February 07, 2022

What is incontinence and how do we treat it?

Do you suffer from incontinence – the lack of voluntary control over urination or defecation? Would you like to know the different options available to treat this condition?

Konstantin Walmsley, M.D., urologist at Hackensack Meridian Mountainside Medical Center, answers questions about good bladder health and the many effective ways to treat incontinence.

Q. What does our bladder do and how does it work?

A. The bladder basically has 2 different functions: filling/storage and emptying. As our bladder fills, it expands. A normal adult bladder typically stores between 300 cc and 500 cc (1.25-2 cups) of fluid. When the bladder reaches its full capacity, it sends a message to our brain along the spinal cord, which in turns sends signals down to the nerves in our pelvis. These signals instruct the urethral sphincter muscle to relax and the bladder muscle to contract. This results in urination.

Q. What are the main types of incontinence? What causes them?

A. There are 2 main types of urinary incontinence:

1. Urgency Urinary Incontinence (UUI) – Leakage due to urgency, that sudden, compelling desire to urinate.

The causes of UUI tend to relate to a syndrome of overactive bladder (OAB) which includes:

  • Symptoms of urinary urgency

  • Frequency (going more than 8 times in a 24 hour period)

  • Nocturia (waking up at night)

UUI can also be caused by constipation and obesity, but if treated effectively, these instances of UUI can be reversed.

About 2/3 of men with an enlarged prostate will have symptoms of OAB and occasionally will have UUI. UUI is also seen in patients with underlying neurological disorders such as stroke or Parkinson’s disease. However, the vast majority of patients with UUI have no identifiable, underlying cause for their condition.

2. Stress Urinary Incontinence (SUI) – Leakage caused by sneezing or laughing.

SUI is caused by weakness of the sphincter muscle. When found in women, it is most commonly seen in the context of childbirth. With men, the most common cause of SUI are complications from prostate surgery.

Q. How does incontinence affect a patient’s life?

A. Incontinence has been shown in multiple validated studies to severely affect someone’s quality of life. These patients often avoid social gatherings, have a higher likelihood of urinary tract infections (UTI) and genital skin irritation and have a higher likelihood of clinical depression.

Q. What are the recommended non-surgical treatments for these conditions?

A. Although there are many medications that can treat UUI, there are no FDA-approved drugs that are effective in the treatment of SUI.

The therapies most often used first are behavioral modifications and pelvic floor physical therapy.

Behavioral modifications include:

  • Avoiding bladder irritants (caffeine, carbonation, alcohol, and spicy/acidic foods)
  • Timed voiding
  • Limiting fluids in the evening before bedtime.

Pelvic floor physical therapy involves strengthening the Kegel muscles with the assistance of a specially-trained physical therapist. We have a pelvic floor PT at Mountainside who is excellent.

Q. What are the recommended surgical treatments for these conditions?

A. UUI can be surgically addressed with Botox and neuromodulation techniques. Botox treatments typically last an average of 6 months. Neuromodulation can be offered peripherally or via the sacral nerve.

Peripheral neuromodulation involves the placement of an acupuncture-type needle in a nerve in the ankle. Sacral neuromodulation involves the permanent placement of a very small electrode into the spine where the bladder nerves receive signals from the brain. The electrical stimulation provided by the wire leads toward a change in the nervous innervation of the bladder, resulting in significant decreases in urinary urgency, frequency, nocturia and UUI.

SUI can be treated with surgical procedures such as bulking procedures and slings. Suburethral sling surgery continues to be the gold standard technique, as it provides long-lasting effectiveness. Bulking procedures have recently become more popular with the introduction of a new bulking agent that is more durable and more effective.

Q. How do you decide whether or not a patient qualifies for a certain type of treatment?

A. I take an individualized approach to each patient, but tend to favor starting therapy with conservative approaches such as pelvic floor PT and behavioral therapies. In my experience, sharing the decision making with the patient is always the best approach. Educating patients about each treatment is imperative towards achieving excellent clinical results.

Q. Do you recommend pelvic floor therapy?

A. Yes, absolutely.

Q. Do you have any advice for those who experience bladder leakage and may be embarrassed or hesitant to seek help?

A. Don’t be afraid or embarrassed to ask for help. You are not alone. There are millions of people unnecessarily suffering in silence with incontinence. The diaper and incontinence pad industry is a multi-billion dollar/year business, which reflects how common this problem is. Step forward and talk to your doctor. There are so many different solutions to this problem. Help is just around the corner!


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