Urinary incontinence is a very common problem that affects about 1/3 of women. Some women may leak, while others may have urinary urgency or increased frequency. This frequency can occur during the day and night, where a woman’s life can be greatly disrupted by her frequent trips to the bathroom. Some women may only leak while coughing, laughing, running, jumping, or during intercourse and this is known as Stress Urinary Incontinence. Other women may experience leakage or urgency at random times throughout the day or night. This is called Urge Urinary Incontinence or overactive bladder. Some women may have a mixture of both, but there are treatment options for both types that board-certified physicians, Dr. Basinski and Dr. Juran, can utilize. The doctors will work with the patient to improve symptoms and her quality of life.
Causes of Incontinence
What Causes Stress Incontinence
In women with stress urinary incontinence, pelvic muscles and tissue have caused the bladder and urethra to relax from their normal positions. As a result, sudden abdominal pressure from coughing, sneezing, laughing or simple lifting can cause accidental loss of urine. Muscles and tissue often are weakened by the following:
- Vaginal Delivery
- Physical Activity
- Family History
- Other Medical Conditions
What Causes Urge Incontinence
Urge incontinence is caused by abnormal bladder contractions. Normally, strong muscles called sphincters control the flow of urine from the bladder. With urge incontinence, the muscles of an “overactive” bladder contract with enough force to override the sphincter muscles of the urethra, which is the tube that takes urine out of the body. The bladder may experience abnormal contractions for the following reasons:
- The bladder may not be functioning properly because its nerves are damaged by various diseases — for example, diabetes, stroke, multiple sclerosis, or Parkinson’s disease
- The spinal cord may be damaged
- The bladder may be irritated
Urethral Support Sling (Urinary Stress Incontinence)
Urethral support sling is a minimally invasive procedure that can help correct or improve urinary stress incontinence. A soft mesh is used to support the urethra. The sling functions similar to a hammock on which your urethra rests to prevent urine leakage.
Generally, placing a sling involves the following steps:
- Small incisions may be made in the vagina, the abdomen or where the top of the thigh meets your pelvic area.
- The mesh is inserted through an incision and placed under the urethra to form a cradle of support.
- The soft, mesh sling is made of a narrow slip of loosely knitted strands of polypropylene. This material is light and porous so your body tissues can grow into it to provide optimal support.
- The mesh is self-fixating and anchors itself to tissue and muscle in the space surrounding the urethra.
Axonics (Urinary Urge Incontinence & Fecal Incontinence)
Axonics is a neuromodulator therapy that regulates the nerves that control the bladder. While the Bladder Sling is typically used to treat Stress Urinary Incontinence, Axonics treats Urge Incontinence. One way to think about it is as a “pacemaker” for the bladder, to prevent your bladder from leaking or making you urinate frequently. This is a procedure typically reserved for patients who have already tried medicine to control their urinary symptoms and did not experience improvement, or were unable to tolerate the side effects of the medicine.
One of the advantages of considering Axonics is that you get a “trial run.” A thin wire attached to the Axonics device is temporarily placed near your sacral nerves and you get to go home for a few days with the device taped to your skin. You will be given a form to keep track of your urinary symptoms to see if Axonics can make a difference for you. If it improves your symptoms, you can choose to have Axonics implanted surgically. If it doesn’t help your symptoms, the temporary wire is removed and there are no long term effects. Axonics works by sending signals to the bladder through nerves that are located just below the skin in the lower back area. The bladder is an interesting organ that requires a constant signal from the brain to stay relaxed. When that signal gets disrupted, the bladder will contract uncontrollably resulting in urinary frequency and/or incontinence. Axonics works like a pacemaker for the bladder by sending a signal to the bladder to stay relaxed.
There are two steps to the Axonics procedure. The first step is the “test”. The test involves placing a tiny wire near the appropriate nerve and attaching this wire to a small stimulator worn on your belt for up to one week. This procedure should take no longer than 10-15 minutes and is performed in our office. Based on improvement from the test, patients continue on to the second step: implant. The Axonics implant is about the size of a book of matches and is implanted well beneath the skin of the upper buttock. When implanted, it provides up to seven years of continuous stimulation. Amazing results have been seen with this simple procedure. We have seen patients go from using the bathroom every hour to now going once every 3-4 hours through the day and not even getting up at night at all to use the restroom. It has been life-changing for many patients! Axonics has recently been approved for use with women who suffer from fecal incontinence. Axonics is one of the few treatments available for people who suffer from this condition. Please call us if you would like more information.
First and foremost, we will discuss your medications and eating/drinking habits. Some medications such as diuretics, which can be used to treat high blood pressure, can cause urinary symptoms. Certain things we eat or drink, including caffeine and alcohol, can cause bladder symptoms. Some women may have an infection that can cause bladder symptoms.
Sometimes medications may be necessary to treat your symptoms before resorting to surgical means. Other times you may need surgery to treat your symptoms. Physical therapy and lifestyle changes can be helpful if surgery is not desired. We will listen carefully to your symptoms before discussing your optimal treatment options with you.
You may also need a diagnostic test called “Urodynamics” to evaluate your urinary leakage. This is a test we do in the office to measure the pressure in your bladder before and after it is filled.