Urinary incontinence – types, causes and treatment

What is urinary incontinence

Accidental and, of course, unwanted leakage of urine. This disorder mainly affects women and significantly reduces the quality of life. However, the modern science may help to get rid of the urinary incontinence and regain self-confidence. 

Sneezing, coughing, laughing, exercising – all this makes your bladder release small drops. There are different types of urinary incontinence, but they are all unpleasant and definitely hinder enjoying your life. And since the incontinence affects 51.1% of women and 13.9% of men, it can be surely called one of the most common female disorders.

Types of urinary incontinence in women

Stress incontinence

Caused by the pressure on the bladder: coughing, laughing, sneezing or working out.

Urge (urgency) incontinence

Also called overactive bladder (OAB). It is a sudden urge to urinate you cannot control. No matter when you last visited the restroom, the need to urinate may arise even if the bladder is not full. Most often occurs in women after menopause.

Functional

Caused by the physical or mental barriers that prevent you from going to the restroom in time or preparing to urinate. For example, a person simply forgets that she wants to pee due to dementia or Alzheimer’s disease. Or just fails to undo buttons or get to that WC because of severe arthritis or Parkinson’s disease. There are also neurological problems, such as a stroke or spinal cord injury, which also interfere with the timely emptying of the bladder. 

Mixed incontinence

When the above types are combined.

Causes

As I mentioned, in the case of imperative incontinence, the cause is hyperactive bladder muscles. Functional incontinence is also understandable. But stress incontinence is usually the result of weakening or damage to the muscles that control urination, namely the pelvic floor muscles and the urethral sphincter.

There are many reasons why there is a weakening or vice versa – excessive muscle activity.

Causes of muscle weakening

Physical damage to the pelvic floor muscles, including traumatic vaginal delivery;
Menopause: with age and a decrease in estrogen production, muscles lose tone;
Excessive pressure on the abdominal area – due to pregnancy or obesity. Or due to chronic constipation. Therefore, it is so important to treat constipation in women, especially in adolescent girls, ASAP;
Surgical interventions, including removal of the uterus (hysterectomy) or prostate gland.

Causes of muscle hyperactivity

Cystitis;
Urinary tract infections, including sexually transmitted infections, bladder or kidney infections;
Kidney stones;
Nerve damage, in particular due to stroke or multiple sclerosis;
Constipation: the rectum is located near the bladder and has many of the same nerves. Hard, compacted feces in the rectum cause these nerves to become overactive and increase the frequency of urination.

Risk factors

Some circumstances don’t depend on you. That includes age, gender, diseases such as diabetes, or family history. But you can change certain points, increasing your chances of urinary incontinence.

Smoking
Obesity
Alcohol 
Drinks containing caffeine
Carbonated drinks
Artificial sweeteners
Chocolate
Chili pepper
Foods with a high content of spices, sugar or acid, especially citrus fruits
Certain medications: especially diuretics, antihypertensive drugs, sleeping pills, sedatives and muscle relaxants
Large doses of vitamin C

Symptoms of urinary incontinence

Depending on the type of urinary incontinence, you may experience the following symptoms:

Small “pee” after physical pressure: sneezing, coughing, laughing, during exercise or lifting weights
You feel the urge to go to the bathroom, even if you have just urinated
Sometimes the urge is sudden and so strong that you do not have time to get to the WC
It is difficult for you to start urinating, it stops in the process, and you cannot resume it, although you feel that you have not yet emptied yourself

Complications

Problems with the skin. Constant moisture in the intimate area can cause rashes, skin infections and even ulcers;
Incontinence increases the risk of repeated urinary tract infections;
Quality of life. The constant fear of not having time to go to the bathroom negatively affects our social life: increases anxiety, reduces self-confidence and may even lead to depression;
Kidney damage. Difficulties with urine flow can lead to kidney inflammation – pyelonephritis.

That is why it is crucial to consult a specialist with this problem.

Therapy of the urinary incontinence

When it comes to functional incontinence, the main thing is to treat the underlying disease. If it’s not possible, for example, in the case of Alzheimer’s or Parkinson’s disease, or other incurable neurological conditions, the solution is to alleviate the symptoms and use barrier products, i.e. urological pads or special absorbing underwear.

In other cases, fortunately, modern science offers many ways to get rid of this pathology. Certain methods will also help to ease the symptoms of functional incontinence.

Platelet-Rich Plasma (PRP) therapy

One of the most contemporary treatments for urinary incontinence is platelet-rich plasma (PRP) therapy. Thanks to new technology, plasma containing an increased number of platelets is separated from your venous blood. Then it is injected into the damaged spot – in case of incontinence, it is the vagina in the urethra area, narrowing its tissues and restoring the body’s own natural collagen, thanks to the incredible effect of platelet growth factors. This restores the natural muscle tone in this area and, accordingly, the control over urination.

Bonus: plasma therapy rejuvenates the vulva and vagina. I’m not fond of the word “rejuvenate”, but here we are.

