URINARY INCONTENENCE

• Stress incontinence. This is loss of urine when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.

• Urge incontinence. Urge incontinence is the loss of urine, due to uncontrollable muscle spasm of your bladder.

• Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder.

• Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.

COMPLICATIONS

• Skin problems. Urinary incontinence can lead to rashes, skin infections and sores (skin ulcers) from constantly wet skin.

• Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.

• Changes in your activities. Urinary incontinence may keep you from participating in normal activities. You may stop exercising, quit attending social gatherings or even stop venturing away from familiar areas where you know the locations of toilets.

• Changes in your work life. Urinary incontinence may negatively affect your work life. Your urge to urinate may cause you to have to get up often during meetings. The problem may disrupt your concentration at work or keep you awake at night, causing fatigue.

• Changes in your personal life. Perhaps most distressing is the impact incontinence can have on your personal life. Your family may not understand your behavior or may grow frustrated at your many trips to the toilet. You may avoid sexual intimacy because of embarrassment caused by urine leakage. It's not uncommon to experience anxiety and depression along with incontinence.

WHAT YOU CAN DO

Print Off and Fill out our Voiding Diary PDF

• Write down key personal information, including any major stresses or recent life changes.

• Bring a list of all medications, vitamins or supplements that you're taking.

• Testing

If further information is needed, you may undergo additional testing, including:

• Postvoid residual (PVR) measurement. For this procedure, you're asked to urinate (void) into a container that measures urine output. Then your doctor checks the amount of leftover (residual) urine in your bladder using a catheter. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

• Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

• Stress test. For this test, you're asked to cough vigorously or bear down as your doctor examines you and watches for loss of urine.

• Urodynamic testing. These tests measure pressure in your bladder when it's at rest and when it's filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, the pressure in your bladder is monitored. This test helps determine what type of incontinence you have.

TREATMENTS

Treatment depends on the type of incontinence, the severity of your problem and the underlying cause. A combination of treatments may be needed.

Initially we will suggest the least invasive treatments first. We usually begin with behavioral techniques and physical therapy first and add other treatments as necessary.

At Columbia Shores Regenerative Health we are able to treat your incontinence from behavioral techniques, pelvic floor exercises, to surgery and bladder Botox.

BEHAVIORAL TECHNIQUES

Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

• Bladder training. We may recommend bladder training. This type of therapy may used alone or in combination with other types of therapy. In bladder training you begin with a frequency of urination that you are able to maintain. Once you able to keep the initial voiding schedule we have you then add 15 minutes between each void until you are able to void on schedule every 2 to 4 hours.

• Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid consumption, losing weight or increasing physical activity are other lifestyle changes that can help.

PHYSICAL THERAPY

• Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles to help control your bladder. Pelvic floor exercises or physical therapy has a significant impact on improving both stress urinary incontinence and urge incontinence.

• Pelvic Floor Exercises PDF

• Kegal Cones. These are a good adjunct to pelvic floor exercises. Initially you insert the largest cone vaginally and hold while standing upright for 10 minutes in the am and 10 minutes in the pm. Once you can keep the cone in for these durations, 2x a day for 2 weeks then you move to the next size smaller and heavier until you get to the last cone. Once at the last cone you continue on this regiment. These cones may be ordered from online stores such as Amazon.

MEDICATIONS

Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

• Anticholinergics. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Possible side effects of these medications include dry mouth, constipation, blurred vision and flushing.

• Estrogen. Estrogen may be taken orally in a systemic form or topical to help with both vaginal and bladder health.

• Imipramine. Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat mixed (stress and urge) incontinence.

MEDICAL DEVICES

Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

• Pessary (PES-uh-re). Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

SURGERY

If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence.

• Sling procedures. A sling procedure uses a synthetic material or mesh to create a pelvic sling or hammock around your bladder neck and urethra. The sling helps keep the urethra closed, especially when you cough or sneeze.

• Bladder neck suspension. This procedure is designed to provide support to your urethra at the level of the neck of your bladder. It involves an abdominal incision, so it's done using general or spinal anesthesia.