Bladder Control Problems/ Incontinence

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Millions of women suffer from bladder control problems, including urinary incontinence (involuntary leakage of urine) and OAB (OverActive Bladder). Types of incontinence include:

Stress urinary incontinence (SUI) – Leakage resulting from effort or exertion (coughing, laughing, sneezing, exercise, running, lifting, etc.) that puts pressure or “stress” on the bladder. This results from weak pelvic muscles or a weakening of the connective tissues between the bladder and vagina. The weakness is due to pregnancy and childbirth or from declining levels of the hormone estrogen.
Urge urinary incontinence – Leakage from involuntary bladder spasms that cannot be suppressed and controlled, resulting in leakage of urine prior to making it to the bathroom. This type of leakage can occur with or without a warning signal of a strong urge to urinate. Most of the time this type of leakage is caused by Detrusor Overactivity (DO) which is an involuntary contraction (or spasm) of the detrusor muscle, which makes up the body of the bladder. This type of leakage can also be triggered by coughing, laughing, and exercise.
Overflow urinary incontinence – Incontinence that occurs when the bladder is constantly full, and reaches a point where it overflows and leaks urine. This condition may be the result of weak bladder muscles, due to nerve damage from various conditions, such as multiple sclerosis, and spinal cord injury. This is also referred to as Neurogenic Bladder.

Treatment for urinary incontinence varies depending on the type of incontinence. The first step in treatment is accurate diagnosis. This includes obtaining a careful medical, surgical, and urological history, as well as a thorough physical and pelvic examination. One of the most important diagnostic tools is urodynamic testing. Physical examination and symptoms alone are not sufficiently reliable indicators of the cause of bladder dysfunction. Urodynamic testing usually takes less than half an hour, and is not painful. During the test one fills the bladder with sterile water through a catheter about the size of a piece of spaghetti. A computer will take pressure measurements of your bladder and urethra. Your doctor will then discuss the results and explain the nature of the bladder dysfunction and the best treatment options.

Medical Treatment Options

Medical treatment may involve hormonal replacement, pelvic floor exercises, bladder retraining, and drug therapy. The majority of drugs used in the treatment of DO fall into a class called Anticholinergics. Acetylcholine is the main neurotransmitter (natural chemical released in your body) responsible for contraction of the bladder muscle. Anticholinergic drugs block the receptors for acetylcholine on the bladder muscle and help weaken bladder spasms. When used in the correct dose, patients will have significant improvement in their symptoms and still be able to urinate. Unfortunately, acetylcholine is responsible for many other body activities including brain function, bowel function, heart function, vision, and salivation. This means that Anticholinergic drugs may have unwanted effects including dry mouth, dry eyes, constipation, blurry vision, fatigue, and memory loss. Fortunately, different organ systems have slight differences in their acetylcholine receptors. The important receptors on the bladder muscle are called M3 receptors. Newer Anticholinergic drugs are more selective for the M3 receptor and therefore may have less unwanted side effects. The most commonly used drugs are Ditropan® (Oxybutynin), Detrol® (Tolterodine), Vesicare® (Solifenacin), Oxytrol® (Oxybutynin Patch), Sanctura XR® (Trospium), and Enablex® (Darifenacin). Ditropan is the oldest and has been in use since the 1970s. We feel that it is associated with the greatest amount of side effects.

Surgical Treatment Options

Although urinary incontinence does not jeopardize physical health, it does interfere with a woman’s lifestyle. Surgery is often an option that may restore a quality of life free from wetness, worry and embarrassment. A highly effective treatment for SUI is the minimally invasive vaginal sling (TVT). For urge incontinence that has failed to respond to drug therapy, or for patients who cannot tolerate the side effects of Anticholinergic medication, sacral nerve stimulation therapy, or Interstim® is often a highly effective treatment.