Urinary Incontinence

Urinary incontinence is a common condition, but it is not a normal part of getting older, and not something you have to live with.

Contrary to what many people think, it is possible to successfully treat urinary leakage that causes hygienic, social and health problems.

Types of Urinary Incontinence
Causes of Urinary Incontinence
Evaluating Urinary Incontinence
Minimally Invasive and Surgical Procedures

At Virginia Mason, our goal is to help you return to an unrestricted life.

Types of Urinary Incontinence

Urinary incontinence is the leakage of urine — it can range from a few drops to a complete loss of bladder control. Approximately one in three women experience urinary leakage during their lifetime. Every year at Virginia Mason, we help hundreds of people overcome urinary incontinence.

The most common types of urinary incontinence are:

  • Stress urinary incontinence: leaking that occurs with exertion, including coughing, laughing, sexual activity, exercise, or any other physically strenuous activity or exertion.
  • Urgency urinary incontinence: leaking that occurs when there is a sudden and uncontrollable need to void. It is associated with having an overactive bladder.
  • Mixed urinary incontinence: leaking that occurs from both stress and urgency incontinence.
  • Overflow incontinence occurs when the bladder overfills and urine leaks “over the top.” Men are more likely than women to have overflow incontinence.

Causes of Urinary Incontinence

Urinary incontinence can be temporary — caused by a urinary tract infection or as a side effect of certain medications.

While aging is a factor, chronic or long-term urinary incontinence may be also be related to:

  • Smoking
  • Obesity
  • Childbearing
  • Loss of estrogen
  • Family history

Stress incontinence can occur when muscles or tissues supporting the urethra (the tube that carries urine) become weak. Intrinsic Sphincteric Deficiency is a form of stress incontinence that occurs when the sphincter valve muscles (which keeps the urethra closed) become weak.

Urgency urinary incontinence occurs when the bladder is overactive. This can happen as a result of aging, hormone deficiency, muscle or nerve damage, or bladder outlet obstruction (such as when an enlarged prostate is “in the way” so the bladder cannot empty easily and the urine overflows.)  A variety of factors can set off overactive bladder, including bladder irritants such as caffeine or alcohol.

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Evaluating Urinary Incontinence

In order to achieve successful treatment, it is important to determine what type of incontinence you have, because the different types are treated differently.

At Virginia Mason, your evaluation for urinary incontinence will include a complete medical history and a physical exam, including a pelvic exam. You may be asked to keep a bladder diary to record information about your voiding habits and leakage.

Radiologic tests, such as ultrasound, CT scan or MRI are also available. Cystoscopy, which looks inside your bladder and urethra with a tiny camera, is another test that might be done.

Some patients may need urodynamics testing. Our video urodynamic lab helps us better understand what your bladder looks like and how your bladder and urethra function.

The urodynamics lab includes:

  • Radiological imaging of the bladder in motion
  • Accurate testing of how the bladder fills and empties and how effective the urethra squeezes and relaxes
  • Electronic tracing of muscle activity
  • State-of-the-art technology that is the gold standard in our field
  • Experienced nurses and doctors that make the experience comfortable for you  

Treating Urinary Incontinence

There are various treatments available for urinary incontinence, ranging from lifestyle changes to medical and surgical procedures.

Stress urinary incontinence:

Lifestyle changes for stress urinary incontinence include stopping smoking and losing weight. Even modest amounts of weight loss may improve your condition.

Non-invasive treatments include:

  • Pelvic floor muscle strengthening, called Kegel exercises
  • Pelvic floor physical therapy with a physical therapist who specializes in incontinence
  • Biofeedback to objectively demonstrate your work and progress
  • Supplemental vaginal estrogen to help restore vaginal tissue strength
  • A small, removable device, called a pessary, that is placed inside the vagina to support the bladder and urethra

Minimally Invasive and Surgical Treatments

For Stress Incontinence

Urethral bulking: Urethral bulking procedures involve injecting small beads of zirconium in a water-soluble gel around the urethra. Much like the injection of collagen into the face for cosmetic filler, this plumps up the urethra to help it become more watertight. It is a simple procedure that can be done in the office, with effects that last about a year.

Sling surgery: The most common surgical treatment for stress incontinence is sling surgery to place a supportive material under the urethra. The sling works as a hammock to support the urethra, and as a backstop when pressure placed on the urethra pushes it downward, as occurs during a cough or a sneeze.

The most common slings are made of a thin strip of synthetic mesh. Others can be constructed with a strong, flat tendon from your body, called fascia. In this case, a strip of tissue is obtained from your leg or lower abdominal wall.

Sling surgery is a minimally invasive procedure, and is typically done as outpatient surgery. If additional procedures are needed to repair pelvic organ prolapse, you may need to stay overnight in the hospital.

Complications from prior surgeries:

Virginia Mason is a regional referral center for other physicians and hospitals for patients who have recurrent symptoms or complications from previous surgeries – including mesh sling, prolapse and incontinence surgeries.

We offer a thorough evaluation including translabial 3D pelvic ultrasound to visualize the mesh in relation to your anatomy. X-rays, CT scans, or MRIs cannot see mesh, so this ultrasound helps us visualize transvaginal mesh or mesh slings that have already been placed.

For Urgency Incontinence

A variety of successful treatments for overactive bladder and urgency incontinence are available. We offer all FDA-approved treatments for overactive bladder. We will help you learn about your condition and consider what treatments are best for you. 

For Mixed Incontinence

Treatment for mixed incontinence is based on the results of your comprehensive evaluation and your symptoms. Your pelvic floor specialist will determine the best order in which to address your symptoms and approach your treatment. Usually, the type of incontinence that is most bothersome is treated first. Treatment can then be adjusted as progress is made.

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