Nobody Should Have to Live With Bladder Leakage

Occasional urinary incontinence may be no big deal. But if you’re bothered by any degree of bladder leaking, it’s never too early to speak to a urology specialist. In most cases, we can help!

Why Do Bladder Leaks Happen?

Essentially, there are two major types of urinary incontinence:

• Urge incontinence, also known as overactive bladder, is common for both men and women. It happens when your bladder is a bit out of sync—so you have strong, sudden urges to urinate but you’re not able to hold it long enough to reach a restroom. What causes this urge are abnormal bladder contractions, meaning your bladder starts to squeeze and empty on its own before you allow it. Sometimes this can happen due to things like a urinary tract infection or consuming too much fluid, which can be easily treated. Other risk factors include menopause in women and an enlarged prostate in men, both natural parts of aging that can prompt tissue changes and weakened nerves in the pelvic floor. Other causes may be nerve-related disorders such as multiple sclerosis or Parkinson’s disease, radiation treatment for prostate cancer, or lifestyle issues like obesity and smoking.
• The other common type, especially in women, is stress incontinence. When you experience pressure to your abdomen—from laughing, coughing, lifting, even intercourse—weakened muscles that typically keep your bladder closed ease open and let urine escape. For women, the major risk factors are pregnancy and childbirth, which cause pressure that can damage nerves and tissues that support your bladder. Stress leaks are also more common in people who are overweight; who frequently strain themselves with weightlifting, chronic cough, or even constipation; or those who’ve had pelvic-area surgeries, such as a hysterectomy in women or prostatectomy in men.

How Common Is Urinary Incontinence?

It’s hard to say exactly how many Americans experience these two most common types of incontinence (and some people experience both). Recent studies suggest more than 50% of adult women and about 25% of men over age 65 have had some degree of urine leakage within the past year. That’s quite significant, and the problem tends to increase with advancing age. Yet, studies show that few incontinence sufferers ever seek treatment for it.

That’s extremely unfortunate, because there are so many highly effective ways to treat incontinence, from conservative behavior changes to more advanced devices and procedures. If one doesn’t work well enough, I always encourage people to try another.

Conservative Approaches to Bladder Leaks

Try these simple steps first.

• Dietary Changes: Cut back on bladder-irritating foods and beverages that can make incontinence worse. These include coffee, tea, spicy and acidic foods and beverages, carbonated drinks, and alcohol. Be sure to drink enough water as well, so your urine is very pale yellow. Dark, concentrated urine is another bladder irritant.
• Constipation Control: Getting into a good bowel regimen can also help to ease an overactive bladder, since constipation can put pressure on your bladder, and worsen your control. Get more fiber in your diet from fruits, vegetables, and beans or add a fiber supplement. Talk to your doctor if you’re taking prescription pain relievers, allergy medicines, antacids, or certain blood pressure medicines, as they often cause constipation. You might also consider taking an over-the-counter stool softener. A general goal: one soft bowel movement per day.
• Timed Voiding: Don’t wait until you get an uncontrollable urge before you hit the bathroom. Try to urinate every three hours, whether you feel the need or not. This can also help keep your bladder from becoming overly stretched and weakened over time.
• Bladder Muscle Exercises: Kegel exercises can strengthen the muscles that help you control your bladder. These exercises are particularly helpful for stress-caused leaks but can also help those with other types. Squeeze your pelvic floor muscles (the ones you’d use to stop urinating). Hold that squeeze for 10 seconds, then relax for 10 seconds. Repeat ten times. Perform this cycle a few times each day while you’re seated and relaxed—although not while you’re urinating. Or consider working with a physical therapist who specializes in addressing pelvic floor issues.
• Urge Suppression Technique: For people with urge incontinence, this exercise can give you time to reach the bathroom. When you feel a sudden urge to urinate, do a series of quick pelvic floor squeezes (again, the muscles you’d use to stop urinating), take a deep breath, then repeat. This exercise signals the brain to temporarily stop the involuntary bladder contractions and give you extra time to make it to the bathroom.
• A Little Weight Loss: A recent study of women found that losing just 8% of your body weight can reduce bladder leak incidents by 50%.

Bladder Control Medications

If behavioral steps don’t offer enough relief, medication is available to treat urge incontinence (overactive bladder). There are two types:

• Anticholinergics: These prescription medicines help relax your bladder by blocking receptors that make it squeeze uncontrollably. They can help reduce those sudden, urgent feelings that you need to urinate. Side effects can include dry eyes or mouth and constipation, so they’re not for everyone.
• Beta 3 Agonists: This newer category of medicines activates receptors in the bladder that help it relax and allow it to hold more urine. It can be used alone or taken with an anticholinergic medicine. Some studies suggest the combination may be more effective.

