Questions & Answers About Incontinence
By Gopal Badlani, M.D.
Professor of Urology
What causes urinary incontinence?
One of the most common types of urinary incontinence in adults occurs during coughing, sneezing and physical exertion and is called stress incontinence. In women, it is usually due to loss of bladder support resulting from multiple childbirths, aging, obesity or lack of estrogen. Men often suffer from stress incontinence following prostate surgery. Neurologic conditions, such as multiple sclerosis, also can result in bladder disorders.
A second common type is urge incontinence, also known as overactive bladder. With this type, the smooth muscle of the bladder contracts prematurely, causing an increase in bladder pressure resulting in a urgent need to urinate. It is usually associated with frequent urination both day and night. Common triggers for urge incontinence include cold weather, running water and laughing. Many people suffer from a combination of both stress and urge incontinence.
How common is the problem?
Urinary incontinence affects about 20 percent of women over age 40 and nearly 30 percent of elderly people active in the community. One percent to 30 percent of men are affected following prostate surgery. Incontinence results in loss of self-esteem and in some people, anxiety and depression. Many people are embarrassed or fearful of mentioning the problem to a family member or physician and the quality of life suffers.
How is the type of incontinence diagnosed?
The first step to successful treatment is accurate diagnosis. Our center is one of a few in the state offering video-urodynamics. This 30-minute procedure uses a small catheter to measure pressure and volume at the same time that the bladder is x-rayed. This combination helps doctors understand the exact cause so they can prescribe the best solution. It allows us to tailor the treatment to the diagnosis.
How is incontinence treated?
In most cases, medication or changes in bladder habits can help the problem. Recommendations can include limiting caffeine, having moderate fluid intake and voiding on a regular schedule. Other behavioral treatments include a bladder drill – resisting the urge to urinate and increasing the time interval by 15 minutes a week -- and exercises to strengthen the pelvic floor. We work closely with physical therapists that use biofeedback and other techniques to teach patients to strengthen their pelvic floor muscles and maximize behavioral treatment. There are also several medications to treat the problem.
What if these treatments don’t work?
When these treatments aren’t successful, a bladder “pacemaker” or Botox ® may be an option. The pacemaker, know as Interstim®, is implanted during an outpatient procedure. It is used to treat the major types of urinary incontinence. The device emits short bursts of electrical current to modulate the sacral serves, which influence the bladder.
What about Botox?
It’s one of the most deadly poisons known to man, but in small amounts botulinum toxin, or Botox, is beneficial for treating overactive bladder and has been shown to be effective in about 70 percent of cases. In an outpatient procedure, Botox injections are delivered through a small scope that is inserted into the urethra, the canal leading to the bladder.
Botox can temporarily paralyze the nerves that cause the bladder muscle to spasm, while allowing surrounding muscles to function normally. The effects – control of overactive bladder – normally last from three to nine months. Botox, while approved for plastic surgery and neurological use , is not FDA-approved for bladder as yet in this country.
Is surgery an option?
In addition, the center offers surgery for incontinence, including bladder augmentation, often an effective treatment for patients with spinal cord injuries who don’t respond to other therapies. The center also offers patients minimally invasive lower urinary tract and pelvic floor reconstruction for prolapse and stress incontinence
Surgery for stress incontinence is designed to support the urethra so it can remain closed during coughs or sneezes. This can be done by inserting a sling to hold the urethra and bladder neck in place or injecting substances such as collagen to firm up the tissues surrounding the urethra. When the problem is prolapse, or “dropped,” organs, our center specializes in using a mesh to support the organs through a vaginal approach to reduce recovery time.
There is a myth that these procedures last only a short time because that was true in the past. However, with the latest techniques and materials, patients can now expect long-term success.
Watch an interview about bladder conditions.