo will work with you to determine the approach that best suits your specific needs and symptoms.

pdfIncontinence Diary and Questionaire