Urinary incontinence is defined as the involuntary loss of urine (i.e. leaking urine when one is not urinating). An estimated 24 percent, or 17 million women in the United States are coping with urinary incontinence. While not a life-threatening health problem, it can be annoying, embarrassing, and a source of emotional distress that keeps women from fully enjoying their lives. The Berger Department of Urology has board-certified experts with vast experience in the diagnosis and treatment of urinary incontinence.

• Stress incontinence describes the loss of urine associated with ‘stress’ placed on the bladder and pelvic floor muscles such as exercise, coughing, laughing, sneezing and/or sexual intercourse.
  
• Urge incontinence describes the loss of urine with a sudden desire to void that cannot be restrained. Fluid intake, spicy foods, infection, and/or any irritant in the bladder (i.e. stone, polyp) may initiate this.
• Mixed incontinence incorporates aspects of both stress and urge as described above.
• Overflow incontinence is seen in patients that have poorly contractile bladders (i.e. Diabetes, Neurologic disoders) or bladder outlet obstruction (BPH, urethral stricture, prolapse bladder/uterus)

Diagnosis
After a complete history and physical, there are many tests that are used to diagnose the type of incontinence, and how to treat it. These tests include:

• Urine studies can be used to determine underlying conditions such as infections, hematuria, diabetes, or cancer.
• Uroflow involves urinating into a computerized commode to determine the volume, speed and method of urinating.
• Urodynamics documents bladder function and incontinence by using a computer to assess bladder activity while it is being filled and while one is urinating.
• Cystoscopy to evaluate the bladder walls for possible polyps, stones or chronic infection.

Treatment
Treatments for urinary incontinence will depend on the cause of the incontinence, severity of the condition and patient preference. Treatment options include:

• Medications, such as anticholinergics (Ditropan, Detrol, Enablex) to calm overactive bladders
• Estrogen replacement therapy to help maintain the strength of supportive pelvic tissues
• Behavioral therapies and lifestyle changes, such as losing weight, eating high-fiber foods, and smoking cessation programs
• Bladder training, in which the patient makes an effort to control when they urinate
• Physical therapy, such as Kegel exercises, to help strengthen pelvic floor muscles
• Vaginal inserts and pessaries, which are devices placed in the vagina to prevent leaking or support the bladder
• Minimally invasive surgery—A new, minimally invasive procedure for urinary incontinence, vastly different from past surgical techniques, offers a more effective and less painful treatment option for this condition.

Known as a urinary incontinence sling, or urethral support sling, the surgery requires only small incisions in the vagina through which Beth Israel surgeons place soft, flexible surgical mesh to cradle the urethra and restore it to its normal anatomical position. The body’s tissue grows around and into the mesh, keeping it in place and reinforcing the urethra. The procedure is done on an outpatient basis or with a one night hospital stay.

In clinical research, this surgery has been shown to be 90 percent effective in treating stress urinary incontinence. In fact, many women regain complete bladder control within hours after surgery. The small incisions reduce pain, speed recovery time, leave no visible scarring, and most patients return to normal, non-strenuous activities quickly.

For a referral to an expert Beth Israel urologist in Manhattan or Brooklyn for treatment of urinary incontinence, call our Physician Referral Service at 1-877-484-3466.