Female urinary incontinence: The bladder is responsible for storing adequate volumes of urine at low pressure and emptying completely on command. During strenuous activity, the urethra is responsible for remaining closed and preventing leakage. Urinary incontinence (or leakage) may occur under several conditions and as a result of a number of causes.
Stress urinary incontinence (SUI) refers to the loss of urine during strenuous activity or activities that increase abdominal pressure, such as coughing, sneezing, laughing or lifting heavy objects. There are two main causes of stress incontinence that may occur separately, or they may occur simultaneously.
Urethral hypermobility (UH) is an anatomic condition where the bladder neck and urethra descend or sag out of the pelvis and into the opening of the vagina. When the pressure in the abdomen pushes the bladder neck into the introitus of the vagina, the increased pressure on the bladder causes urine to be pushed through the sphincter muscle. If the bladder neck and urethra are well supported inside the pelvic area, then the increase in pressure on the bladder is also applied to the urethra and therefore the sphincter is able to resist leakage. If the sphincter is particularly strong, prolapse may occur without associated leakage.
Intrinsic sphincter deficiency (ISD) is a functional condition where the bladder neck is not firmly closed. During periods of increased pressure in the abdomen, the weakened sphincter muscle is easily overcome, resulting in urinary leakage. The bladder neck and urethra may be well supported, but significant ISD can result in leakage anyway. It is common to have some degree of ISD-related stress incontinence at the same time as urethral hypermobility.
Urge incontinence (UI) is a functional bladder condition also known as an unstable bladder. During urge incontinence, the bladder is trying to contract resulting in a strong urgency to void. This urge to void can be so strong that the bladder simply contracts and pushes urine through the urethra even when voiding is not intended. The sound of running water or the anticipation of being able to void are common causes of urgency. Urgency can also occur in the case of ISD or SUI when a small amount of urine leaks into the bladder and causes a strong urge to void or even urge incontinence.
Overflow incontinence occurs when the bladder does not completely empty and remains somewhat overdistended. In this situation, incontinence occurs when the overdistended bladder contracts and pushes urine out, but cannot empty adequately. Leakage or voiding stops despite a large amount of residual urine remains in the bladder. This condition is most common in people with advanced diabetes or prolapse of the bladder out of the vagina.
What can be done about urinary incontinence? At the Northern Institute of Urology, Dr. Harris can complete the evaluation of incontinence in one or two visits. We recommend women keep a voiding diary (a record of the date, time and volume of voiding, as well as associated events or symptoms) and bring it to the initial consultation can generally diagnose the problem during the initial visit. If the problem is functional and not anatomic, medical or physical therapy is often effective. Pelvic floor muscle biofeedback is often successful in managing urge incontinence and mild to moderate ISD (see pelvic muscle exercises). In the case of anatomic causes, surgery is highly effective with very little risk or recovery time. Dr. Harris maintains the state of the art management of urinary incontinence.
Cystoscopic collagen implantation is a short outpatient procedure that essentially bulks up the bladder neck sphincter to treat ISD. In women who have undergone a prior suspension procedure and remain well supported, but SUI persists, a collagen implant will often successfully manage residual ISD. While collagen implantation can last up to and sometimes over 3 years, it can be easily repeated, as necessary. See Dr. Harriss collagen implant outcomes data for results.
Sling procedures are the most effective management of urethral hypermobility, and in some cases, ISD. There are literally dozens of permutations of the sling procedure. Dr. Harris maintains a large database of sling procedure results as part of his outcomes research. By analyzing clinical results and published literature from other centers of excellence, the techniques used in Dr. Harriss sling surgery are modified to provide the best possible results. Review Dr. Harriss pubovaginal sling outcomes data for results.