In Females there are three major types of incontinence:
- Urgency Incontinence-Can’t get to the bathroom in time.
- Stress Incontinence-Leakage associated with activity, cough or sneeze.
- ISD (Intrinsic sphincter deficiency)-Leakage that “just happens” while sitting or by standing or walking.
Urgency incontinence occurs when a person has the urge to urinate but doesn’t have the time to get to the restroom. This is a severe manifestation of overactive bladder and can be seen with interstitial cystitis. This an issue that is managed in a very similar fashion to OAB and IC.
- Diet-Some patients are sensitive to what they eat or drink. In general acid foods or drink make the symptoms of urgency worse. Awareness of this and keeping a bladder diary can allow a patient to identify his or her “triggers” to the symptoms of urgency. ICA elimination diet for interstitial cystitis.
- Physical therapy to help recognize and strengthen the external sphincter with Kegel exercises is sometimes of benefit.
- Medications are the main stay of therapy for urgency and urgency incontinence. These drugs either allow the bladder to relax and hold more urine or prevent the bladder from contracting. Our staff is well versed in the use of the medicines for urgency incontinence.
- Neuromodulation therapy is considered when conservative measures and medicines do not work. There are two forms of this type of therapy and our physicians are experienced in providing both.
Christie Woodruff N.P. works with our female incontinence patients to assure the most effective treatment modality is used specific to the incontinent patient. A CMG is often times done to help classify the type of incontinence in order to better direct therapy. Christie performed our first Percutaneous Tibal Nerve Stimulation (PTNS) for incontinence in February of 2013. This form of neuromodulation is increasingly being used as a non drug/non surgical treatment for overactive bladder and incontinence. We are pleased to offer this innovative form of incontinence therapy for our patients. The PTNS method is done in the office as a series of treatments and the Interstim consists of a trial and then full insertion if it results in improvement in the patient’s symptoms.
The most common cause of stress incontinence in females is a hypermobile urethra. With activity the urethra moves and in turn promotes the loss of urine. This is the type of incontinence that occurs with coughing, laughing, getting in or out of a car and sneezing.
- This type of incontinence is not usually responsive to oral medicines used for urgency incontinence.
- Stress incontinence requires surgery and the most common procedure done is the tension free mid urethral sling. This sling is very successful in the management of stress incontinence and is not the type of sling you hear about with erosions and lawsuits.
- Slings usually take less than an hour to perform, the procedure is out-patient and patients usually wear a catheter a day or less.
- This procedure is commonly performed in the Northeast Georgia Urological Surgery Center.
Intrinsic Sphincter Deficiency (ISD)
Sometimes the problem is an incompetent sphincter mechanism at the bladder neck. This is referred to as Intrinsic Sphincter Deficiency and is more difficult to correct. The use of urethral slings and bulking agents are in the surgical armamentarium of the urologist to correct these issues.
- Historically this type of incontinence was referred to the patient having a “lead pipe” urethra. In other words, the tone of the urethra and bladder neck keeping urine from leaking out is absent. A patient stands or walks and urine leaks out with gravity.
- This is not helped with medication.
- The most common treatment is using bulking agents to close the bladder neck in attempt to obstruct the leakage of urine.
- This procedure requires no incision and can be repeated but the results vary. It can be used with or without a mid urethral sling.
- Coaptite bulking agent implantation for ISD is commonly performed at the Northeast Georgia Urological Surgery Center.
Christie Discusses Incontinence on the Radio-A Podcast
The physicians and staff of Northeast Georgia Urological Associates are very experienced in all forms of incontinence as well the medical and surgical management of these disorders. Please contact us for an appointment.