Approximately 30-65% of women in the United States experience urinary incontinence (involuntary loss of urine). Possible causes include injuries from childbirth, aging, certain vaginal surgeries, radiation therapy, and medications that interfere with muscle, nerve, and bladder function.
There are three types of urinary incontinence—stress incontinence, urge incontinence, and mixed incontinence.
The choice between non-surgical and surgical treatment depends on the severity of the incontinence, the patient’s general health, how much the incontinence is affecting the quality of patient’s life, and the patient’s own desires.
Stress incontinence is the most common cause of involuntary urine loss in premenopausal women. It refers to accidental urine loss when a woman coughs, sneezes, jumps, jogs, dances, or lifts a heavy object. Women with stress incontinence frequently have cystocele as well.
Urge incontinence is involuntary urine loss shortly after a sudden and an uncontrollable urge to urinate. Urine loss often occurs before the person can get to the bathroom. The amount of urine lost is often sufficient to soak underwear, pad, and clothing.
Women with urge incontinence often have to go to the bathroom constantly, day and night. They frequently suffer from cystocele as well.
Mixed incontinence is when a woman has both stress and urge incontinence. Women with this type of incontinence usually require treatment for both conditions.
The initial evaluation for urinary incontinence involves a detailed history and physical examination and a simple cystometry. During simple cystometry, the nurse will put a small catheter into your bladder to make sure that you are emptying your bladder completely and then fill your bladder with water. You will be asked to cough and bear down to see if and how much you leak from your bladder. This initial evaluation process takes approximately one hour.
If your incontinence requires surgical correction, you will also need a multichannel urodynamic study to determine the best surgical procedure for your condition. This study involves putting one small catheter in your bladder and another small catheter in your vagina. The study takes approximately 30 minutes.
- Kegel exercise with biofeedback to strengthen the pelvic floor muscle
- Medication to increase the tone of the muscle around the urethra
- Collagen injection to increase the resistance of the urethra
- Burch colposuspension
- Marshall-Marchetti-Krantz procedure
- Suburethral sling procedure
- Anterior repair (usually in conjunction with another procedure)
- Paravaginal repair (usually in conjunction with another procedure)
- Needle suspension (rarely performed)
- tension-free vaginal tape (for selected patients)
Most surgical repairs require 1-2 days of hospitalization.
Treatments for urge incontinence are primarily non-surgical. These include:
- Bladder training (going to the bathroom at specific time only)
- Kegel exercise
- Medication (to relax the bladder muscle)
- Functional electrical stimulation (running a mild electric current through the bladder using a vaginal probe for approximately 20-30 minutes each week for 4-6 weeks)
- Neurostimulator implant (a permanent implant to stimulate the nerve to the bladder)
Surgical treatment usually involves repairing the co-existing cystocele. This is usually done if a patient failed to respond to non-surgical treatments.
Women with this mixed incontinence usually require treatment for both stress and urge incontinence. Frequently, treatment for one condition may markedly improve both types of incontinence. The initial therapy is usually non-surgical.