Urinary Incontinence and Overactive Bladder

What is stress incontinence?

Stress incontinence occurs when physical activities, such as coughing, sneezing, laughing, or exercising, put pressure on the bladder, causing urine leaks. Due to weakened pelvic muscles, this condition is more common in women, especially after childbirth or menopause. Stress incontinence can also occur in men, particularly after prostate surgery.

Symptoms of stress incontinence

Symptoms of stress urinary incontinence include involuntary urine leakage during activities that increase abdominal pressure. Simple tasks like jumping or running can exacerbate this issue for many women, while men may experience it when lifting heavy objects.

How is stress incontinence diagnosed?

Diagnosing stress incontinence begins with understanding your medical history and symptoms. The healthcare providers on our team often perform the following physical exam: we will ask you to cough or bear down so we can check for urine leakage. We can also conduct advanced urodynamic testing using a catheter to assess bladder function and confirm the diagnosis if necessary.

Treatment options for stress incontinence

Treatment for stress incontinence can be conservative or surgical.

• Physical therapy: A pelvic floor physical therapist can teach specific exercises (Kegel exercises). Kegel exercises focus on pelvic floor rehabilitation because they can help improve the tone of your pelvic floor muscles and sphincter control. Biofeedback, which uses sensors to monitor physiological changes on a screen, is often used to ensure you are using the proper technique.
• Urethral bulking agents: In-office procedures, such as Bulkamid injections, help your urethral muscles contract more tightly. It reduces leakage and is a minimally invasive treatment. It takes only a few minutes under local anesthesia and has no downtime. During the procedure, we look inside your bladder with a small scope connected to a camera. Through the scope, we inject the Bulkamid into your urethra to help it contract. There are few side effects or risks associated with Bulkamid, and no activity restrictions after the procedure. You can immediately return to your everyday life without the risk of urine leakage.
• Sling procedures: For more severe cases, surgical intervention may involve inserting a mesh or fascia sling to support your urethra. The pelvic surgery sling procedure is performed in the operating room and typically takes 15 to 20 minutes to complete. A small piece of mesh is surgically inserted underneath your urethra to support it and act as a backboard so that urine does not leak when you move around. You can go home on the same day, but you must avoid heavy lifting or strenuous activity for about a month. When performed correctly by an FPMRS-trained specialist, the sling procedure carries a low risk of side effects or complications. It is also durable and effective.

What is an overactive bladder?

Overactive bladder (OAB) is a type of incontinence where your bladder contracts uncontrollably. It causes frequent urination, a strong urge to urinate, or urine leaks. It differs from stress incontinence in that OAB does not require physical activity, such as running or coughing, to trigger symptoms of an overactive bladder. Both men and women can experience OAB, although women may be more susceptible due to hormonal changes and pelvic anatomy.

Symptoms of overactive bladder

OAB is characterized by a sudden, intense urge to urinate, frequent bathroom trips, and sometimes nocturia (waking up at night to urinate). These symptoms can interfere with sleep and daily activities.

Diagnosing overactive bladder at Tower Urology

Our diagnostic process includes a detailed medical history, a bladder diary to track symptoms and fluid intake, and urodynamic testing to assess bladder function and identify underlying causes.

Risk factors for overactive bladder

Several factors can contribute to OAB, including age, hormonal imbalances, neurological conditions like multiple sclerosis or spinal cord injuries, and lifestyle factors such as high caffeine or alcohol consumption. Chronic conditions, such as diabetes or recurrent urinary tract infections (UTIs), also increase the risk.

Treatment options for overactive bladder

Treating OAB involves lifestyle adjustments, medications, and, if necessary, non-surgical medical interventions, including:

Lifestyle changes

Dietary modifications, such as avoiding caffeine, alcohol, and acidic foods, can reduce symptoms. Bladder training techniques and pelvic floor exercises guided by a physical therapist may also improve bladder control.

Medication Options

• Anticholinergic drugs: These medications, such as oxybutynin or tolterodine, calm the bladder muscles but may cause side effects like dry mouth.
• Beta-3 adrenergic agonists: Mirabegron relaxes bladder muscles with fewer side effects, making it a suitable option for many patients.

Procedural options

If medications are ineffective or unsuitable, Tower Urology offers several minimally invasive procedures:

• Bladder Botox: Botox injections reduce bladder spasms, improving symptoms for up to six months with little to no side effects. The procedure takes approximately 10 minutes and can be performed in either the office or the operating room.
• Sacral neuromodulation: This “bladder pacemaker” regulates nerve signals to the bladder, helping to reduce urgency and frequency. A small electrode stimulates the nerves that feed your bladder. The electrode is connected to a small battery implanted in your upper buttock. The benefit of this option is that it includes a trial period, so if it doesn’t work for you, you don’t have to continue with the full implant.
• Percutaneous tibial nerve stimulation (PTNS): PTNS involves electrical stimulation through an acupuncture-like needle inserted into your ankle to target your bladder nerves, ultimately improving control. It takes about 30 minutes and is done over 12 sessions. After that, periodic maintenance sessions can be performed in the office about once a month.
• Tibial nerve stimulator implant: This option is similar to sacral neuromodulation, but the device is implanted in your ankle instead. This option provides long-term symptom relief. A bracelet is worn around the implant for 30 minutes daily to receive the stimulation needed to control your bladder symptoms.