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Urinary incontinence

Urinary Incontinence

Urinary incontinence is the involuntary loss of urine. This condition often interferes with normal daily activities and many individuals who suffer from incontinence often feel embarrassed or shy away from activities they enjoy for fear of having an “accident” or not being able to find the nearest bathroom in time.

Women are more prone to urinary incontinence as a result of pregnancy and childbirth, while in men urinary incontinence is more frequently a result of neurologic injury or prostate problems. Prevalence increases with advanced age.

Stress Urinary Incontinence

Stress incontinence is the loss of urine during activities that put abdominal pressure on the bladder, such as coughing, sneezing, laughing, lifting, or changing position.

Causes of Stress Incontinence

Although stress urinary incontinence is more common with age, it is not caused simply by aging. Other causes of stress incontinence include:

  • In women--pregnancy and childbirth, which can stretch, weaken, or even damage pelvic floor muscles; menopause, due to decreased hormones.
  • Obesity and chronic cough (often caused by smoking).
  • Certain medications, excessive alcohol consumption and caffeine.
  • Pelvic surgery or radiation treatment, which may injure pelvic floor muscles.
  • In men--prostate conditions, such as enlarged prostate.

Symptoms of Stress Incontinence

The most common and obvious symptom is urine leakage when you cough, laugh, sneeze, exercise or lift heavy objects.

Urge Incontinence/Overactive Bladder

Urge incontinence, also known as overactive bladder (OAB), is the loss of urine that follows a sudden and overwhelming urge to urinate that you can’t control. This bladder control issue is typically caused by miscommunication between the nerves in the bladder and the nerve signals in the brain that tell the bladder when it is time to empty.

Causes of Overactive Bladder

  • Increasing age.
  • Other pelvic floor or abdominal surgery that may have injured surrounding muscles.
  • Conditions such as obesity, diabetes, and/or neurological conditions such as multiple sclerosis, Parkinson’s disease, stroke, or spinal cord injury, bladder stones, and infections.
  • Certain medications such as diuretics, sedatives, and antidepressants.
  • Foods including caffeine, alcohol and spicy foods can worsen symptoms.

Symptoms of Overactive Bladder

The extreme, uncontrollable, and frequent urge to urinate is the main symptom people experience with urge incontinence, or overactive bladder. This frequency and urgency to urinate has you running to the bathroom many times during the day and night and can interfere with life’s activities.

Other Types of Urinary Incontinence

  • Mixed incontinence is a condition characterized by symptoms of both stress and urge incontinence.
  • Overflow incontinence is "dribbling" of urine, urinating frequently and in small amounts. It is also called chronic retention of urine. This type of urinary incontinence occurs when there is more urine in the bladder than it can hold.

There are a number of options for urinary incontinence treatment, both non-surgical and surgical techniques, including minimally invasive procedures performed by the experienced surgeons at Holy Cross Hospital in Silver Spring and Holy Cross Hospital in Germantown.

Treatments

If you are living with urinary incontinence, Holy Cross Health offers a number of non-surgical and surgical treatment options. Our pelvic floor specialists will work with you to determine the right therapy, or combination of therapies, for your condition.

Non-Surgical Treatment Options for Urinary Incontinence

Physical therapy – Physical therapy is an effective first-line treatment option that focuses on strengthening and relaxing the muscles of the pelvic floor. Working with a physical therapist, patients learn how to perform pelvic floor exercises that strengthen the muscles. This helps minimize urine leakage in stress incontinence and helps coordinate muscle contractions to manage the urgency associated with overactive bladder. Biofeedback is often incorporated in these sessions to ensure you are isolating the correct muscles during pelvic floor exercises.

Diet and lifestyle changes – Holy Cross Health’s pelvic floor specialists may recommend specific dietary modifications, such as changes in fluid intake and elimination of certain foods, as well as lifestyle changes, including losing weight and quitting smoking, to help improve some urinary symptoms.

Medications – Your doctor may prescribe certain medications specifically for the treatment of overactive bladder (OAB).

Minimally Invasive Surgical Options for Treating Urinary Incontinence

Surgical Procedures for Stress Urinary Incontinence:

  • Injectable bulking agents – The injection of a bulking agent into the layers of the urethra (the tube where urine leaves the bladder) helps to “bulk up” the urethral wall to support the bladder and prevent urine leakage. 
  • Mid-urethral sling – During this outpatient procedure is a small incision is made in the vagina, and a sling made of either natural or synthetic material is inserted under the urethra to give support to prevent leakage of urine.
  • Burch colposuspension (also called retropubic suspension) - In this procedure, an incision is made on the lower abdomen and the neck of the bladder is sewn to the back of the pubic bone to provide added support.

Surgical Procedures for Overactive Bladder (OAB):

  • Botox injections – Botox is when injected directly into the bladder.
  • Sacral nerve stimulation – In this procedure, surgeons place a small pacemaker-like device under the skin through a small incision in the lower back. Electrodes from the device send pulses to the sacral nerve to help control urinary symptoms.

View our pelvic health team. To find a physician or to make an appointment, search Obstetrics and Gynecology, Urology, or Colon Rectal Surgery in the physician directory or call 301-754-8800.