In my Lior Medical Center, we use the Swiss Regen Lab system. It is the centrifuge and test tubes of this system that allow you to get a whole and intact platelet. The unique technology, confirmed by clinical studies, allows not only heal urinary incontinence, but to rejuvenate the skin, treat inflammation, alopecia, orthopedic and gynecological problems.

Basically, platelet-rich plasma therapy is the least invasive and safest way to get rid of urinary incontinence if the problem is already significantly affecting your life. If you are experiencing the initial symptoms, you may consider the following self-help options. 

Non-surgical treatments

Lifestyle improvement;
Lose weight: losing just 5% of your weight improves the situation;
Stop drinking alcohol, caffeinated and carbonated drinks, spicy foods, chocolate and sweets – anything that irritates the bladder;
Kegel exercises for the pelvic floor, which, by the way, help men with this problem as well;
Quit smoking;
Do not lift heavy things – I know, our women can do everything, but even if you are going to lift this heavy package, do it right – strain the pelvic floor muscles and lift heavy things from bent knees, not from bent back;
Treat constipation – this is mainly about eating foods that contain fiber, as well as responding to the urge to defecate immediately;
Drink more water: foremost, it helps to avoid constipation, and secondly, if you avoid water because of incontinence, it reduces the volume of your bladder, which on the contrary provokes incontinence.

Pharmaceutic treatment

Your doctor – and your doctor only – can choose medications that will help relieve your symptoms. However, they all have contraindications and side effects.

Surgery

Sling procedure

This method helps to return the urethra and bladder neck to the correct anatomical position.

The doctor makes one small surgical incision in your vagina. Another small incision is made just above the pubic hairline or in the groin. Most procedures are performed through an incision inside the vagina.

The doctor creates a sling of tissue that is threaded under the urethra and bladder neck and attached to the strong tissues in your lower abdomen, or simply left in place for your body to repair and incorporate into your tissues.

The most common complication after this surgery is difficulty emptying completely when urinating.

The tension-free vaginal tape (TVT)

An artificial (synthetic) material known as mesh is inserted behind the bladder to support it. It stays in your body permanently.

This procedure has numerous complications, so it is prescribed only if there are no alternatives and surely after a detailed discussion with your doctor.

Colposuspension

Cutting the lower abdomen, lifting the bladder neck and stitching it in this raised position.

There are two types of this procedure:

Open colposuspension – the surgery is performed through a large incision
Laparoscopic colposuspension – the surgery is performed through one or more tiny incisions using small surgical instruments

Both types offer effective long-term treatment for stress urinary incontinence. However, only an experienced surgeon must perform such a surgery.

Bladder bulking injection

Bulking agents are injected into the walls of the bladder to help close the sphincter. The goal of a bladder bulking injection is to help patients gain control over their urine flow. Your doctor should prescribe the right bulking agent, since there is no evidence that one is better than another.

Bulking agents are usually injected through a cystoscope (thin camera) to the bladder.

This method is less invasive since incisions are not required, but it’s less effective than the other procedures. In half of the cases, women do not benefit from injections. Besides, the effect decreases over time, and you may need a second injection.

Artificial urinary sphincter (AUS)

This is an artificial ring that controls the flow of urine from the bladder into the urethra. It is mainly used for men, but sometimes this method is also recommended for women. Nonetheless, this method requires really outstanding skills from the surgeon, as well as his/her awareness of modern methods of installing an artificial sphincter than those practiced for men since the 70s of the last century.

Electrical stimulation

Using special devices, the doctor sends a mild electric current to nerves in muscles that are involved in urination. It may be the sacral nerve (sacral neuromodulation), which improves the transmission of signals from the brain to the muscles that envelop the bladder and reduces the urge to urinate. The procedure is quite painful, but some patients report significant release, or complete cessation of urinary incontinence. Tibial nerve stimulation procedure requires several sessions (up to 12) and is recommended if other methods have failed.

Catheters

This method is used if you cannot control urine leakage at all. A special catheter is inserted into the urethra from time to time or permanently to drain urine.

Augmentation Cystoplasty (Bladder Augmentation)

The uncommon method, which means that your bladder is enlarged by adding a piece of intestinal tissue to the bladder wall. Since normal urination is usually not possible after this procedure, it is recommended if you are ready to use a catheter.

Risks of surgery

Damage to adjacent organs;
Decomposition of synthetic materials;
Changes in the vagina (vaginal prolapse);
Damage to the urethra, bladder or vagina;
Abnormal passage (fistula) between the bladder or urethra and the vagina;
Irritated bladder that causes more frequent need to urinate;
Difficulty emptying the bladder and the need to use a catheter;
Worsening of urine leakage.

Whatever treatment you choose, remember that only a doctor can help you get rid of this unpleasant but definitely curable problem. It is a good specialist who will be able to choose the therapy that is right for you. And do not forget about prevention!

You can learn more about your health and body from my courses: A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com.

You can always find your doctor at the Lior Medical Center.