Urinary Stress Incontinence
Urinary incontinence is a type of involuntary urine leaking that occurs when we laugh, cough or strain from activities such as exercise when the bladder is full, or without any apparent provocation. The most prevalent type of incontinence is stress urinary incontinence. While it can affect women of all ages vaginal childbirth, aging, loss of estrogen, and weight gain increase incidence. Large babies and prolonged labor during childbirth are also common causes.
Urinary stress incontinence is a symptom of a condition called Hyper Mobile Urethra wherein the angle between the urethra (tube which drains the bladder) and the bladder is changed in such way that it allows the urine to escape with any small increase in introabdominal pressure (or abdominal strain)
Urinary incontinence surgery is accomplished by the placement of a tape to support the angle between the urethra and the bladder. This procedure is called TVT- O (tension free transvaginal tape – obturator). It improves urinary stress incontinence in up to 90% of cases.
Urge urinary incontinence, another main type of bladder problems is caused by the dysfunction of the bladder muscle (detrusor instability). The bladder muscle goes into involuntary spasms and forces uncontrollable urine leaking. This conditions is also called Overactive Bladder. Anticholinergic medications are the most effective way to treat this type of urine loss. The medications are usually well tolerated; the most common side effect is dry mouth.
Other, less invasive approaches are also employed to decrease urine loss: scheduled or prompted voiding, bladder training, or pelvic muscle exercises called Kegels.
Often the cause of urine leaking is not immediately clear; the extent to which Hyper Mobile Urethra and/or detrusor instability is responsible must be determined. This is achieved through a careful history and physical examination as well as an in office test called urodynamics. Maintaining a voiding diary (recording of fluid intake, voids and leaks) for 3 days also provides data regarding the severity of the symptoms of urine loss.
If you suffer from urinary incontinence, please contact Dr. Zilberstein’s office for a consultation about a choice of solution options.