Incontinence. It’s not something we talk about at brunch or during halftime at a Boise State game, but it is something that affects many lives each and every day. Thankfully, there are things urologists can do to help.
Up to 40 percent of women and 35 percent of men experience some degree of incontinence, the accidental leakage of urine. There are many different types of incontinence. Stress urinary incontinence is leakage that happens when laughing, exercising, straining, sneezing, coughing or the like. This is more common in women than men, but it also can happen to men who have had pelvic or urological surgeries. Urgency urinary incontinence is leakage when one has the need to urinate and just can’t hold it. Mixed urinary incontinence is a combination of the two. These are the most common types of incontinence. More rarely, people will experience leakage with a change in position or while sleeping, or they will sometimes even leak constantly.
But why does incontinence happen? It depends on the person and their health history. Some risk factors are aging, pregnancy, race, obesity, smoking, diet, medical conditions such as diabetes and certain surgical procedures or radiation treatment. Many men who have undergone treatment for prostate disease will develop some leakage.
The good news is that there is help. Urologists can’t help you get your 20-year-old bladder back, but there are many treatments that can significantly reduce the leakage and improve your quality of life.
The first step is to see a urologist. He or she can help you figure out what type of incontinence you have and build a treatment plan that is specific to you.
Conservative treatments include behavioral modifications, such as changes to diet and fluid intake, exercises to increase pelvic-floor strength and medications. For men and women with stress urinary incontinence, slings can be placed beneath the urethra (the tube where urine flows from the bladder). These slings help reposition the urethra to where it was before childbirth or a prostatectomy. This helps prevent leakage during physical exertion. In women, these slings can be made of mesh or from tissue harvested from the abdomen or thigh, or from cadavers or from animals. Men also have the option of an artificial urinary sphincter, an inflatable cuff that is placed around the urethra to prevent leakage.
Urgency urinary incontinence often results from the bladder muscle contracting when you don’t want it to. There are medications available that help many people.
If the medications don’t work, one option is stimulation of the nerves that control the bladder to help prevent the muscle from squeezing. This can be achieved with either an outpatient treatment in which the nerve is stimulated with an acupuncture-like needle placed at the ankle or with a surgical procedure in which a small stimulator and wire are implanted in the lower back near the sacral nerves.
Another option is a Botox injection in the bladder. In the same way that Botox injected in the forehead relaxes the muscles of the face, an injection in the bladder relaxes the bladder muscle and prevents it from squeezing inappropriately.
These therapies can make a difference. If you’re having issues, seek out a urologist to discuss your options. We can help.
Dr. Lisa Parrillo is a reconstructive urologist who recently joined Idaho Urologic Institute. Parrillo is a graduate of Pomona College in Claremont, Calif., and attended medical school at Eastern Virginia Medical School in Norfolk, Va. She completed her urology residency at University of Pennsylvania in Philadelphia and went on to complete a fellowship in Genitourinary Reconstructive Surgery at the University of Colorado. Parrillo is a member of the American Urological Association who sees both male and female patients. She also participates in research studies at Idaho Urologic Institute. Find more information at idurology.com.
Learn more online
Learn more about incontinence and other urological conditions at the Urology Care Foundation website at urologyhealth.org.