Urinary Incontinence Treated by Gynecologic and Urologic Specialists at Mercy

Urinary incontinence is the loss of bladder control, resulting in the uncontrolled leaking of urine. It can be caused by everyday habits, underlying medical conditions or physical problems and is a common concern, especially for older adults.

The severity of the problem can range from small dribbles to an outpouring of urine, causing embarrassing problems. For women, pregnancy, childbirth, weight gain and menopause are contributing reasons for weakened muscles. Urinary incontinence can also result from a urinary tract infection or damage in the urinary tract and in the nerves that control urination.

Symptoms of urinary incontinence range anywhere from the occasional leaking of urine to uncontrollable wetting, and are the result of the type incontinence experienced, including:

Stress incontinence - the loss of bladder control when pressure is exerted on the bladder, such as coughing, sneezing or exercising

Urge incontinence - the loss of bladder control resulting in the sudden, intense urge to urinate that cannot be halted

Overflow incontinence - the loss of bladder control resulting in constant dribbling usually associated with urinating frequently and in small amounts

Mixed incontinence - loss of bladder control in which symptoms of multiple types are experienced

To help diagnose urinary incontinence, our doctors may request a blood test or urinalysis to check for infection, chemicals and signs related to causes of incontinence. Patients may also be asked to record liquid intake, urination frequency, amount of urine, urge to urinate and frequency of leakage over a few days to help discover patterns in urine loss. Additional diagnostic tools may include:

• A PVR measurement
• An ultrasound
• Stress test
• Urodynamic testing
• Cystogram
• Cystoscopy

Treatment for urinary incontinence may depend on the type, severity and cause of the condition. Generally, less invasive treatments, such as lifestyle changes or therapies, will be tried first. In most cases lifestyle changes like losing weight, minimizing caffeine consumption, quitting smoking or simple Kegel exercises that strengthen the pelvic muscles can control incontinence. Our doctors may prescribe bladder training exercises or medication.

Treatment for urinary incontinence may include the following:

Kegel exercises – a series of exercises aimed at strengthening the muscles that help control urination (pelvic floor muscles). They are performed by squeezing the muscles you would normally use to stop urination.

Biofeedback therapy – a painless, safe and non-invasive physical therapy used to help teach a patient to control the body’s functions. Electrical sensors connected to the body help you receive information, or feedback, about your body. This information can then be used to make subtle changes in your reactions to conditions of the body and improve control of urinary functions.

Sacral nerve stimulation – a procedure using electrodes to stimulate and strengthen pelvic floor muscles. A surgically implanted device delivers electrical impulses to the sacral nerves that control bladder activity.

Surgery – Mercy’s physicians will help determine if surgery is a suitable option for your condition. Surgeries for urinary incontinence may include the following:

• Transvaginal tape - a synthetic mesh tape that prevents urine leakage during sudden movement, such as laughing, coughing, and sneezing and while exercising by reinforcing the ligaments and tissues that support the urethra.
• Transobturator tape - synthetic mesh tape is placed under the bladder neck (urethra). This tape functions as a "hammock" supporting the urethra in times of stress, such as coughing, sneezing, laughing, jumping, etc.
• Anterior repair - anterior repair is performed vaginally through an incision in the anterior (upper) wall of the vagina. It tightens the supports and puts the bladder back in its normal position.
• Burch or MMK procedures - the bladder neck is elevated by lateral (sideways) sutures that pass through the vagina and pubic ligaments. (Lateral sutures prevent urethral obstruction and allow the repair of small hernias.) The vaginal wall and ligament are brought together, and the sutures are tied behind the pubic bone.
• Sling procedures - involve placing a sling around the urethra to lift it back into a normal position and to exert pressure on the urethra to aid urine retention. The sling is attached to the abdominal wall.