MEDICAL MONDAYS: News Notes
Harriette Scarpero, MD: urologist
SAINT THOMAS HEALTH SERVICES
TOPIC: Overactive Bladder—What's New?
Monday, January 14, 2013
news notes via www.webmd.com
Topic Overview: Female Urinary Incontinence
Urinary incontinence is the accidental release of urine. It is not a serious health problem, but it
can be embarrassing.
The treatment you need depends on what is causing the problem. Treatment may include
exercises, a removable device to strengthen the urinary tract, medicines, or surgery.
At home, you can try going to the bathroom at set times and completely emptying your bladder
when you urinate.
If you smoke, your doctor may advise you to quit. Coughing from smoking puts more pressure on
the bladder, which can make the problem worse.
What is urinary incontinence?
Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze,
or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. Bladder control
problems are very common, especially among older adults. They usually do not cause major health
problems, but they can be embarrassing.
Incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation.
It gets better when you treat the problem that is causing it. But this topic focuses on ongoing (chronic)
There are two main kinds of chronic incontinence. Some women have both.
Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put
pressure on your bladder. It is the most common type of bladder control problem in women.
Urge incontinence happens when you have a strong need to urinate but can't reach the toilet
in time. This can happen even when your bladder is holding only a small amount of urine. Some
women may have no warning before they accidentally leak urine. Other women may leak urine
when they drink water or when they hear or touch running water. Overactive bladder is a kind of
urge incontinence. But not everyone with overactive bladder leaks urine.
Mixed incontinence is a combination of different types of bladder control problems, usually stress and
urge incontinence. These problems often occur together in older women.
What causes urinary incontinence?
Chronic bladder control problems may be caused by:
Weak muscles in the lower urinary tract.
Problems or damage either in the urinary tract or in the nerves that control urination.
Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch
the pelvic floor muscles. When these muscles cannot support your bladder properly, the bladder
drops down and pushes against the vagina. You cannot tighten the muscles that close off the
urethra. So urine may leak because of the extra pressure on the bladder when you cough,
sneeze, laugh, exercise, or do other activities.
Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may
be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or
stroke. Many times doctors don't know what causes it.
What are the symptoms?
The main symptom of urinary incontinence is the accidental release of urine.
If you have stress incontinence, you may leak a small to medium amount of urine when you cough,
sneeze, laugh, exercise, or do similar things.
If you have urge incontinence, you may feel a sudden urge to urinate and the need to urinate often. With
this type of bladder control problem, you may leak a larger amount of urine that can soak your clothes or
run down your legs.
If you have mixed incontinence, you may have symptoms of both problems.
How is urinary incontinence diagnosed?
Your doctor will ask about what and how much you drink. He or she will also ask how often and how
much you urinate and leak. It may help to keep track of these things for 3 or 4 days before you see your
Your doctor will examine you and may do some simple tests to look for the cause of your bladder control
problem. If your doctor thinks it may be caused by more than one problem, you will likely have more tests.
How is it treated?
Most bladder control problems can be improved or cured.
Treatment for stress incontinence includes:
Doing Kegel exercises to strengthen the pelvic floor muscles. It is one of the best ways to
improve stress incontinence.
Using a removable device called a pessary (which is placed inside the vagina). It can help reduce
stress incontinence by putting pressure on the urethra.
Taking medicines, but they may have bothersome side effects.
Having surgery to support the bladder or move it back to a normal position, if other treatment
For urge incontinence, your doctor may:
Suggest behavior changes to fix the problem. For example, bladder training helps you to increase
how long you can wait before you have to urinate.
Prescribe medicine to treat urge bladder problems.
If you have more than one kind of bladder control problem, first your doctor will treat the one that bothers
you the most. Then he or she will treat the other cause, if needed.
Your doctor may suggest things you can do at home, such as going to the bathroom at set times and
completely emptying your bladder when you urinate.
It may also help to cut back on caffeine drinks, such as coffee, tea, or sodas.
How can you prevent urinary incontinence?
Strengthening your pelvic muscles with Kegel exercises may lower your risk for incontinence.
If you smoke, think about quitting. Quitting may make you cough less, which may help with
Frequently Asked Questions About Female Urinary Incontinence
Is female urinary incontinence inevitable with age?
Although female urinary incontinence does occur more often in older women, you can take steps to
minimize or even avoid the problem. Maintain a normal weight -- a body mass index (BMI) of below 25 -
- since being overweight strains the pelvic floor. If you're carrying an extra 50 pounds or more, you are
at higher risk for female urinary incontinence. Cigarette smoking also raises your risk because chronic
smoking tends to lead to chronic coughs, which can also weaken pelvic floor muscles.
Don't many women "leak" a little from time to time?
