Urinary Incontinence

Urinary IncontinenceUrinary Incontinence is extremely common. It is estimated that 38 % of women > 60 years of age have urinary incontinence at least once/month, but urinary incontinence can occur in women of any age.  Urinary incontinence can be associated with pelvic organ prolapse (sagging of the vaginal walls) but not always.

There are several different types of urinary incontinence and the appropriate treatment depends on the type of incontinence.  Many of the treatments do not require surgery. An educated patient can make the best decision regarding their individual care, and Peachtree Gynecology will provide you the guidance and expertise to help you make that decision.

The 2 major types or urinary incontinence are stress incontinence, which is leaking with coughing, laughing, sneezing, lifting and exercise; and urge incontinence which is leakage which occurs while rushing to the bathroom.  Stress incontinence is due to either a weakness in the urethral sphincter (bladder neck muscles) or a lack of support to the bladder neck.

Urge incontinence is caused by an overactive or spastic bladder (detrusor) muscle, and is often associated with symptoms of urgency, frequency and frequent nighttime urination.  Overactive bladder symptoms can be much worse if you have a bladder infection or by eating/drinking foods that are known to be bladder irritants.  Occasionally, women will have symptoms of urge incontinence which is due to incomplete bladder emptying, called overflow incontinence, which is like a full bucket constantly leaking over the edge.  Almost a third of patients with urinary incontinence will have a mixture of stress and urge incontinence.

As part of your evaluation for urinary incontinence, we will take a detailed history and physical examination, particularly looking at pelvic floor support and muscle strength. A urine sample will be tested and sent for a culture. You may also be asked to keep a bladder voiding diary to record the amounts and times that you empty your bladder, and any episodes of leakage and their cause.

Urodynamic studies are often suggested as a way to evaluate which type of incontinence a patient has and determine the best course of treatment. The studies evaluate lower urinary tract function by placing a small catheter in the bladder and another in the vagina (or rectum in patients with prolapse) to look at bladder leakage, voiding patterns, bladder emptying, bladder sensations, bladder capacity, strength of the urethral sphincter, and the activity of the pelvic floor muscles. These are done in the office and take about 30 minutes. No special preparation is required except that we ask you come to the office with a full bladder.   The treatment of the urinary leakage depends on the type of leakage.  Stress incontinence is usually treated with stabilization of the bladder neck with a minimally invasive sling or with urethral bulking procedures.  There are also pessaries, which are small devices placed in the vagina that can be used to stabilize the anterior vaginal wall and bladder neck and help alleviate stress incontinence. Pelvic floor exercises, pelvic floor physical therapy and/or biofeedback therapy can also be helpful. There are a few medications that can help increase the tone of the urethral sphincter, but these have limited efficacy.

Surgery is the primary treatment for stress urinary incontinence and a tension-free pubovaginal sling is now the gold standard with cure rates of 90-95%. This procedure can be done as an outpatient with minimal recovery period of 1- weeks and seems to have good longevity in studies looking at outcomes up to 10 years.

Urge incontinence is treated with a combination of behavioral therapy and anticholinergic medications, which is successful in the majority of patients.  Patients with an overactive bladder that do not respond to medical and behavioral therapy may be candidates for surgical intervention with the implantation of a bladder pacemaker called an InterStim device.  We also offer Urgent PC peripheral neuromodulation, which stimulates the bladder through a small wire place just above your ankle to the tibial nerve and is done in the office.  Botox injections to the bladder have also been used in experimental protocols with variable success, but are associated with a high rate of urinary retention.

Complications of Anticholinergic medications include: dry mouth, constipation, headache, and dizziness. *Patients with untreated narrow angle glaucoma and urinary retention cannot use these medications. The medications are most effective when used in together with behavioral therapy including timed voids (emptying by the clock), avoidance of bladder irritants and pelvic floor exercises.(links to various documents)  Other useful Behavior Modifications include weight loss, caffeine/alcohol reduction, fluid management, decreased heavy lifting, cessation of smoking, and improving constipation.

Call us today for appointment at 678-539-5980 and be on your way to a dryer, more active lifestyle.