Urinary Incontinence

Urinary Incontinence is the uncontrollable loss of urine. There are a number of different kinds of urinary incontinence. The more common types of urinary incontinence include:

  • Genuine stress incontinence (GSI) is loss of urine when you cough, sneeze, jump, laugh, lift, or run. GSI is caused by decreased support for the bladder and urethra (the tube that leads out from the bladder). This is a form of pelvic prolapse.  Usually only drops of urine are lost with GSI. Factors that increase the likelihood of genuine stress incontinence may include: previous pregnancy with labor and delivery, obesity, chronic coughing, heavy lifting, frequent straining, or estrogen (hormonal) deficiency.
  • Intrinsic sphincter deficiency (ISD) is loss of urine frequently in situations similar to those that cause GSI (laugh, cough, sneeze, etc). ISD is a result of a deficient bladder sphincter. In most cases, the urethra tube leading from the bladder is more shaped like a funnel than a straight tube. Usually the loss of urine is a flood with ISD rather than the drops that are lost with USI.
  • Detrusor instability or urge incontinence (DI) is loss of urine when you feel the need to urinate but cannot make it to the bathroom or if you lose urine when you are in bed. DI is caused by irritability of the bladder muscle (detrusor). This is also called an overactive bladder.  Common bladder irritants include:
    • Alcoholic beverages
    • Cranberries and cranberry juice
    • Apples and apple juice
    • Grapes and grape juice
    • Cantaloupe
    • Pineapple and pineapple juice
    • Carbonated beverages
    • Strawberries
    • Chili and spicy foods Tea (except caffeine-free herbal)
    • Citrus fruits and juices
    • Tomatoes and tomato juice
    • Chocolate Vinegar
    • Coffee (including decaf)
  • Other factors that may aggravate urinary incontinence include:
    • increased urine output with excess fluid intake or taking “water pills”
    • primary urinary tract problems including infection and tumor (bladder tumors are unusual)
    • certain medications you may be taking
    • immobility such as with severe arthritis.

Many patients suffer from more than one type of urinary incontinence at the same time. Each type of urinary incontinence must be approached individually. A test called urodynamics helps determine the type or types of incontinence.

Treatment of urinary incontinence depends on the cause or causes.

  • General recommendations include:
    • work towards a healthy weight
    • avoid unnecessary heavy lifting
    • reduce coughing by treating asthma and stopping smoking
  • Avoid bladder irritants. Some patients with an irritable bladder (DI) will benefit from medication to treat this condition.
  • Void (urinate) at regular intervals (every 2 ½ – 3 hours) whether you feel the need to go to the bathroom or not. It is not healthy to hold your urine for long periods of time.
  • Correct estrogen deficiency. Discuss this with your physician.
  • Medication may be helpful. There are a number of medications available to treat bladder irritability. Discuss this with your physician.
  • Kegel’s exercises can sometimes improve urinary incontinence. While you are urinating, contract the muscle to stop the flow of urine. This is a Kegel. Once you feel comfortable that you know which muscle to contract, contract the muscle 5 times after you have emptied your bladder. Do this (5 times) each time after you have emptied your bladder. As this becomes easier, increase the number of contractions to 10 times. Also, hold the contractions longer and harder. Like any exercise, Kegel’s must be done regularly to be effective. After 2-3 months, many patients notice significant improvement in the loss of urine, especially when it is due to lack of support of the bladder and urethra.
  • Biofeedback is a painless exercise done in many bladder (continence) centers across the country.  Biofeedback assists in re-training the bladder by teaching you which muscles to contract and which muscles not to contract – this help improve bladder control.
  • Surgical Treatment. Some forms of incontinence including GSI and ISD may require surgery to correct or improve the problem.
    • The Burch procedure is now frequently performed laparoscopicallyIt is one of the procedures to correct genuine stress incontinence (GSI or dropped bladder) and sometimes is helpful with intrinsic sphincter deficiency (ISD). In many cases it has been replaced by the sling.
    • The suburethral sling for urethral suspension is indicated to treat ISC and is used in many cases to treat genuine stress incontinence.
    • Collagen injection is sometimes used to treat ISD. Its biggest drawback is that it frequently needs to be repeated every year.
    • Botox injection into the bladder may be helpful in some cases of urge incontinence (detrusor instability or irritable bladder).

InterStim® is a surgical treatment for the overactive bladder that does not respond to less invasive treatments.  A nerve stimulator is surgically implanted to stimulate the bladder and muscles related to urinary function.  Your physician can discuss this procedure if it is appropriate for you.

The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

 Advanced Healthcare for Women
5354 Reynolds Street, Suite 518
Candler Professional Building
Savannah, Georgia 31405
Telephone 912-355-7717
Fax 912-355-0979