Overactive Bladder and Urinary Incontinence

Did you know urinary incontinence is more common than asthma? Urinary incontinence, or involuntary leakage of urine, can be associated with having an overactive bladder (OAB) or weak pelvic floor. It affects up to 75 percent of the female population and 3 to 11 percent of the male population. Urinary incontinence generally becomes more prevalent with age, so you might think "this is part of the aging process" or "my bladder is just getting older." While this is true, you do not have to suffer with the symptoms of an aging bladder. 

Different types of urinary incontinence

There are two main categories of urinary incontinence. Stress incontinence is when urine escapes during some sort of physical exertion like laughing, coughing or exercise. Urge incontinence is leakage of urine with a strong urge to urinate—this is the typical case of having the sudden urge to go to the bathroom and urine escaping before you get to the toilet.

Does urinary incontinence only happen in women?

More women than men experience urinary incontinence. The most common type of incontinence in men is urge incontinence, accounting for about 80 percent of cases. In men, stress incontinence can occur and may happen after prostate surgery, trauma or neurologic damage. Stress incontinence in women is often associated with the weakening of the pelvic floor related to prior pregnancies. With both women and men, the incidence increases with age.

How are urgency urinary incontinence and overactive bladder treated?

Treatment for urinary incontinence varies depending on the type of incontinence. The important thing to know is that overactive bladder and urge incontinence often improve with behavior modifications, lifestyle changes, changes in your diet, and pelvic floor exercises. 

Before beginning a treatment plan, your primary care provider or urologist will want to rule out a few important things. They need to make sure there is no infection in the urine, as an underlying bladder infection can be the cause of new urine leakage, urinary frequency and urgency. They will also check for the presence of blood in the urine, as this may warrant a workup before starting any overactive bladder treatments.

Treatment options for urgency urinary incontinence and overactive bladder

Treatment choices include a range of non-invasive and conservative approaches as well as minimally invasive procedures. 

• Bladder training - The first option for all patients is bladder training. Bladder training involves both psychologic and physical exercises to retrain the brain-bladder connection. We also recommend all patients with incontinence consider barrier protections such as pads, absorbable undergarments and barrier creams to prevent skin irritation.
• Behavioral therapies and exercise - In addition to bladder training, there are behavioral therapies and exercises that can improve urinary symptoms. Limiting consumption of caffeinated beverages and sodas as well as stopping fluid intake two to four hours before bedtime may improve both daytime and nighttime urinary symptoms. You can also consider working with a pelvic floor physical therapist to learn how to strengthen muscles that prevent leakage. A bladder or voiding diary is a great tool that helps you track your urinary symptoms over a few days as you make changes in your lifestyle.
• Medication and procedures - If symptoms persist after trying more conservative measures, there are several FDA-approved medications and procedures available. In the last ten years, we have seen the emergence of new, safe and effective once-daily bladder medications that significantly improved overactive bladder symptoms. If medication is not effective or you prefer a longer-lasting option without a daily medication, there are a few procedure options available:
  • Botox, commonly known for cosmetic uses, is also an effective FDA-approved treatment for overactive bladder. This is an in-office procedure in which a small amount of Botox is injected directly into the bladder wall. The effect can last six to 12 months, providing significant relief for many patients. 
  • Sacral neuromodulation is another treatment for overactive bladder and urinary incontinence. First, a percutaneous nerve evaluation (PNE) is conducted. At the urologist's office, a small temporary wire is placed near the nerve in the lower back and tested for a few days. If the nerve evaluation is deemed successful, a small device similar to a pacemaker can be implanted just under the skin of the buttock to provide continuous stimulation of the nerves. These devices, which are inserted in an operating room while the patient is under sedation, can last up to 20 years. 
  • Another, less invasive option that also works by nerve stimulation is called percutaneous tibial nerve stimulation (PTNS). This is an acupuncture-type treatment that involves placing a thin needle at the inside of the ankle and connecting it to a small electrical current to stimulate the tibial nerve, which runs through the ankle and shares origins with the bladder nerves. Treatment sessions are done once weekly for 30 minutes for a 12-week period. If successful, the patient can move to monthly maintenance sessions.

There are plenty of options for managing and treating urge urinary incontinence and overactive bladder that don't require planning your life around bathroom locations, highway rest stops and changes of underwear. Take note of your symptoms, and talk with your healthcare provider or one of the specialists at the Minimally Invasive Urology Institute about your concerns.