Urinary Incontinence – Specialized Care for Urinary Incontinence in NYC
Urinary incontinence refers to inability to control urinary flow at will resulting in urine leakage. Urinary incontinence leads to involuntary urinary leakage which can cause a number of problems including depression, urinary tract infections (UTI), skin wounds and embarrassment. Lack of bladder control leads to urinary incontinence.
What are the Causes of Urinary Incontinence?
Urinary incontinence is caused by abnormal function of the bladder muscles (urinary urge incontinence) or inadequate strength of the urethral muscles that control urination (stress urinary incontinence). Sometimes a combination of these factors causes urinary incontinence (mixed urinary incontinence)
Who Gets Urinary Incontinence?
Urinary incontinence is common across all age groups. The causes of urinary incontinence differ in younger and older men as well as in younger and older women.
Can Urinary Incontinence be Treated?
Effective treatment options are available for urinary incontinence including behavioral therapy, medical treatment is surgical treatment.
How Can Bladder Control Be Restored?
Depending on the causes of urinary incontinence, focused treatment is initiated to address the functional problems underlying bladder control problems.
Treatment Options for Urge Urinary Incontinence Offered at New York Urology Specialists
- Behavioral treatment including timed voiding, biofeedback.
- Anticholinergic agents.
- β3-adrenergic receptor agonist
- Tibial nerve neural modulation (UrgentPC)
- Sacral nerve neuromodulation (Interstim)
- Botox (onabotulinumtoxinA) injection into the detrusor muscle of the bladder.
- Multimodal Combination therapy
Types of Urinary Incontinence.
Urinary incontinence can be broadly divided into 4 major types:
- Stress urinary incontinence
- Urge urinary incontinence
- Overflow urinary incontinence.
- Mixed Urinary incontinence
Mixed urinary incontinence, usually refers to a combination of stress urinary incontinence with a component of urge urinary incontinence.
All types of urinary incontinence can occur in both men and women. Stress urinary incontinence is more common in women, but frequently occurs in men who have had prostate surgery for prostate cancer.
Urge urinary incontinence is fairly rare in younger men but more common in younger women. Urge urinary incontinence occurs more often in older men than in younger men.
Stress urinary incontinence.
Stress urinary incontinence usually occurs with increased intra-abdominal pressure as happens with cough, exercise, or after lifting heavy weights/objects. Patients usually have no problem controlling their bladder in most situations, but leak urine involuntarily during certain activities such as coughing, laughing or during exercise such as running or jumping. Stress urinary incontinence is fairly common in women, both younger and older women are often affected by incontinence. Many women have minimal stress urinary incontinence (a few drops) and normally do not require wearing a pad. Other women have significant leakage and require wearing pads, liners or diapers.
Effective treatment options for stress urinary incontinence are available.
Overflow Urinary Incontinence
Overflow urinary incontinence occurs in men and women who are actually in urinary retention, unable to urinate properly. In this situation, bladder fills to the extent that the urinary sphincter muscles cannot hold the urine back, and urinary leakage occurs. This is referred to as overflow urinary incontinence. Overflow urinary incontinence is a dangerous condition as high pressure with high volume of urine retained in the bladder prevent adequate kidney drainage and can lead to renal failure.
Urge urinary incontinence.
Urge urinary incontinence refers to situations when a patient has an urgency to urinate that occurs suddenly and without warning. Patient is unable to make it to the bathroom in time to pee. Usually urgent need to urinate occurs suddenly and often. As a result, patients with urinary incontinence are afraid to leave home, often have to carry a urinal with them to avoid embarrassing accidents. Urge urinary incontinence can also occur at night.
Urinary urge incontinence usually occurs as a result of overactive bladder (OAB), which is characterized by frequent need to urinate, urgency to urinate, and often urinary incontinence.
Treatment Options for Stress Urinary Incontinence.
Treatment of stress urinary incontinence starts with a full evaluation. Usually the 1st step is to try to build up strength in the pelvic muscles that are involved in controlling urination. Kegel exercises are effective for many women.
Behavioral and nonsurgical approaches are effective for many women with stress urinary incontinence.
Weight loss may also be beneficial for some women who are overweight and who suffer from stress urinary incontinence. Women who suffer from severe chronic cough often derive significant benefit from treatment of cough, which causes urinary incontinence.
Because leakage of urine is more likely to occur when the bladder is full, timed voiding, which may also be helpful. Timed voiding refers to planned urination every 2-3 hours even without the feeling that you need to go to the bathroom.
Pelvic floor therapy including biofeedback is useful for many women.
Common Causes of Urinary Incontinence
Urge Urinary Incontinence can be caused by detrusor overactivity or neurogenic bladder
Detrusor overactivity. Detrusor overactivity refers to overactive bladder muscle that contracts when it should not resulting in urinary urgency and urge incontinence as the patient is often unable to get to the bathroom in time to urinate. This is also commonly called “OAB” or overactive bladder.
Neurogenic bladder refers to a condition where a neurological disease causes detrusor overactivity or OAB. This is commonly seen with multiple sclerosis, spinal injury and other neurological conditions such as stroke. As a result of sudden unexpected urge to urinate, the patient is unable to make it to the bathroom and leaks.
Stress Urinary Incontinence.
Stress urinary incontinence is more common in women than in men. While stress urinary incontinence occurs in younger women as well as older women, it is more common in older women, especially among women who had multiple vaginal deliveries. Typical symptoms of stress urinary incontinence include leakage of urine with cough, leaks with exercise and with laughter. The common theme is that increased intra-abdominal pressure causes pressure on the bladder that cannot be overcome with the contraction of the urethral muscles that control urination. This leads to stress urinary incontinence.
UTI (urinary tract infections) commonly cause urinary incontinence in men and women.
Treatment Options for Stress Urinary Incontinence.
- Behavioral treatment: Weight loss if overweight, treatment of atrophic vaginitis, Kegel exercises
- Timed voiding.
- Biofeedback, Kegel exercises.
- Periurethral bulking agents.
- Temporary obstructing devices
- Surgical repair with urethral sling
- Repair of Pelvic Organ Prolapse
Mixed Urinary Incontinence:
Commonly symptoms of both stress urinary incontinence and urge urinary incontinence may coexist. This is called mixed urinary incontinence. Both components of mixed urinary incontinence (stress and urge) require treatment in order to address the underlying problems.
Mixed urinary incontinence is common in women. Mixed urinary incontinence is also common in men who underwent urethral or prostatic surgery. It also occurs in men who had radiation therapy to the pelvis for treatment of bladder cancer or prostate cancer.
Dr. Alex Shteynshlyuger is a board certified urologist in NYC who specializes in treating men and women with urinary problems including frequent urination, difficulty emptying the bladder, urinary urgency and incontinence.
We offer affordable, highest-quality urology care. We offer weekday, weekend and evening office hours.