For people living with urinary incontinence, the sudden loss of bladder control may be a nearly constant concern. This uncomfortable and potentially embarrassing condition affects more than 25 million Americans, and the severity and symptoms can vary.
In cases of stress incontinence, a cough, sneeze or burst of laughter may trigger bladder leakage. Urge incontinence, also known as overactive bladder, is an unexpected and nearly uncontrollable need to urinate immediately.
While some men develop urinary incontinence due to prostate problems, aging and other reasons, the condition is more common among women.
Pregnancy and childbirth are leading causes, because the bladder is supported by the muscles, connective tissues and ligaments of the pelvic floor. If these are weakened during pregnancy, labor and delivery, the bladder and other pelvic organs can move out of position and prolapse, or lower into the pelvis. As a result, the bladder may not function properly, which can lead to urinary incontinence and other problems, such as urinary tract infections and pelvic discomfort. In some cases, excessive weight gain or damage to nerves along the urinary tract also may contribute to bladder problems.
“Some people are embarrassed to talk about urinary incontinence with their doctors, so they suffer in silence when they could be feeling better,” says Carol Salem, MD, medical director of the Scripps Minimally Invasive Robotic Surgery Program. “Both stress and urge incontinence are common problems, and once we know what’s causing it, we have several treatment options.”
Urinary incontinence caused by weakened pelvic floor muscles may respond to physical therapy, often including targeted exercises, muscle training and biofeedback, to restore strength and function. Nutrition counseling can identify foods that make bladder symptoms worse. Medication also may help control bladder spasms.
Urge incontinence may respond to percutaneous tibial nerve stimulation (PTNS), which uses a tiny needle inserted near the tibial nerve in the lower leg to send electrical impulses to the nerves that control the bladder. Patients generally receive PTNS in a physician’s office weekly for about 12 weeks, with additional treatments scheduled as needed.
If non-surgical treatments do not provide long-term relief, minimally invasive and robot-assisted surgical options may be required to correct the cause of urinary incontinence. Robotic surgery can be especially helpful if the pelvic organs have prolapsed.
The first step in finding relief is to talk with your doctor. Most cases of urinary incontinence and other bladder conditions can be treated by a primary care physician, gynecologist or urologist. If necessary, your doctor can refer you to a specialist.