Urinary Incontinence

Urinary incontinence is an involuntary, or accidental, loss of urine, usually due to weak muscles in the urinary tract.  There are several factors that contribute to incontinence, primarily vaginal birth, and menopause due to decreased levels of estrogen.  Other factors include nervous system disorders, smoking, obesity, and neurologic, gastrointestinal, or pulmonary diseases.  Urinary incontinence most commonly affects Caucasian females.

Although urinary incontinence reportedly affects 13-25 million people in the United States, this number is a low estimate, as many cases go unreported due to embarrassment, or the belief that there is no treatment.  However, Women’s OB-GYN has a thorough understanding of urinary incontinence, and offers comprehensive treatment.  Dr. Thomas Minnec, Dr. Andrew Wagner, and Dr. Jennifer Schmidt specialize in treating patients with urinary incontinence.  They offer both office-based treatments, as well as surgical-based options.

The different kinds of urinary incontinence are explained below:

Stress Incontinence (SUI)

Stress incontinence is an accidental loss of urine, released upon intraabdomical pressure, such as coughing, laughing, sneezing, or walking.

Urge Incontinence/Detrusor Instability (DI)

Urge incontinence, also known as detrusor instability, is the involuntary loss of urine associated with an abrupt, strong, and uncontrollable desire to urinate.  The detrusor is the smooth muscle wall of the bladder, which experiences over activity, resulting in incontinence.

These types of bladder spasms may be related to conditioning.  For example, many people may be continent when they are out all day, but when they arrive home, they are unable to control a sudden urge to void, due to familiarity with routine urinations.  A person with DI might also experience urges at the sight of a bathroom or the sound of running water.

Mixed Incontinence
People with mixed incontinence experience both stress (SUI) and urge (DI) incontinence symptoms.  At least 40% of women experiencing incontinence suffer from mixed incontinence.

Overflow Incontinence

Overflow incontinence occurs when a small amount of urine escapes a chronically full bladder, without feeling the urge to urinate.  This usually happens when a woman stands, bends, or exerts herself.  It is most common in women with a large cystocele. It may also be due to under activity of the detrusor muscle.

Women’s OB-GYN offers a thorough diagnosis and treatment procedure for patients with incontinence.  Proper diagnosis requires the following procedure:

  • Clinical evaluation
  • Medical and surgical history form
  • Voiding diary – track spontaneous voids over a 24-72 hour period
  • Physical examination of the lower urinary tract
  • Urinalysis and culture – a clean, midstream urine sample
  • Stress test – cough repeatedly with a bladder volume of at least 300cc
  • Cystometrics – detects detrusor over activity

Women with stress incontinence can be treated through behavioral modification, pharmacological treatment, or surgical management, while women with urge incontinence respond best to behavioral techniques, or medications.  A treatment plan should offer the least invasive approach first; surgical options are reserved for women who decline, or do not improve, following conservative management.  There are also products available, such as protective perineal pads, which provide security against unplanned voids.  However, such products are only temporary fixes, and will not cure the problem.

All incontinent women should avoid excess fluid intake, limiting their intake to approximately 2 liters per day.  Consumption of caffeinated beverages should be eliminated entirely or at least reduced to no more than 8 ounces per day.