Urinary incontinence (UI), otherwise known as the involuntary loss of urine, is a common problem for women especially after they have children or as they age. Severity can range from occasional leaks to not being able to perform daily activities due to urine loss.

There are several types of urinary incontinence, including stress, urge, mixed, overflow, and functional. In order to determine the type and treatment, we perform a comprehensive evaluation. We will take a detailed history and perform a directed physical exam. Urodynamic testing, where measurements are taken to evaluate the bladder’s function and efficiency, may also be required. Some urodynamic tests are simple and can be done in the office. More sophisticated testing may involve testing the electrical activity of the muscles while the bladder fills.

What is Urinary Incontinence?

Do you catch yourself saying, “I have to go right now?” Are you struggling to control your bladder?

If you're experiencing the inability to control your bladder, you’re not alone. Urine leakage or urinary incontinence (UI) is a common condition that many women and some men encounter. While prevalent, it is not normal at any age and should be something you consult with your medical provider about. With approximately 30-50% of women experiencing urinary incontinence at some point during their lifetime, it’s essential to know what it is and how to treat it. Problems with bladder control are serious health issues, and they can affect the way you live your life.

Do I have Incontinence?

Are you unsure whether or not you may be experiencing a loss of bladder control? Consider the questions below:

  • Do you use the bathroom so often that it disrupts your day-to-day activities?

  • Do you make mental notes of where the bathroom is located when visiting new places?

  • Is it hard to make it to the bathroom on time?

  • Are you using pads or panty liners to help absorb bladder leakage?

  • Are you worried about laughing, coughing, sneezing, or lifting heavy objects because it may result in leakage?

  • Do you experience pressure or a bulging feeling in your vagina?

  • Has your urine stream become weakened or turned into a spray?

Severity of Urinary Incontinence

The severity of urinary problems varies from person to person, and what is a minor inconvenience to one might be a serious issue to another. In severe cases, the impact on life means that a person may limit their social activities and no longer enjoy spending time outside of their home.

Causes and Risks of Urinary Incontinence

Urinary incontinence is not a disease, it’s a symptom. This means it is caused by underlying medical conditions or physical problems. There may also be certain foods or beverages that are encouraging UI issues such as diuretics which stimulate your bladder and increase the volume of urine produced. The following can cause temporary urinary incontinence:

  • Alcohol

  • Caffeine

  • Carbonated beverages

  • Chocolate

  • Spicy, sugary, and acidic foods

  • Certain medications for high blood pressure and heart conditions

  • Large amounts of vitamin C

Non-Surgical Treatments

Non-surgical treatments for UI include medication, lifestyle changes, behavioral changes, alternative options, and devices. We’ll outline each below:

Medication

Medicines can help control how the bladder functions. There are a wide variety of options available on the market. Medications relieve urinary incontinence by:

  • Blocking muscle spasms in the bladder

  • Calming nerve signals to the bladder

It’s best to talk with your provider about whether or not certain medications are a good fit for you. There are a few additional non-surgical treatment options to discuss with your provider if medication does not work.

Lifestyle Changes

Changing aspects of your lifestyle may help reduce your symptoms of incontinence.

  1. Maintain a healthy weight: The more overweight you are, the more likely you are to develop incontinence. As a result, it’s best to maintain a healthy weight to keep symptoms at bay. You can speak with your provider about the best ways to reduce or maintain weight for your body type.

  2. Limit foods and drinks that irritate your bladder: Foods or beverages that cause bladder irritation can increase your potential for developing urinary incontinence.  While it’s important to limit the consumption of things like caffeine, alcohol, and sugary beverages, don’t limit your water intake.

  3. Avoid smoking: Smoking is not good for your health and can also cause issues with urinary incontinence. Speak with your provider about ways you can quit.

Behavioral Changes

 Similar to lifestyle changes, there are also behavioral changes you can make to help with incontinence.

  1. Pelvic floor muscle exercises: Pelvic floor exercises are a great way to strengthen your pelvic muscles. Strengthening your pelvic floor with Kegels, yoga, or Pilates can prevent urinary incontinence.

  2. Scheduled toilet trips: You may consider scheduling your trips to the toilet to help regulate when you go to the bathroom. Work with your provider to come up with a good system to get you back to feeling your best.

  3. Intermittent catheterization: If you’re unable to empty your bladder properly, using a catheter every once in a while may help. Discuss this method with your provider.

  4. Absorbent pads: You may find that using absorbent panty liners, disposable underwear, and pads can help get you back to enjoying social activities without worrying about accidents and leakage.