You're right, many women -- young and old -- have a little leakage now and then. If it happens
infrequently, it's not a problem. But when female urinary incontinence becomes a bother to you (or
those you live with), or when it interferes with exercise, sexual intimacy, or socializing, it's time to ask
your doctor for an evaluation, and then to explore treatment options. Ignoring the problem of urinary
incontinence won't make it go away, it may only make you feel isolated or depressed. Talk to your doctor
and get help.
Can what I drink cause urinary incontinence?
There are many causes for urinary incontinence. But one may surprise you: drinking too many fluids.
Though we're all taught that drinking lots of water is healthy, overdoing it can actually lead to problems.
Unless you're an extreme athlete, keep your daily fluid intake (of all types of drinks) to about 50 or 60
ounces -- more if your exercising or in hot weather. And since caffeine increases the flow of urine from
the body and is a muscle stimulant to boot, try limiting or avoiding caffeinated drinks if you have urinary
incontinence. Be sure to talk to your doctor before any major changes in your fluid intake.
Can female urinary incontinence be cured?
In the early stages, female urinary incontinence is often reversible with simple lifestyle changes.
Talk to your doctor about reducing caffeine intake or getting off medications that may aggravate the
condition, such as some high blood pressure drugs. Certain medical procedures may help female urinary
incontinence, too. Retropubic suspension uses surgical thread to support the bladder neck, while the sling
procedure is a natural or synthetic strap to support the urethra.
Pelvic Organ Prolapse - Topic Overview
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when a pelvic organ-such as your bladder-drops (prolapses) from its normal
spot in your lower belly and pushes against the walls of your vagina. This can happen when the muscles
that hold your pelvic organs in place get weak or stretched from childbirth or surgery.
Many women will have some kind of pelvic organ prolapse. It can be uncomfortable or painful. But it isn't
usually a big health problem. It doesn't always get worse. And in some women, it can get better with time.
More than one pelvic organ can prolapse at the same time. Organs that can be involved when you have
pelvic prolapse include the: Bladder. This is the most common kind of pelvic organ prolapse, also the
Urethra, Uterus, Vagina, Small bowel, Rectum .
What causes pelvic organ prolapse?
Pelvic organ prolapse is most often linked to strain during childbirth. Normally your pelvic organs are kept
in place by the muscles and tissues in your lower belly. During childbirth these muscles can get weak or
stretched. If they don't recover, they can't support your pelvic organs.
You may also get pelvic organ prolapse if you have surgery to remove your uterus (hysterectomy).
Removing the uterus can sometimes leave other organs in the pelvis with less support.
Pelvic organ prolapse can be made worse by anything that puts pressure on your belly, such as:
Being very overweight (obesity).
A long-lasting cough.
Pelvic organ tumors.
Older women are more likely to have pelvic organ prolapse. It also tends to run in families.
What are the symptoms?
Symptoms of pelvic organ prolapse include:
Feeling pressure from pelvic organs pressing against the vaginal wall.
This is the most common symptom.
Feeling very full in your lower belly.
Feeling as if something is falling out of your vagina.
Feeling a pull or stretch in your groin area or pain in your lower back.
Releasing urine without meaning to (incontinence), or needing to urinate
Having pain in your vagina during sex.
Having problems with your bowels, such as constipation.
How is pelvic organ prolapse diagnosed?
Your doctor will ask questions about your symptoms and about any pregnancies or health problems. Your
doctor will also do a physical exam, which will include a pelvic exam.
How is it treated?
Decisions about your treatment will be based on which pelvic organs have prolapsed and how bad your
If your symptoms are mild, you may be able to do things at home to help yourself feel better. You can
relieve many of your symptoms by adopting new, healthy habits. Try special exercises (called Kegels)
that make your pelvic muscles stronger. Reach and stay at a healthy weight. Cut back on caffeine, which
acts as a diuretic and can cause you to urinate more often. Avoid lifting heavy things that put stress on
your pelvic muscles.
If you still have symptoms, your doctor may have you fitted with a device called a pessary to help with
the pain and pressure of pelvic organ prolapse. It is a removable device that you put in your vagina. It
helps hold the pelvic organs in place. But if you have a severe prolapse, you may have trouble keeping a
pessary in place.
Surgery is another treatment option for serious symptoms of pelvic organ prolapse. But you may want to
delay having surgery if you plan to have children. The strain of childbirth could cause your prolapse to
You may want to consider surgery if you have a lot of pain because of the prolapsed organ.
You have a problem with your bladder and bowels.
The prolapse makes it hard for you to enjoy sex.
Types of surgery for pelvic organ prolapse include:
Surgery to repair the tissue that supports a prolapsed organ.
Surgery to repair the tissue around your vagina.
Surgery to close the opening of your vagina.
Surgery to remove the uterus (hysterectomy).
Pelvic organ prolapse can come back after surgery. Doing Kegel exercises to make your pelvic muscles
stronger will help you recover faster from surgery. The two together can help you more than surgery