Urinary incontinence, the involuntary loss of urine, affects millions of people of all ages. Contrary to common beliefs, it isn’t a natural part of aging and isn’t confined to women. In men, the condition can be the result of surgery for prostate cancer, neurological conditions such as multiple sclerosis, and less commonly, enlarged prostate.
- Many people avoid normal activities because of incontinence
- Incontinence results in loss of self-esteem and can cause anxiety and depression in some people
- Urinary incontinence is costly
- Many people are embarrassed or fearful of mentioning their problem to a family member or physician
- Over 80 percent of patients can be helped or cured
- An expert evaluation will increase the chances of successful therapy
- Treatments can include behavior changes, medications, and pacemakers for the bladder. In men, an artificial urinary sphincter is an option.
What Causes Urinary Incontinence?
A common type of urinary incontinence in adults occurs during coughing, sneezing and physical exertion and is called stress incontinence. It results when the urine passage and the sphincter, the small circular muscle that controls the start and stop of urine, doesn’t function properly.
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 radiation therapy or surgery for prostate cancer. 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 an 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.
Urinary Incontinence Treatment
Because incontinence can be managed by wearing pads, some patients wonder when it’s time to seek help. People generally decide to take action when urine leakage interferes with their daily lives, such as:
- Ability to do household chores (cooking, laundry, housecleaning)
- Physical recreation such as walking, swimming, or exercise
- Entertainment activities (movies, concerts, etc.)
- Ability to travel by car or bus more than 30 minutes from home
- Being able to participate in social activities outside your home
- Emotional health, (are you nervous or depressed?)
There are many treatments available – depending on the type of incontinence – which is why expert diagnosis is important.
Treatment Options for Women
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. There are also several medications to treat the problem.
- Bladder Pacemaker: Known as Interstim®, this device is implanted during an outpatient procedure. It produces mild electrical pulses to help normalize neural activity from the bladder to the brain. It can be used to treat patients with urge incontinence, urgency-frequency, or urinary retention.
- Botox®: It’s one of the most deadly poisons known to man, but in small amounts botulinum toxin 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 normally last from three to nine months.
- Surgery: Bladder augmentation is often an effective treatment for patients with spinal cord injuries who don’t respond to other therapies. Wake Forest Baptist also offers 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.
Treatments for Men
While there are no medications specifically for male stress incontinence, some medications designed for other uses, such as Sudafed and some psychiatric drugs, affect the sphincter valve and can improve incontinence.
- Cunningham Clamp: While inexpensive and easy to use, can be uncomfortable. The device, placed on the penis, closes the urine passage (urethra) that is close to the bottom of the penis. Other options, such as injecting collagen or body fat into the sphincter, last only a short period of time and are effective only about 17 percent of the time.
- Male Sling: The sling is basically a “hammock” that supports the urethra and restores it to its proper position, reducing pressure on the sphincter. It is implanted during a minimally invasive surgery that requires only three small incisions. The ideal candidate is the patient who uses two pads or less per day as a result of incontinence from prostate treatment.
- Artificial Sphincter: The artificial sphincter is often recommended for patients with moderate to severe incontinence. This device is a “cuff” that fits around the urine passage. The patient squeezes a device implanted in the scrotum to open the valve and allow the passage of urine. All parts of the device are implanted in the body during an outpatient procedure.