Urinary Incontinence

Stress urinary incontinence is referred to as “stress” as it is leakage caused by increased pressure. Any pressure placed on the abdomen and bladder can cause bladder leakage. Pressure can be a cough or sneeze, lift or even bending over.  Stepping off a curb or down stairs can cause an increase in pressure putting “stress” on the bladder.

Symptoms may include mild leakage to large volume loss of urine. Activities that may lead to bladder leakage include:

• Laughing
• Sneezing
• Coughing
• Exercise or jumping
• Heavy lifting
• Sexual intimacy

Bladder leakage may even occur with everyday movement such as standing up from a seated position or walking up and down stairs. Activities that may cause leakage will vary for individuals.

Bladder leakage occurs when the ureter pelvic ligaments holding the urethral sphincter are weak. When they sag like a stretched rubber band during a stress move, then the urine leaks out.

Usually this happens after a pregnancy. Advanced maternal age, infant size, race and type of delivery are all contributing factors.

Other risk factors include prior pelvic surgery such as previous hysterectomy and chronic increased straining from smoking, obesity, or constipation. Straining to evacuate a bowel movement can further stretch the ligaments. Estrogen status also affects stress urinary incontinence.

C-section is protective. Additionally, hormone replacement therapy, or at least estrogen replacement might be protective.

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Patients may modify risk factors including:

• Quit smoking to minimize coughing
• Lose Weight
• Decrease caffeine consumption
• Drink less alcohol
• Manage Constipation
• Modify high impact activities such as horse-back riding and tennis.
• Hormone therapy

Consider physical therapy to improve strength to try to overcome the passive loss of resistance. If you are feeling feminine dryness or notice that the leaking has been worse premenopausal, then consider adding either hormone replacement therapy or local estrogen, or even the MonaLisa Touch laser.

• Bulking agents – collagen
• Botox to relax the bladder
• Medications
• Electrical nerve stimulation
• Mid-Urethral Slings

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If you are experiencing any of the symptoms of stress urinary incontinence, please see your physician for a diagnosis and treatment plan. To schedule an appointment with one of our board certified urologists, please call (425) 454-8016.

• Bladder inflammation or irritation
• Bladder cancer
• Bladder stones
• Obstruction of the bladder. An obstruction includes things such as a tumor or urinary stones. These objects can block normal urinary flow.
• Neurological disorders. Neurological disorders that may cause urge incontinence include: multiple sclerosis (MS), Parkinson’s disease, stroke, brain tumor, diabetes and spinal injury. Each of these can interfere with the nerves that control the bladder and cause incontinence.
• BPH
• Unknown – In many cases the causes may not be none.

Other temporary causes that are easily treatable:

• Urinary tract infections – bladder irritation can cause the sudden urge to urinate. UTI’s can easily be treated with antibiotics. In cases of recurrent UTI’s, there are a number of ways to reduce or prevent them from occurring. Find out more about preventing UTI’s.
• Constipation – The rectum and its proximity to the bladder can have an impact on the nerves causing an overactive bladder or urge incontinence.

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• Behavioral Modifications: Modifying behavior may include things such as timed voiding, double voiding, Kegels, scheduled bathroom breaks and bladder training.
• Medications: There are many medications that provide relief from the symptoms of urge incontinence
• PTNS works on the principals of acupuncture and involves 12 weekly visits during which tiny acupuncture needles are placed in the ankles.
• Bladder Botox injections are administered via a cystoscope, or a lighted fiber optic scope directly into the bladder lining. It works similarly to aesthetic Botox, by reducing the contraction of the bladder muscle. Although very effective, Botox injections provide temporary relief and are not a cure. The drug wears off approximately every 8 months to 1 year.
• Implants: Interstim and Axionics implant devices are placed along the nerve root that controls bladder and bowel function. The device sends electric pulses to sacral nerves (located above the tailbone). A small neuro-stimulator is placed in the upper buttock area under the skin and attached to a lead. Patients use a remote control device to turn their device up or down or off.

  These implants are such a game changer for patients with refractory OAB and even for accidental bowel leakage. The implant normalizes voiding and bowel movements. Many patients “set it and forget it” and don’t even need to use their remote very often. Others prefer to choose daytime and nighttime programs.

  This technology first became available in 1997 and has been covered by most insurance companies including Medicare. Over the years there have been improvements in the battery and lead. Our physicians have been implanting patients since then and have seen so many incredible success stories.

Request an Appointment

If you are experiencing any of the symptoms of urinary incontinence, please see your physician for a diagnosis and treatment plan. To schedule an appointment with one of our board certified urologists, please call (425) 454-8016.

• Blockage
• Weak bladder muscles
• Injury to the nerves that affect the bladder
• Disease that affect the nerves including diabetes, Parkinson’s disease, multiple sclerosis and spina bifida
• Benign prostate hyperplasia (BPH) – enlarged prostate
• Severe prolapse of a women’s uterus or bladder

Treatments for overflow incontinence are medication, catheters and sometimes surgery.