While no medicines are currently FDA-approved for stress incontinence, the following well-tested interventional therapies can dramatically improve bladder control.

Devices and Minimally Invasive Procedures

For urge incontinence:

• Percutaneous Tibial Nerve Stimulation: Similar to acupuncture, this technique involves inserting a fine needle electrode into nerves in the ankle that connect to nerves controlling the bladder. The electrode sends mild electrical impulses to the bladder that can minimize its unpredictable squeezing. Weekly sessions take about 30 minutes and continue for 12 weeks. A recent study showed that more than 70% of patients who had this low-risk therapy experienced at least 50% fewer incontinence episodes.
• Sacral Neuromodulation: This nerve stimulation technique involves placing a small pacemaker just under the skin in your hip area. The lead wire sends electrical impulses to the nerves controlling bladder contractions, helping minimize the sudden urges. Once placed, it can be set for up to five years, when battery replacement is needed. The only downside may be that you can’t undergo an MRI with the current device in place; however, a new MRI-compatible model may be available by 2021. A rechargeable version is also in the works.
• Botox®: The same substance used to paralyze your frown muscles for a younger-looking face can also calm an overactive bladder. The liquid is injected into the bladder through a small needle that we guide with a camera. The results last from three months to a year, with very few side effects. Again, patients often experience half as many urgency episodes after this treatment, although it must be repeated. A new Botox gel formulation in development for incontinence will allow us to place it directly in the bladder area without an injection—for even less discomfort.

For stress incontinence:

• Vaginal Pessary: This small device made of silicone can be inserted into a woman’s vagina to help support her pelvic organs and provide compression to help prevent stress-induced bladder leaks. It’s a simple device that can offer immediate results. The device can stay in for up to three months and be changed by your doctor, or a woman can take it in and out as frequently as they like (similar to a diaphragm). A recent review of studies found that women report high levels of success and satisfaction with the pessary, particularly if properly fitted by a healthcare specialist. It’s an excellent option for someone who is not a good surgical candidate or who only leaks occasionally, such as during exercise.
• Bulking Agents: This low-risk, quick-fix approach involves injecting a silicone or other filler material into the urethra to plump the area and help it stay closed during sneezes, lifting, exercise or other activities that cause bladder leaks. Bulking therapy works better for women than men, and may need to be repeated, since the material tends to break down within a couple of years. However, it can be a good option for older patients who may not be good candidates for surgery, or those who want quick results and don’t have time for other procedures before an event such as travel.

Surgical Approaches

• Sling: This gold standard for treating stress incontinence involves a 20-minute outpatient surgery to place a supportive sling under the urethra. Made of mesh or from tissue taken from the patient’s own abdomen or thigh, the sling acts like a firm backbone. It supports the weakened tissues and muscles that help keep the urethra closed to prevent bladder leaks. It has a 90% success rate for women and can also be used in men with stress-induced leaking.
• Artificial Urinary Sphincter: This device, currently used for men only, includes a fluid-filled cuff that hugs around the urethra to keep it closed, a small pump in the scrotum, and a fluid-filled balloon in the abdomen. When you want to urinate, you squeeze the pump to empty the fluid from the cuff that is hugging the urethra into the balloon that sits in the abdomen. The cuff stays open for a few minutes so you can urinate. Then, it automatically closes again to reseal the urethra and keep you dry. This device works very well, can stay in place for up to 10 years, and offers a high level of patient satisfaction. It’s also being tested for use in women.

What’s Ahead?

At MedStar Washington Hospital Center, we offer all the latest urinary incontinence treatments from guidance on behavioral approaches to innovative surgical techniques. We’re also involved in researching potential new treatments, including autologous derived muscle cells to treat stress incontinence in women. This involves taking some muscle tissue from the leg, growing these cells in a lab and then injecting them into the urethra to help grow additional sphincter muscle, which could improve bladder control. So far, the study shows great promise!

In the meantime, women and men have many highly effective treatments available to help relieve the most common types of incontinence. At the Hospital Center, we work with you to explore underlying causes, help you choose the right therapy, and explore another option if we don’t see results. Many patients tell me that finally treating their incontinence has been life-changing.

I encourage anyone who’s more than mildly annoyed by this common condition to make an appointment with a urologist. Incontinence is not something you have to just deal with. We can take steps to treat it and dramatically improve quality of life.