Urinary Incontinence

Urinary incontinence, or UI, is a distressing and serious health problem. Involuntary urine leakage can cause significant quality of life issues.

It affects up to 1 in 3 women after the age of 40, and by the age of 60, 1 in 2 women have the disorder. The incidence is not limited only to older women, as it also occurs in men and people as young as 18. In fact, UI is more prevalent than hypertension, depression and diabetes, yet it is underreported. Fewer than half of all patients are willing to report their symptoms to their physicians.

At The University of Kansas Health System, we provide advanced diagnostic testing by fellowship-trained specialists to target the cause of incontinence. We offer a range of noninvasive therapies as well as surgical options to cater to each person's needs and condition.

Urinary incontinence is defined by a loss of bladder control. This can result in urine leakage, urgency and frequency that disrupts a person's life. Urinary incontinence can be an embarrassing condition that may also be associated with depression and social isolation.

The main symptom of urinary incontinence is a frequent, sudden urge to urinate – even if you've recently urinated. Leaking urine when coughing, sneezing, laughing or exercising is also very common.

Risk factors for urinary incontinence can vary depending on what type you have. However, the following may put you at risk:

• Aging. For women, menopause and hormonal changes can contribute to thinning in vaginal and urethral tissues. For men, the prostate gland can enlarge with age, leading to urinary changes.
• Being overweight. Having obesity or excessive weight may result in increased pressure on the bladder and pelvic muscles with activity.
• Cancer treatment. Urinary incontinence can be a side effect or symptom of various cancers and cancer treatments. While many leading-edge cancer treatments can reduce these side effects, some patients will need additional care for urinary incontinence.
• Changes in the anatomy of your urethra, bladder or pelvis after childbirth, menopause or prior surgery. Changes in the normal bladder and urethral support can affect the integrity of the urinary system.
• Excessive intake of fluids. High water intake, such as when dieting or trying to satiate thirst, results in overfilling the bladder causing leakage.
• Medical conditions such as COPD and lower extremity swelling.
• Medications. Some medications can weaken the muscles of the urethra causing leakage, while others may weaken the bladder itself, thus not allowing appropriate emptying. Also, some medications, such as water pills, cause your bladder to be overfilled, rapidly causing leakage in some women.
• Recurrent bladder infections and bladder wall inflammation. Recurrent infections often result in hypersensitivity of the bladder and the need for frequent emptying.
• Spine and neurological disease. Some medical conditions, such as multiple sclerosis and stroke, affect the nerves and the function of the bladder and urethra directly.
• Weakness or deficits in pelvic floor strength and support. With age and deliveries, pelvic muscles often weaken despite performing Kegel exercises.

Many physicians can conduct an initial evaluation for urinary incontinence. Your primary care physician, internal medicine doctor or gynecologist may refer you to a specialist, such as a fellowship-trained urologist or a subspecialist within their discipline for additional evaluation and treatment. At that visit, your physician will begin with a comprehensive history and assessment of your ability to urinate. You may be asked to complete a voiding diary. For women, the visit will also include a pelvic examination as well as a visual assessment of the urethral anatomy.

Occasionally, urodynamic studies and/or cystoscopy are also needed. Additional testing may be recommended only if indicated and is scheduled at a time that is convenient for you.

Once your evaluation is complete, your physician will discuss the findings with you and suggest options for your treatment plan. These options often include nonsurgical interventions as the first choice. If surgery is needed, you can see fellowship-trained surgeons who specialize in minimally invasive gynecologic or urologic surgery.

Each type of urinary incontinence is treated differently. Some require only medical treatment, whereas other types require surgical management. Incontinence also often has multiple causes. To achieve a successful outcome, each of the underlying causes must be identified and addressed in the treatment plan.

Depending on the type of incontinence, treatments may vary. We offer many noninvasive state-of-the-art procedures. Treatment options include:

Conservative treatment

• Bladder training or voiding frequency
• Fluid modification
• Lifestyle modification
• Pelvic floor rehabilitation therapy or pelvic muscle strengthening
• Drug therapy

Nonsurgical treatment

• Biofeedback techniques
• Intra-urethral plug
• Pessary
• Bladder BOTOX® injections
• Collagen injections

Surgical treatment

• Bulking injections are an endoscopic option where synthetic material is injected in the tissues at the bladder neck. This helps partially close the opening of the urethra and improve continence. This is performed through a cystoscope as an outpatient procedure.
• Minimally invasive mid-urethral slings were approved by the FDA in 2006. The appeal of this technology is that it uses a single incision, requires a shorter hospital stay and reduces postoperative pain. Male slings include the InVance™ or AdVance™ systems.
• Sacral neuromodulation is an option that requires surgical placement of a stimulator. This device is implanted near the sacral nerve and has an external control to increase or decrease the amount of stimulation and help control bladder function.
• Another option for treating stress urinary incontinence in women, introduced in the 1940s, is the pubovaginal sling, or PVS, which is placed at the bladder neck. This can utilize autologous tissue (self tissue), cadaveric tissue or xenograft (animal-based tissue) for the graft material. This is associated with high success rates and high patient satisfaction. Our fellowship-trained urologists have the most experience with the placement of PVS in the region.
• Artificial urinary sphincter (AUS) is the gold standard of intervention for male stress incontinence. It is a proven and effective treatment for mild to severe incontinence. A ring called a cuff is wrapped around the urethra to provide extra pressure to hold in urine. There is an implantable pump placed within the scrotum, under the skin, which is pumped to allow urination.
• Bladder augmentation is a surgical therapy that uses a segment of intestine to increase the size and capacity of the bladder. This also helps to reduce the pressure on the wall of the bladder, which can help to protect kidney function. This procedure is used in select patients when other forms of therapy have not been successful, or in some patients with spinal cord injuries or a history of spina bifida.

There are several specialties that treat urinary incontinence. Which team you see will depend on your specific symptoms, medical history, treatment plan and more. You may see:

• Female Pelvic Medicine and Reconstructive Surgery
• Gynecology
• Minimally Invasive Gynecologic Surgery
• Minimally Invasive Urologic Surgery
• Urology