Treatments & Services

Treatment for Urinary Incontinence

Urinary Incontinence and Urinary Frequency

Bladder control problems range in type and severity with various treatment options, including behavioral changes or medical therapy. Types of bladder control issues treated by Emory Urology include:

  • Frequent urination, or the need to urinate more often than usual.
  • Urgent urination, or the sudden, intense need to urinate accompanied by discomfort in the bladder. Urinary frequency and urgency may be signs of a urinary tract infection. Other possible causes include diabetes, pregnancy, interstitial cystitis, diuretic medications, and certain neurological conditions.
  • Overactive bladder is a condition in which involuntary contractions of the bladder cause a sudden, urgent need to urinate. The urge to urinate may be difficult to suppress. Overactive bladder can lead to urinary incontinence.

Urinary incontinence is the uncontrolled leakage of urine. There are two main types of urinary incontinence, although some patients may experience a mixture:

  • Stress incontinence is the unintentional loss of urine due to increased pressure in the abdomen. Stress incontinence occurs when abdominal pressure rises due to activities like coughing, sneezing, or exercising.
  • Urge incontinence is a strong and uncontrollable urge to urinate, often caused by contractions or spasms of the bladder that lead to unintentional voiding of urine.

Causes of Urinary Incontinence

Urinary incontinence causes may include one or more of the following:

  • Injury or surgery in pelvic region
  • Childbirth
  • Weakness of muscles of urinary bladder or pelvic floor
  • Urinary tract infections
  • Blockage of urethra
  • Brain or spinal cord injuries
  • Congenital defects

You can take steps to improve urinary continence, including avoiding constipation, smoking, overuse of diuretics, antidepressants, and cold medications. Urinary incontinence may also be improved by emptying your bladder as much as possible, by practicing double-voiding (urinate, wait a few seconds, then urinate again) and retraining the bladder by scheduling voiding every 3 to 6 hours.

Factors Affecting Urinary Incontinence

Diet – Bowel and bladder functions are closely related. Part of the bowel called the rectosigmoid colon begins as a continuation of the descending colon and becomes continuous with the rectum hanging down into the pelvic cavity in the form of a loop. The rectosigmoid colon and the bladder share the same small space within the bony pelvis. When the rectum is empty, bladder function is at its best and when the rectum is loaded with stool, bladder storage and emptying functions are impaired. Good bowel function is an absolute requirement for good bladder function.

Factors that lead to constipation also tend to provoke bladder symptoms. We live in an age of fast foods, and many people may have a diet lacking in fiber. A healthy diet should include not only all of the required nutrition, but also natural sources of fiber and stool softeners. Regular bowel habits are easier to maintain when you have a regular eating schedule. The ancient physicians advocated that for a healthy bowel, one should eat breakfast like a king, eat lunch like a peasant, and dinner like a pauper. Even today, this is sound advice. In our culture, eating patterns are often erratic. We may eat a quick, small breakfast, grab a quick snack for lunch at work, and eat a big meal in the evening before retiring to bed. This is the opposite of what is required for a healthy bowel, which most benefits from activity following eating to facilitate digestion.

Exercise – Walking has been abandoned in favor of mechanical transport, with automobiles and elevators reducing our population's daily activity. However, the simple act of walking gently shakes and moves the gut, facilitating digestion. Any benefits to digestion and bowel health will further benefit bladder function.

Nerve Stimulation – Normal nerve stimulation from the brain to the bladder allows healthy, coordinated bladder emptying. Disruption of these nerves by congenital defects (e.g., spina bifida) or injuries later in life (e.g., uncontrolled diabetes, stroke) leads to bladder dysfunction. This can cause urinary incontinence, urinary retention, or sometimes the first sign is recurrent urinary tract infections.

Diagnostic Tests

Post Void Residual (PVR) – A non-invasive test using a simple ultrasound measures how much urine remains in your bladder after you have made a complete effort to urinate. This gives insight into whether your urinary leakage is due to bladder muscle spasticity or because your bladder is too full (a.k.a. “Overflow incontinence”).

Cystoscopy – Examination of the lower urinary tract with a small scope can identify scar tissue, obstructive prostate, outpouchings of the urethra, or several other conditions that can contribute to incontinence.

Urodynamics – Urodynamics investigates the physiologic behaviors of the bladder while filling, storing, and voiding urine. It measures bladder pressures, volumes, and flows to identify normal and abnormal behaviors of the bladder.

Treatment Options

Based on the type of incontinence, medical history, and sex, there are different treatment options. While incontinence principles are similar, male and female anatomy differences may contribute to other problems and different treatments.

Medical Therapies – Multiple classes of medication can be used in treating urinary incontinence depending on whether you empty your bladder or not and the underlying cause of the incontinence. Many people have significant improvement and long-term success with medical management alone.

Catheter Drainage – For patients who have leakage related to poor bladder emptying not helped by medications, mechanical drainage with a catheter is an option. In some cases, the catheter is left in place at all times, but for patients who are capable, intermittent catheterization (where a single-use catheter is inserted to drain the bladder and then removed) can provide the benefits of draining the bladder, but with lower rates of infection compared with catheters stay in at all times.

Surgical Management – Not all urinary incontinence can or should be treated surgically, but for those that can, Emory Urology offers a complete range of surgical options for urinary incontinence based on the cause of the leakage. Depending on the anatomic and physiologic cause of your incontinence, there are different treatments available.

  • Female stress incontinence and pelvic reconstruction: Incontinence in women can result from changes to the pelvic anatomy after childbirth, surgery or other causes. We have several surgeons who specialize in female pelvic reconstruction.
  • Prostate obstruction with overflow incontinence: If your urinary incontinence results from enlarged prostate causing you to not empty your bladder, you could be a candidate for either a minimally invasive or surgical treatment to remove obstructing prostate tissue.
  • Following treatment for prostate cancer: surgery, radiation, or any therapy for prostate cancer can result in urinary incontinence. There are several surgical options that can specifically benefit men with this unfortunate side effect of cancer treatment.
  • Overactive bladder and urge incontinence: if medications are not sufficient to control your overactive bladder, then you may benefit from minimally invasive procedures, including Botox injection into the bladder or different forms of nerve stimulation (InterStim sacral neuromodulation or peripheral tibial nerve stimulation).

Get Care at Emory Healthcare

Our caring team of urology experts can help you with your incontinence-related health concerns. To learn more or schedule an appointment, please call 404-778-4898, Mon–Fri 8:00 a.m.–5:00 p.m.