  5. Bladder retraining: You can retrain your bladder by holding off urinating until a set time. Start in small time increments like 20 to 30 minutes and then work your way up to 2-4 hours between trips to the bathroom.

Alternative

There are two alternative medicine options that can potentially reduce your incontinence symptoms: biofeedback and acupuncture.

  1. Biofeedback: Biofeedback uses different devices to identify how the pelvic muscles are contracting. Biofeedback is completed by a physical therapist and involves touching the contracted muscles, connecting small sensors to the vagina, rectum, abdomen, and legs, and using vaginal weight training. These techniques can help strengthen and thus improve control of your pelvic muscles.

  2. Acupuncture: Inserting tiny needles into the surface of your skin can help to stimulate the nerves around your pelvic floor and alleviate incontinence by helping you regain control of your pelvic muscles.

Devices

Various vaginal devices can help achieve greater bladder control and/or prevent leakage. Vaginal devices:

  • Tampon

  • Urethral plug

  • Vaginal pessary

These devices are inserted into the vagina to lift the bladder by applying compression, thus stopping the cause of leakage. They are a low-risk treatment option that can be administered in the doctor’s office or at home. Furthermore, these devices combat other pelvic issues such as pelvic organ prolapse, uterine prolapse, and bowel control.

Non-Invasive Procedures

If non-surgical options do not work, there are a few non-invasive procedures that may reduce incontinence.

Nerve stimulation

Nerve stimulation involves sending small electrical currents to your bladder or pelvic floor. Two types of nerve stimulation help improve nerve sensation and strengthens the pelvic muscles:

  1. Percutaneous Tibial Nerve Stimulation (PTNS): PTNS delivers small electrical currents near your ankle. This less invasive procedure is completed through multiple treatments which help stimulate the nerves of the pelvic muscles.

  2. Sacral Nerve Stimulation (SNS): SNS delivers electrical stimulation to your sacral nerves through a device implanted in your buttocks. SNS is similar to a pacemaker and is an effective procedure which improves the symptoms of UI.

Injections

With a low complication rate, many women find injections to be a more desirable option than surgery.

  1. Urethral bulking agents: During this procedure, a long-acting gel or paste-like substance is injected into the muscular walls of the urethra. Once inserted, the bulking agents narrow the urethra to reduce urine leakage.

  2. Botulinum toxin (Botox®): Botox A, commonly used in cosmetic care, can also be an effective incontinence treatment. During this treatment, a series of Botox injections are made into the bladder or pelvic floor region. The use of Botox paralyzes the bladder muscles which then decreases the feeling and sensitivity of needing to urinate.

Benefits of injections include:

  • Less invasive than surgery

  • Does not require incisions

  • Low complication rate

  • Performed in a doctor’s office on an outpatient basis

However, as with any medical procedure, there are risks. Injection risks include:

  • Post-procedure urinary retention

  • Urinary tract infection

  • Hematuria (blood in urine)

  • Pain

  • Temporary body weakness

Discuss the risks and benefits of injections with your provider to find out if bulking agents or Botox are good options for you.

Surgical Treatments

In severe cases, or when non-surgical options have been unsuccessful, surgery for urinary incontinence may be needed.    There are three different types of surgical treatments provided by MetroPartners OBGYN to treat urinary incontinence:

  • Urethral Sling Procedures

  • Vaginal repairs

  • Robotic sacrocolpopexy

  • Axonics Therapy

Your provider will evaluate your condition and symptoms to determine which treatment option is best for you and your lifestyle. 

Female Pelvic Health and Reconstruction

Incontinence can often seem embarrassing. If you’re hesitant to disclose your incontinence issues to your provider, remember that you’re not alone and it’s nothing to hide. The first step to taking back your life is speaking with a pelvic floor specialist about your pelvic health.

MetroPartners OBGYN providers are experts in treating conditions such as urinary incontinence. Should you and your provider determine that surgery is your best option, rest assured that our specialists are leaders in pelvic floor reconstructive surgery, including laparoscopic and robotic approaches.

Twin Cities Doctors with Specialized Training & Expertise in Pelvic Health

Although many of the MetroPartners OBGYN physicians care for patients with incontinence and prolapse issues, we do have a leading expert in female pelvic medicine and reconstructive surgery, Dr. Kevin A. Hallman. Dr. Hallman is an experienced provider specializing in women’s pelvic floor issues and holds the following certifications:

  • Board-certified Fellows in the American College of Obstetricians and Gynecologists (FACOG)

  • Board-certified inaugural Fellows in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery (FPMRS)