By: Jennifer Sobol, D.O.
If you’ve never had an “accident” on your way to the bathroom, urinary incontinence may be someone else’s problem. But if you’re among the millions who live with incontinence or overactive bladders, these accidents can signal real problems.
More than 33 million Americans experience loss of bladder control. The effects can immediately transform an everyday experience into an emergency. Incontinence forces you to plan activities that most people take for granted like movies, meetings, road trips.
Not All Incontinence Is the Same
There are three basic forms of incontinence:
Stress incontinence: When leakage occurs due to physical pressure on the bladder from sneezing, coughing, or athletic activities.
Urge incontinence (overactive bladder, or OAB): OAB is characterized by a sudden need to urinate because the bladder contracts involuntarily.
Overflow incontinence: This is when the bladder doesn’t empty as it should and later leaks urine. Among men, this can happen when the urethra is blocked by an enlarged prostate (BPH).
Incontinence Can Come on Suddenly
Incontinence occurs when the muscle, or sphincter, that closes the bladder outlet is not strong enough to hold back urine. Other contributing causes include muscle weakness in the bladder or pelvic floor, and problems (such as miscommunications) among the nerves that control urination.
Incontinence affects twice as many women as men. This can be due to pregnancy, childbirth, and menopause. (The bladder position can shift during pregnancy, for example.).
Men with enlarged prostates may experience overflow incontinence due to the enlarged tissue compressing the urethra.
Other risk factors include smoking, pregnancies, obesity, diabetes, bladder disease, and certain medications.
Your Pathways to Treatment Options
A lot of people address incontinence by wearing panty liners or keeping a spare pair of underwear in the bathroom. There are more practical, long-term solutions. Following are some of those options.
Lifestyle changes and medications
For many people, changes in diet, cutting back on caffeine, and pelvic floor exercises, or Kegels, may improve urinary function. Oral medications also can help, but they can come with potentially serious side effects and may not work long-term.
Biofeedback and electrical stimulation
Biofeedback is a method of training patients to gain control of their body functions. It does this using electronic monitoring devices, such as probes, to track when the bladder and urethral muscles contract.
Sacral Nerve Stimulation
An implantable device sends mild electrical pulses to the sacral nerves to reduce symptoms of bladder control problems, so you can get back to living.
Stress incontinence occurs often if the muscles and ligaments that support the urethra and bladder are weakened due to childbirth, surgery, radiation therapy, or aging. Collagen or Botox injections, applied around the urethra and neck of the bladder, have shown to be effective in improving muscle functions. Additionally, Bulkamid injections are used to add additional volume to the wall of the urethra, helping to prevent urine from leaking out of the bladder during normal daily activities.
Men who experience incontinence as a side effect of an enlarged prostate can find relief through one of several medical options that destroy or remove the excess tissue compressing the urethra.
- UroLift: Uses small implants to hold open the obstructed pathway that’s blocking urine flow.
- GreenLight Laser Therapy: Applies laser energy to remove prostate tissue that is compressing the urethra.
- Rezum: A non-surgical treatment that uses the natural energy stored in water vapor, or steam, to remove excess prostate tissue that is pressing on the urethra.
- Aquablation: Ues the power of water delivered with robotic precision to provide long-lasting BPH relief without compromise.
- Prostate Artery Embolization (PAE): Prostate artery embolization, or PAE, is a non-surgical procedure that can improve lower urinary tract symptoms by blocking the blood flow to the prostate, thereby reducing the size of the prostate.
Bladder suspension surgery
For women, a urologist can readjust the bladder if it moved due to pregnancy or other cause. The most common approaches:
- Retropubic suspension: The surgeon secures surgical threads (sutures) to ligaments within the pelvis, to support the urethral sphincter and bladder neck.
- Sling procedures: A common therapy for stress incontinence, the surgeon feeds a “sling” made from mesh or human tissue under the urethra, and secures it to support the urethra and neck of the bladder.
If One Treatment Doesn’t Work, Don’t Give Up
No one – let alone 33 million people – should suffer silently with incontinence. It’s a real condition with real treatments; many, in fact. We know how to talk about it because we do this every day. If you or someone you care about is living with incontinence, a call to a urologist is the first step to managing it.
If one treatment option doesn’t work for you, we’re dedicated to finding one that does.
You can learn more about overactive bladder here. To review all of our specialties and treatment options, click here.