Talking About Urinary Incontinence: Types and Treatment

Urinary incontinence, the involuntary leakage of urine, is a common issue for many women. Incontinence can affect a woman’s physical activity, self esteem, sexual function and can limit participation in normal day-to-day activities. Although incontinence can affect many aspects of a woman’s life, many women do not tell their physician.

Why? For many women, incontinence is embarrassing. They do not feel comfortable talking with their physicians about their incontinence. For other women, they feel that incontinence is a normal part of the aging process and that they just have to “live with it.”

“I would encourage women to talk to their physician about their incontinence because it is not something to be embarrassed about and it is not something that they have to live with,” says Damon Hoffmann, D.O., a specialist in Urology at Washington Health System.

Depending on the type of incontinence, there are a variety of treatments available that can dramatically improve leakage episodes.

Evaluation
There are several different types of urinary incontinence, and a woman may have more than one type of incontinence. A medical evaluation will help to reveal the type of incontinence and treatment options.

“A thorough history, physical examination and urodynamic testing can give a great amount of information about the type of incontinence,” Dr. Hoffmann says. “This evaluation process will identify easily treatable and reversible causes of incontinence such as urinary tract infections, medication side-effects and certain medical conditions.”

“It will also differentiate the disorders of the bladder that cause long-term incontinence problems: stress incontinence, urge incontinence, mixed incontinence and overflow incontinence,” he notes.

Stress Incontinence
Stress incontinence is the most common cause of urinary incontinence in younger women. Stress incontinence refers to the leakage of urine with laughing, coughing, sneezing or with exercise such as running. Stress incontinence is caused by a weakening of the pelvic floor muscles that support the bladder and urethra. Pregnancy, childbirth, aging, chronic constipation and a chronic cough can weaken the pelvic floor muscles.

Initial treatments are aimed at increasing pelvic floor strength and minimizing stressors.

“Kegel exercises and pelvic floor physical therapy can increase pelvic floor strength,” recommends Dr. Hoffmann. “Lifestyle changes such as weight loss, avoidance of caffeine, smoking cessation, and treatment of chronic constipation or cough can also significantly improve stress urinary incontinence symptoms.”

“If incontinence symptoms are not sufficiently treated with pelvic floor exercise and lifestyle modification, surgical therapy, often in the form of a sling procedure, can be used with excellent results,” he says.

Urge Incontinence
Urge incontinence or overactive bladder is characterized by leakage of urine associated with a feeling of urgency. This form of incontinence results from spasms of the bladder muscles.

“The lifestyle modifications and pelvic floor exercises mentioned above can also help urge incontinence symptoms. When additional therapy is necessary, medications and a nerve stimulator procedure called the Interstim procedure, are available that help control the bladder spasms and decrease leakage episodes,” notes Dr. Hoffmann.

Mixed Incontinence
Mixed incontinence is the most common form of urinary incontinence. As the name implies, women with mixed incontinence have both stress and urge symptoms.

“They often require a combination of the treatments that were described for stress and urge incontinence,” Dr. Hoffmann explains. “I often recommend treating the most bothersome symptoms first and then evaluating whether additional treatment is necessary.”

Overflow Incontinence
A smaller subset of patients experience overflow incontinence when the bladder does not contract effectively or if there is a physical blockage to the outflow of urine.

“Women with this form of leakage experience dribbling or continuous leakage. The treatment of this form of incontinence depends upon the underlying cause,” says Dr. Hoffmann.

Many Treatment Options
Regardless of the type of incontinence, leakage of urine is something that can affect a woman’s quality of life. Although many women feel uncomfortable discussing incontinence, it is an extremely common condition with many treatment options available. The first step to experiencing relief of the leakage of urine is to begin the discussion with your doctor.

To make an appointment with the WHS Urology group, call (724) 229-2424 or visit www.whs.org/urology.

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