Urinary Incontinence and What to Do About It

If you’re leaking a little when sneezing or constantly feeling the sudden urge to “go,” you might be aware of the silent stigma surrounding urinary incontinence. Statements among peers such as “It’s normal,” or “Just live with it,” can become common misbeliefs. But the reality is this: facing urinary incontinence and not suffering in silence can improve a woman’s quality of life.

“Stress urinary incontinence can affect up to 35% of all women — and it doesn’t just affect older women. While it’s common, any type of urine leakage is not normal. If incontinence is bothersome to a woman’s quality of life, she should consider asking for help. There are many effective treatments available,” advises AdventHealth urogynecologist Lindsay Kissane, MD.

Dr. Kissane discusses the two most common types of urinary incontinence in women along with some effective treatment solutions.

Types of Urinary Incontinence

“One of our initial goals when we see a patient is to determine what type of urinary incontinence she has. There are two main types: stress urinary incontinence and urgency urinary incontinence,” Dr. Kissane advises.

She adds, “Stress urinary incontinence is loss of urine with activities like sneezing, walking, coughing or jumping, whereas urgency urinary incontinence is loss of urine associated with urgency to urinate.”

While the risk for urinary incontinence increases with age, both types can happen to women of any age.

Dr. Kissane lists a few additional risk factors for urinary incontinence:

• Previous pregnancy
• Vaginal birth
• Family history
• Being overweight
• Certain neurological conditions

“A risk factor specific to urgency incontinence is consuming too much caffeine,” Dr. Kissane adds.

This is because caffeine is a diuretic and can also increase bladder activity and urgency.

Diagnosing Urinary Incontinence

“At the first visit, we take an extensive medical history of each patient — this is one of the most important parts of our initial appointment. This is when I ask about specific symptoms, such as when a patient leaks, when it’s most bothersome, how often she empties her bladder and if there are any modifiable behaviors that could be contributing to her symptoms,” says Dr. Kissane.

From there, a few simple in-office tests are performed.

“Depending on the patient’s history and symptoms, we often recommend a urinalysis to rule out a bladder infection, a bedside ultrasound to determine if the bladder is emptying completely, and a pelvic exam to look for pelvic floor abnormalities as well as the strength and condition of the pelvic floor muscles,” Dr. Kissane notes.

Treatment for Urinary Incontinence

Dr. Kissane shares, “Many women think mesh procedures are the only way to treat urinary incontinence and they are scared based on what they’ve seen or heard about that, but we have a lot of safe treatment options, many of which are nonsurgical.”

She adds, “The treatment options are different based on which type of urinary incontinence the patient is dealing with. We always start with the most conservative option first.”

Pelvic Floor Exercises

For stress incontinence, pelvic floor muscle exercises with or without physical therapy can help many women reduce their symptoms. In fact, Dr. Kissane states that up to 75% of women can show improvement in leakage after pelvic floor muscle training.

She adds, “Physical therapy with pelvic floor rehabilitation can also help with urgency urinary incontinence, as strengthening and using certain muscles upon sensing the strong urge to go can help retrain the bladder.”

Dr. Kissane recommends, “For those who want to try exercises at home first, there are some great smartphone apps that can introduce and guide you through how to do Kegel exercises. This alone helps many women with both stress and urge incontinence.”

Modifying Lifestyle Factors

Dr. Kissane continues, “For urgency urinary incontinence, we first counsel women about behavioral and dietary modifications – especially caffeine intake. Many women experience a great benefit from taking out or reducing caffeine. Other things that can aggravate the bladder are alcohol and carbonated beverages, or drinking too much water. Limiting water to 60 to 80 ounces of water a day can help as well.”

Pelvic Floor Devices

Dr. Kissane shares, “After pelvic floor exercises for stress incontinence, patients might consider a pelvic floor device, also known as a pessary. A pessary is a vaginal insert that’s made of silicone. During an office visit, we “fit” the patient for a pessary that is comfortable, so that when she wears the device, she does not feel it. The pessary supports the urethra to apply compression during activities that can cause leakage. Women can take it out and put it back in themselves, or the device can be taken out at our office for proper cleaning every three months.”

Medications and Other Therapies

“If lifestyle changes and physical therapy haven’t relieved symptoms, medications can also help with urgency incontinence,” advises Dr. Kissane.

“If medications have not worked for urgency incontinence, we can move on to other therapies. One effective third-line treatment is Botox injections into the bladder muscle, which can be done in the office through a small camera while the patient is awake with minimal discomfort. This offers up to an 80% success rate and typically lasts six to 12 months.

Additionally, nerve modulation can help retrain the way the bladder and brain communicate, reducing overactive bladder and urgency incontinence. Nerve modulation can be done through an office procedure similar to acupuncture (called percutaneous nerve stimulation), or through an implantable “pacemaker” for the bladder (called sacral neuromodulation).

Surgical Solutions

Dr. Kissane comments, “There are multiple types of procedures to treat stress incontinence. The gold standard surgical treatment is the mid-urethral sling. It can be placed with a very quick procedure in outpatient surgery. 80% to 90% of women with stress incontinence report treatment success with this procedure.”

Dr. Kissane’s Message to You

“Many women tend to feel embarrassed about urinary incontinence, especially if they are younger. Knowing when to seek help may feel challenging, but if your quality of life is being impacted, consider speaking with your Ob-Gyn or primary care provider about seeing a urogynecologist. There are many effective treatment options for incontinence to get you back to enjoying your daily life without embarrassing or bothersome urinary leakage,” Dr. Kissane concludes.

Dr. Kissane is an experienced urogynecologist at AdventHealth for Women. After medical school, she completed a four-year OB/GYN residency and an additional three-year fellowship in urogynecology (Female Pelvic Medicine and Reconstructive Surgery). In her fellowship training, she solely treated women with pelvic floor disorders such as pelvic organ prolapse, fecal incontinence and urinary incontinence.

Learn more about AdventHealth for Women’s urogynecology services, or click here to make an appointment with Dr. Kissane.