Regaining bladder control is possible thanks to various treatment options.
Urinary incontinence is a common experience for many women, especially after age 50, during pregnancy and after giving birth. However, there is no need to suffer through it.
“There is almost always something we can do to help improve your urinary symptoms and ultimately improve your quality of life as a result,” says Mitchell Goldenberg, MD, a urologist with USC Urology, part of Keck Medicine of USC, who sees patients at USC Verdugo Hills Hospital.
Cause of urinary incontinence in women
Dr. Goldenberg treats two types of urinary incontinence often. Urgency incontinence, often associated with overactive bladder (OAB), refers to bladder muscles squeezing when they’re not supposed to. This creates an urge to suddenly urinate. The other type, stress incontinence, is usually due to weakened or uncoordinated pelvic floor muscles. Patients may experience leakage when they cough, laugh, sneeze or exercise.
Urinary incontinence happens to women more often than men because experiences like pregnancy, childbirth and menopause directly impact the muscles that control the bladder.
Incontinence is also more likely following bladder or uterine surgery. Smoking cigarettes and obesity are also risk factors.
Urinary incontinence treatments
There is no one-size-fits-all approach to treating urinary incontinence. “I like to give my patients all the possible choices because everyone is different in how they experience and are affected by their symptoms,” Dr. Goldenberg emphasizes.
Pelvic floor physical therapy
A pelvic floor physical therapy program typically begins with a full assessment including pelvic examination by a specially trained physical therapist who evaluates the strength, flexibility and coordination of the patient’s muscles. This initial examination allows the therapist to accurately understand which muscles need to be targeted to improve the patient’s urinary symptoms.
Pelvic floor physical therapy often involves muscle-strengthening exercises such as Kegels, Pilates, stretching and yoga. Therapists may also incorporate relaxation techniques such as biofeedback and mindfulness.
Dr. Goldenberg says patients who are committed to their program may see results in two to three months. “I always tell patients they get out of it what they put into it,” he explains. “It’s like having a personal trainer at the gym. If you do the exercises only when you’re with the trainer, you probably won’t see results.”
Pelvic floor physical therapy can give people the knowledge and skills they need to effectively manage symptoms for the rest of their lives, Dr. Goldenberg adds. “Often, they can correct the underlying issues without needing more invasive treatments.”
Urinary incontinence medication
Patients with urgency incontinence may benefit significantly from medications that relax the bladder muscles, Dr. Goldenberg says. This can allow patients to urinate less often and give them more time to get to the bathroom when they feel the need.
However, he says that for patients confirmed to have stress incontinence only, he doesn’t recommend medications. “Those patients generally have issues with their pelvic floor muscles, and no medications are available to address these specific symptoms.”
Botox treatment
Patients with urgency incontinence symptoms who don’t respond adequately to oral medication, or who simply prefer another alternative, can benefit from botulinum toxin injections – Botox (onabotulinumtoxin A) being the brand approved for bladder conditions.
Botox injections are administered in the doctor’s office and usually take only a few minutes. Like other medications, Botox helps the bladder relax and can provide more immediate relief for urgency incontinence symptoms. The effects typically last for around six months before another injection is needed.
Surgery for urinary incontinence
If urinary incontinence is severely limiting a person’s daily activities, they may prefer treatments that can provide more immediate results. “Surgery should not be thought of as a last resort,” Dr. Goldenberg stresses. “Not all leakage is the same, and surgery is a choice to be considered based on each patient’s unique circumstances.”
One surgical option for patients with urgency incontinence is sacral neuromodulation, which has been shown to improve bladder control. A small device about the size of a pacemaker is implanted into the lower back. The device sends electrical pulses to the sacral nerves, which control the organs in the pelvic region.
For patients with stress incontinence symptoms, an option is urethral sling surgery. The provider inserts a sling, made of either synthetic material or the patient’s own tissue, to support the pelvic floor muscles.
A less invasive option is urethral bulking, which involves using an injection to narrow the urethra and make it harder for urine to leak out when not desired.
Finding the right urinary incontinence treatment for you
“However you view your urinary symptoms, it is important to talk to your doctor about the pros and cons of the different treatment options available,” Dr. Goldenberg says.
“Urinary incontinence is so prevalent and can have such a big impact on someone’s quality of life,” he continues. “Don’t hesitate to speak with your primary doctor, urologist or gynecologist about your symptoms and start discussing these often simple, yet highly effective, treatments.”
Author: Erin Laviola