Women’s Health & Urogynecology

Female Incontinence

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Female incontinence also known as bladder leakage, is very common in women, and usually is treatable. There are different types of urinary incontinence.

Urinary incontinence, also known as bladder leakage, is very common in women, and usually is treatable. There are different types of urinary incontinence. Stress incontinence and Urge incontinence are the most common.

Stress urinary incontinence is the sudden loss of urine, with NO urge to urinate, that occurs with physical activity or movement, such as coughing, sneezing, bending over, lifting or exercise.

Urge incontinence (also called overactive bladder) is leakage of urine associated with a strong feeling of needing to urinate/urgency followed by loss of urine, often before you can make it to the bathroom.

Many women have a combination of these two conditions.

Accidental Bowel Leakage as it sounds: involuntary loss of stool. It can be related to pelvic floor damage to muscles and nerves as well as to the consistency of stool.

At Urology of Indiana, we have extensive experience in the evaluation, diagnosis and treatment of bladder and bowel control problems. To properly care for you, your provider will obtain a detailed history of your symptoms, medical and surgical history, medications, prior treatments and results. Often, a urine specimen and test to see how well you are emptying your bladder are done. A physical examination is performed focusing on your lower abdomen and pelvis focusing on anatomy, muscle strength and function.

Medical History

Obtaining your medical history provides insight into the reasons for your bladder and bowel problems. Patterns of urination, bowel movements and leakage, a history of illnesses, pelvic surgeries and a list of current medications also help to ensure an accurate diagnosis and effective treatment. Sometimes obstetric/pregnancy and gynecologic history provide important history.

Physical Exam

You will have a focused physical examination including the lower abdomen, pelvic and often rectal area. The exam is focused on anatomy, muscle and nerve function and strength. Identifying support problems that may or may not be related to your incontinence is important. You may be asked to strain/bear down or cough during part of the exam and then tighten your pelvic floor muscles to assess strength and function.

Testing

You may be asked to leave a urine specimen for urinalysis. A quick test may also be performed to see how well you are emptying your bladder either by catheter or ultrasound.

If your incontinence is complex or does not respond to conservative treatments, additional testing may be required. This can include urodynamic, endoscopic or imaging tests to obtain more extensive evaluation of the lower urinary and gastrointestinal tract to help determine an appropriate treatment plan.

Fortunately, most of urinary and bowel incontinence can be improved or cured, but it depends on the type of incontinence that is present.

Stress Urinary Incontinence (Leakage With Movement and No Urge)

This type of incontinence is related to the tube you urinate through (urethra) not closing tight enough to hold in urine.

Treatment Options Include:

  • Pelvic floor strengthening, often with a trained physical therapist
  • Devices you can wear in your vagina to help the urethra close tighter – either a pessary fit in the office or an over-the-counter device.

Effective Surgical Options:

  • Slings are considered by most to be the gold standard for stress incontinence, but they are not right for everyone. It is a common, well-studied outpatient surgery.
  • Urethral bulking agents are injected under anesthesia around the urethra. They are not as effective as a sling but not as invasive, and often a better choice for particular patients.
  • There are other less common surgical options that can be discussed involving fascia and sutures.

There is currently no FDA approved medication for stress urinary incontinence.

Urge Incontinence/Overactive Bladder (“OAB”; Leakage With Urge)

This type of leakage is not treatable with surgeries such as slings, bulking agents or lifting the bladder. Treating overactive bladder requires a comprehensive, multifaceted approach. It requires looking at fluid intake – what, how much and when is important. Drinking too much can make OAB worse. Drinking bladder irritants can make urgency worse, especially caffeine. Drinking before bed or overnight can make nighttime urination and leakage worse.

  • We assess functional issues such as mobility, memory and ease of getting to toilet.
  • We review medical history and medications that can affect OAB.
  • Maintaining a healthy weight, normal blood sugar, avoiding constipation, not smoking, timing urination to not wait too long and strategies such as bladder training and urge strategies can help.
  • A trained physical therapist can treat this as well by incorporating these strategies into a care plan.
  • Medications are commonly used. Newer medications are better tolerated and have better safety profiles than older medications.

For patients who do not tolerate medications or for whom they do not work, effective third-line therapies exist:

  • Botox injections in the bladder: Botox placed in the wall of the bladder via scope. Done in the office on average twice a year.
  • Posterior tibial nerve stimulation: Small needle inserted near the ankle to deliver gentle stimulation to nerve for 30 minutes. Done in office weekly for 12 weeks then monthly.
  • Sacral nerve stimulation: Stimulator placed surgically in butt cheek region to stimulate nerves that control bowel and bladder. Done in two stages. First stage can be done in the office or operating room. Second stage is done in operating room.
  • eCoin: Placement of nickel-sized nerve stimulator surgically under skin near the ankle. Done with local anesthesia/numbing.

You and your physician will work together to identify the treatment that is right for you.

Accidental Bowel Leakage (“ABL”)

Treatments for ABL require a comprehensive approach starting with optimizing stool consistency. This involves dietary changes and medications. We work with our Gastrointestinal colleagues when necessary.

  • Vaginal device: Fit and worn in the vagina to push on back of the vagina to help stool stay in.
  • Sacral nerve stimulation: Stimulator placed surgically in butt cheek region to stimulate nerves that control bowel and bladder. Done in two stages. Both are outpatient procedures done in the operating room approximately 2 weeks apart.
  • Anal sphincteroplasty: Surgery to fix a broken anal sphincter.