Urinary Incontinence

Urinary incontinence (losing control of your bladder and leaking urine) is a common problem. It can happen to anyone at any age. But research shows that it’s more common in older women. Urinary incontinence affects more than 40% of women over 50.

The good news is that urinary incontinence is very treatable. Overlake Medical Center & Clinics is home to a comprehensive Urogynecology and Pelvic Health Program that can help you determine what type of incontinence you have and what you can do about it.

We’ll walk you through the pros and cons of different treatment options so you can decide what sounds best for you and your lifestyle. Our goal? To help you gain control over your bladder again – and free you from the worry and inconvenience of living with unexpected or embarrassing bladder leaks.

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What are the Types of Urinary Incontinence?

There are 3 main types of urinary incontinence:

Stress Incontinence

Stress incontinence happens when there’s increased pressure (stress) in your abdominal area.

Stress incontinence can happen when you:

• Cough.
• Sneeze.
• Laugh.
• Lift something.
• Bend over.
• Step off a curb or go down stairs.
• Do activities like tennis, yoga or running.

Overactive Bladder

Overactive bladder happens when your bladder contracts – without your permission. This involuntary contraction of your bladder causes a sudden, strong urge to urinate. Sometimes the feeling is so strong that you leak urine before you can get to a bathroom.

Overactive bladder is sometimes also called urge incontinence.

Overflow Incontinence

Overflow incontinence is the opposite of overactive bladder. It happens when your bladder loses its sense of urgency. If you have overflow incontinence, you’re not able to tell when your bladder is full and needs to be emptied. So your urine flows out, involuntarily.

Sometimes, overflow incontinence is called underactive bladder.

Symptoms of Urinary Incontinence

Causes of Urinary Incontinence

Stress incontinence is caused by:

• Weakness of the pelvic ligaments, which happens as women age.
• Hormonal changes during menopause. Less estrogen can lead to pelvic tissue weakness.
• Being pregnant or having a vaginal delivery, which can stretch out pelvic tissues.
• Other risk factors that can weaken tissues, including obesity, smoking and diabetes.

Overactive Bladder is caused by:

• Aging, which is the most common cause.
• Dietary irritants like coffee or drinking too many fluids.
• Anxiety.
• Urinary tract infections.
• Inflammation or irritation.
• Bladder cancer.
• Bladder stones.
• Neurological disorders, including multiple sclerosis (MS), Parkinson’s disease, stroke, brain tumor, diabetes and spinal injury.
• Obesity.
• Weak pelvic floor.

Overflow Incontinence is caused by:

• A blockage in your bladder or urethra (the tube that carries urine out of your body).
• Weak bladder muscles.
• A nerve injury that’s affecting your bladder.
• Conditions that affect the nerves including diabetes, Parkinson disease, multiple sclerosis and spina bifida.
• Pelvic organ prolapse.

How is Urinary Incontinence Diagnosed?

Our urogynecologists will ask you a series of questions about your symptoms. They’ll also do a physical exam and may ask you to do something that causes you to leak – like coughing.

Depending on your symptoms and the type of incontinence you have, our doctors may also:

• Do a urine test to check for signs of infection or bleeding.
• Ask you to keep a “bladder diary” for a few days where you track things like how much you drink, how often you feel like you have to urinate and how many incontinence episodes you have.
• Do a series of tests that check how well your bladder and urethra work. These tests are called urodynamics.
• Order an ultrasound to get more detailed pictures of your bladder and urethra.
• Use a thin flexible tube with a camera on the end to look closely at the inside of your urinary tract. This test is called cystoscopy.

How is Urinary Incontinence Treated?

Treatment for Stress Incontinence

In some cases, changes to your day-to-day life help with stress incontinence. These changes include:

• Quitting smoking, if you smoke. This can minimize coughing and tissue damage.
• Losing weight, if you’re overweight. Research shows that losing just 5 percent of your body weight can improve urinary incontinence.
• Treating constipation, if that’s a problem for you.
• Changing up high-impact activities that lead to incontinence. For example, you might substitute Pilates for cycling or power walking.

Other treatment options for stress incontinence include:

Physical therapy

Pelvic floor physical therapy can help strengthen and improve coordination of the muscles that support your bladder and urethra. A pelvic health physical therapist can teach you exercises and techniques to correctly identify and engage these muscles, which may help reduce urine leakage.

Physical therapy may be an option if:

• You have stress urinary incontinence (SUI).
• You want to try a nonsurgical treatment.
• You need help identifying and correctly using your pelvic floor muscles.
• You're looking to improve muscle strength and coordination.

Your physical therapist will create a treatment plan based on your symptoms, muscle strength and goals. PT can be used to treat SUI and may also help prevent symptoms from developing or worsening.

Muscle strengthening

Muscle-strengthening treatments may use direct nerve stimulation to help you identify and activate your pelvic floor muscles. These devices stimulate the nerves that control the muscles, helping you learn how to contract them correctly and build strength over time.

