Urinary / Bladder Issues
Loss of bladder control or urinary leakage
Bladder control problems affect 30 to 50% of women.
Although the rates go up with age, urinary incontinence among young women is common.
Though common, urinary incontinence is NOT “normal” at any age.
Click here to see the 7 types of urinary incontinence
Diagnosis
Bladder control issues are not a normal part of aging—seek care and ask your provider about treatment options. Take time to learn how your bladder control problems might relate to possible pelvic floor disorders. There may be steps to take to help improve your pelvic health.
Bladder Diary
Your provider may have you fill out a bladder diary to better understand how often and how much you urinate and what leads to urinary leakage.
The diary can help you track voiding behavior. Many urinary issues develop slowly, over time. You may not be aware of how often you void, or how often you revise usual activities because of fear of leakage—because the problem has been sneaking up on you for so long. Seeing this reality “in writing” can be useful for you and your provider.
At the beginning of treatment, bladder diaries are helpful in establishing the nature and severity of your bladder control problem. Also, because many times the benefits of treatment take a long time to become obvious, small changes in bladder diary information can help a woman’s provider know whether or not a set of treatments is working.
Bladder Tests or Urodynamics
Depending on your symptoms and physical exam, your provider may want to do some additional bladder testing.
What is Urodynamic Testing?
Urodynamics test the functions and behaviors of the bladder and the urethra (the tube that leads from your bladder to the outside). This procedure usually involves the placement of a very small catheter, or tube, in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder, so that your doctor can tell how the bladder behaves as it is getting full.
Why is Urodynamic Testing Necessary?
This kind of testing can be very helpful to figure out what parts of your bladder and urethra are functioning correctly, and which parts are not. The reasons that a woman might be experiencing incontinence, urgency, or difficulty emptying her bladder can be very complex. Urodynamics help the doctor find out what might be going on. The often help your doctor determine the best treatment for you.
Are Urodynamic Tests Uncomfortable?
Urodynamic testing does involve the use of some very small catheters, but is not painful. As your bladder is filled with sterile fluid, you may feel as though you have the urge to urinate. These sensations are an important part of the test itself, so be sure to tell the staff what you are feeling. You may be asked to cough, bear down, or other maneuvers which might make you leak urine; do not worry about this. It is important to remember that these tests can often help you find the right treatment to fix these problems.
Some people have mild burning or irritation when they urinate after the test. This typically goes away within a day. Most women can resume their normal activities after testing.
What Prep is Required Before Testing?
Your doctor may request that you arrive at the office with a full bladder.
What is Cystoscopy?
Cystoscopy is a way to look at the inside of your bladder. Your doctor passes a tiny telescope into the bladder. This allows your doctor to make sure that there are no abnormalities such as stones, tumors, or inflammation might be contributing to your bladder symptoms.
Is Cystoscopy Uncomfortable?
The procedure is not painful.
What Prep is Required Before Testing?
Generally, no preparation is required.
Treatments for Overactive Bladder (OAB)
Some women who have incontinence aren’t very bothered by it, especially when it doesn’t happen very often, or doesn’t prevent them from doing things they want to do. Very often, however, many women suffer with this problem for a long time before bringing it up with someone who can help.
Anti Spasm Medication
Suppress overactive muscle activity, which may be causing the bladder to contract during the filling stage.
Side Effects
These medicines can cause dry mouth, constipation, decreased persperation, and/or blurred vision. These medications need to be used cautiously in the elderly, as some could worsen memory.
Two particular medications, Myrbetriq and Gemtesa, work through a different pathway than the other medications and and do not have the above side effects. But these medications are the most expensive medications and often are not covered by insurance plans.
If lifestyle and behavioral treatments don’t work for women with overactive bladder (OAB), another option may be an injection of onabotulinumtoxin A, or Botox. Botox is a powerful neurotoxin. It works by paralyzing the bladder muscle and decreasing sensitivity to nerve fibers.
Botox injections are not for every woman. You and your doctor need to weigh the severity of your symptoms and other health conditions. For example, Botox may be a high-risk treatment option for women with dysphagia, neuromuscular disorders, and certain respiratory disorders. At this time Botox is not recommended for pregnant women. Breastfeeding women are advised to use with caution.
If you are a candidate for Botox, the injections pose some risks, including:
Postprocedural urinary retention
Urinary tract infections
Hematuria
Pain
Transient body weakness
As well as experience treating women with pelvic floor disorders, select a health care provider who has training in administering Botox injections in the bladder and pelvic floor region.
Botox injection is usually an outpatient procedure conducted under local anesthesia in a doctor’s office. However, based on your health needs, your doctor may perform it as an outpatient procedure in an operating room.
Before injecting the Botox, your doctor may perform a cystoscopy. Next, a series of Botox shots are injected in the bladder.
After the procedure, you will remain for a period of observation to check your ability to void. If you are unable to go (urinary retention), the doctor may instruct you on the use of a catheter to empty your bladder at home.
Sacral Nerve Stimulation
A neurostimulator device is attached to a lead wire and implanted under the skin. It delivers a gentle stimulation to the nerves that help control your bladder and bowel symptoms.
Treatments for Stress Urinary Incontinence
Urethral Bulking Agent (Bulkamid)
In this procedure, a long acting or permanent paste-like substance is injected into the muscular wall of the urethra using a cystoscope. This injection causes the tube of the urethral to narrow which results in less urine leakage. Although the rate of continence is less after this procedure when compared to other surgeries for stress urinary incontinence (SUI), this procedure:
Is much less invasive.
Does not require incisions.
Has a low complication rate and can be performed in an office or on an outpatient basis.
Doctors frequently recommend this procedure for women in poor health, for whom more invasive surgery or anesthesia is not safe; in women with intrinsic sphincteric deficiency; or for those women who continue to leak after other incontinence surgery.
Surgery
Doctors may suggest surgery to improve bladder control if other treatments for incontinence have failed.
Surgery helps stress urinary incontinence. The best surgical procedures improve or cure the incontinence associated with coughing, laughing, sneezing, and exercise in about 85% of women. However, the success rate for mixed incontinence, a combination of stress and urge incontinence, is lower. The reason is that current surgical procedures are not designed to treat the urge incontinence component. Treatment for the urge incontinence can be added to increase the overall success.
Experts recommend you consider surgery for urinary incontinence if:
Incontinence symptoms are bothersome.
Your doctor confirmed the diagnosis of stress incontinence using bladder testing.
Non-surgical treatments for incontinence failed to provide relief of symptoms.
The benefits of surgery are expected to be greater than the possible risks.
Talk with your doctor about the benefits, risks, after-care requirements, and long-term considerations of surgery.
Click Here To Learn About Surgery Options
Most Women Who Seek Help, Find Relief
The good news is that most women (80 to 90%) who seek help find that their symptoms improve. There is a wide array of treatment options, ranging from lifestyle and behavioral changes to surgical options. Get evaluated and review potential treatment options for your UI. The more you know, the more confident you will be in choosing the direction of treatment. With treatment, you can recover parts of your life that you may have let go. Depending upon the extent of your symptoms and treatment goals, there may be one or more options for your bladder control problem.