Urinary Incontinence

Urinary incontinence is the loss of bladder control. Millions of people suffer from bladder control and it is often an embarrassing problem. There are several different types of urinary incontinence including stress, urge, overflow, and mixed incontinence.

Stress Incontinence

Urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)

Urge Incontinence

Urine loss with urgent need to void and involuntary bladder contraction (overactive bladder or OAB)

Mixed Incontinence

Both stress and urge incontinence

Overflow Incontinence

Constant dribbling of urine; bladder never completely empties.

Symptoms

Urinary incontinence is the involuntary loss of urine and is a symptom of a bladder control problem. Other symptoms of bladder control problems include:

  • Urinary frequency
  • Urinary urgency
  • Nighttime urination
  • Urinary incontinence
  • Slow urinary stream or incomplete bladder emptying

 

At Urology of Indiana, we have significant and extensive experience in the evaluation, diagnosis and treatment of all types of urinary incontinence and bladder control problems and symptoms. Our team of physicians and medical professionals will carefully gather your history, and with the help of specialized tests, determine a diagnosis and treatment plan designed specifically for you.

Medical History

To evaluate and diagnosis symptoms related to bladder control problems, a complete medical history, including a 3-day voiding diary and questionnaire, a physical examination and one or more diagnostic tests may be conducted to help the physician determine the type of urinary incontinence and develop an appropriate treatment plan.

Obtaining your medical history provides insight into the type of incontinence. Bowel habits, patterns of urination and leakage, and the degree to which there is pain, discomfort, or straining when voiding are key indicators. A history of illnesses, pelvic surgeries and a list of current medications also provide valuable insight to ensure an accurate diagnosis.

Physical Exam

A physical examination will be conducted, including examination of the abdomen, rectum, genitals, and pelvis. The physical examination helps identify medical conditions that may be the cause of incontinence.

Urinalysis

A urinalysis is also performed to further identify potential medical conditions, including:

•    Bacteriuria: presence of bacteria in urine indicating infection
•    Glycosuria: excess glucose in urine which could indicate diabetes
•    Hematuria: blood in urine which could indicate kidney or bladder disease
•    Proteinuria: excess protein in urine which could indicate kidney, cardiac, or blood disease
•    Pyuria: presence of pus in urine indicating infection

Additional Testing

If urinary incontinence is complex or does not respond to conservative treatments, additional testing may be required, including urodynamic, endoscopic and imaging tests to obtain more extensive evaluation of the lower urinary tract to help determine an appropriate treatment plan.

If your condition requires surgery, our doctors perform the most recent surgical therapies, including sling procedures, InterStim™ Neuromodulation Therapy, pelvic reconstructive surgery, da Vinci™ robotic laparoscopy, and minimally invasive treatment for prostate enlargement in men, such as microwave and laser procedures.
Non-Surgical Treatment

Behavioral Modification

In patients with urge incontinence and overactive bladder changes in diet and urinary habits often improve symptoms. Dietary modification involves avoiding irritants in food and drink that can worsen urinary symptoms. Patients often have different dietary triggers but substances such as caffeine, acidic foods, and carbonated beverages can often worsen overactive bladder and urge incontinence.

Modifications in urinary habits such as timed and double voiding can also improve many types of bladder problems. Timed voiding involves urinating on a schedule such as every 2 hours while awake. This can serve to improve and regulate overactive bladder and urge incontinence. Double voiding involves urinating once again within five minutes to assure the bladder is being properly emptied.

Medical Therapy

Anticholinergics are a class of drugs indicated for the treatment of overactive bladder and urge incontinence. These drugs relax the smooth muscle of the bladder to decrease urinary frequency, urgency, and urge incontinence.

Surgical Treatment

Stress urinary incontinence (SUI) is often treated initially with biofeedback and pelvic floor training. For patients with severe or refractory SUI there are several successful and well tolerated surgical options.

Slings

Pubovaginal or urethral slings have become a very popular treatment option for women who suffer from SUI. Slings provide a backboard of support for the urethra allowing for correction and cure of SUI. Most urethral slings are placed as an outpatient surgical procedure. Several different types of sling materials and placement techniques are currently available.

Injection Therapy

Injecting material to increase the bulk around the urethra can improve the function of the urethral sphincter and compresses the urethra near the bladder outlet. Injectable agents can help patients who are not candidates for surgery and have persistent intrinsic sphincter deficiency (very weak urethral sphincter) without urethral hypermobility.

Neuromodulation

Neuromodulation involves the placement of a bladder pacemaker (Interstim). This treatment is indicated for patients with severe symptoms of urinary urgency, frequency, and overactive bladder that have not responded to behavioral and medical therapies.