Muscle strengthening may be an option if:

• You have difficulty identifying or activating your pelvic floor muscles.
• You need help improving muscle strength and coordination.
• You're looking for a nonsurgical treatment option.
• You want to learn techniques to better control leakage during activities such as coughing, sneezing or exercise.

Your specialist can help determine whether nerve stimulation is appropriate for you and explain how the treatment works and what to expect.

Vaginal devices

Vaginal devices provide temporary support to the urethra and can help reduce urine leakage during activities that put pressure on your bladder. Options may include an incontinence pessary, which is placed inside the vagina, or an over-the-counter device designed to provide support during specific activities.

Vaginal devices may be an option if:

• You have stress urinary incontinence during activities such as exercise, coughing or sneezing.
• You prefer a nonsurgical treatment.
• You want support that can be used temporarily or during specific activities.
• You're interested in trying a device before considering a procedure.

Your specialist can help you determine which type of device may be appropriate and how to use it safely and effectively.

Midurethral sling

A midurethral sling is a minimally invasive procedure that provides additional support to the urethra. A small strip of supportive material is placed beneath the urethra to help prevent it from moving too much when you cough, sneeze, exercise or otherwise put pressure on your bladder.

A sling may be an option if:

• You have bothersome stress urinary incontinence.
• Conservative treatments haven't provided enough improvement.
• You're looking for a durable treatment option.

Your specialist will explain the procedure, potential benefits and risks, recovery time and whether a sling is appropriate for you.

Urethral bulking

Urethral bulking is a minimally invasive treatment that uses injections to add volume around the urethra. The added support can help the urethra close more effectively and reduce urine leakage.

Bulking may be an option if:

• You prefer an injection-based treatment.
• You want a minimally invasive approach.
• A sling isn't right for you.
• You understand that repeat treatments may be needed.

The procedure is typically brief, and recovery is generally short. Your specialist can help you understand what to expect and whether urethral bulking fits your goals.

Which treatment is right for you?

There isn't one treatment that's right for everyone. Your urogynecology specialist will consider your symptoms, health, previous treatments and personal preferences when recommending an approach.

Together, you can discuss:

• How often and when you experience leakage.
• How much SUI affects your daily activities.
• Your previous treatments.
• Your goals and expectations.
• The benefits and potential risks of each procedure.
• Recovery and what to expect afterward.

Treatment for Overactive Bladder

In some cases, changes to your day-to-day life help with overactive bladder. These include:

• Bladder training, which may include stretching out how long you go between urinating or scheduling bathroom breaks.
• Avoiding foods and drinks that irritate the bladder. These include caffeinated drinks, acidic drinks like orange juice, alcohol and spicy foods. 

Other treatment options for overactive bladder include:

• Medications. For some women, prescription medications for overactive bladder work well. We can help you identify the best ones to try.
• Percutaneous Tibial Nerve Stimulation (PTNS). PTNS is a nonsurgical treatment that requires 12 weekly sessions. During PTNS, a slim acupuncture-type needle is placed near the ankle close to your tibial nerve. When this nerve is stimulated, it helps block abnormal bladder signals.
• Bladder Botox injections. Botox blocks the ability of some nerves to communicate with bladder muscles. Like Botox for the face, the effects are effective, temporary and can be repeated. A Bladder Botox injection usually lasts about eight months to a year.
• InterStim and Axonics implant devices: These FDA-approved small devices work by stimulating nerves that control bladder function. They’re placed under your skin through a minimally invasive procedure that uses a small cut (incision) in your upper buttock. Then, you use different remote-control settings to calm your nerves – and relieve the feeling of urgency.

Treatment for Overflow Incontinence

Treatment options for overflow incontinence include:

• Medications. There are several FDA-approved medications for overflow incontinence. We can help you identify the one that may work best for you.
• Catheters. Catheters are thin, flexible tubes that allow urine to drain from your bladder through your urethra.
• Percutaneous Tibial Nerve Stimulation (PTNS). PTNS is a nonsurgical treatment that requires 12 weekly sessions. During PTNS, a slim acupuncture-type needle is placed near the ankle close to your tibial nerve. When this nerve is stimulated, it helps block abnormal bladder signals.
• InterStim and Axonics implant devices. These FDA-approved small devices work by stimulating nerves that control bladder function. They’re placed under your skin through a minimally invasive procedure that uses a small cut (incision) in your upper buttock. Then, you use different remote-control settings to calm your nerves – and improve your bladder control.

At Overlake’s Urogynecology and Pelvic Health Program, we provide innovative, holistic pelvic care at any stage of life. That care may include medications, surgery and physical therapy. Our specially trained urogynecologists have years of experience helping women gain control over their bladders, feel better about themselves and their bodies, and enjoy life more. We take the time to find out what’s most important to you and tailor your treatment to what you feel most comfortable with. To make an appointment or to ask us a question, call us today at one of our three locations:

Locations

Overlake Clinics Pelvic Health Bellevue
1135 116th Ave - Suite 420
Phone: 425.635.3450

Overlake Clinics Urology Bellevue
1135 116th Ave - Suite 620
Phone: 425.454.8016

Overlake Clinics Urology Kirkland 
13126 120th Ave NE
Phone: 425.569.7250