Female Urinary Incontinence

Understanding the distress that 1 out of every 3 women may share

Urinary incontinence is a loss of bladder or urethral control that results in unintended leakage of urine. There are several causes for this, but it is reportedly an extremely common condition seen around the world.

Are you aware that there are effective treatment options for urinary incontinence that can improve (or may completely resolve) the symptoms?

There are several types of female urinary incontinence

• Stress Urinary Incontinence — Is caused by weakened or damaged muscles and/or tissues on the bottom of the pelvis (pelvic floor muscles). If you experience unexpected urine leakage when pressure is increased in abdomen (increased abdominal pressure) by coughing, sneezing, lifting something heavy, or laughing at a joke—you may have stress urinary incontinence.
• Urge Incontinence (overactive bladder) — Is the result of frequent contractions of muscles around the bladder due to infection, neurological injury, diseases or disorders. For example, if you feel a sudden, overwhelming urge to use the restroom even if you have just used it, and you experience urinary leakage before you reach it, urge incontinence may be the reason.
• Mixed Incontinence — If the symptoms in both types of incontinence described above apply to you, you may have mixed incontinence, a combination of stress and urge incontinence.

Information on causes and treatment methods of female urinary incontinence, especially stress urinary incontinence, is provided herein.

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Stress Urinary incontinence symptoms

Do these symptoms sound familiar?

• Accidental leakage of urine (from a few drops to the point where clothing is wetted)
• Accidents when abdominal pressure is suddenly increased, such as coughing, sneezing, laughing, bending, and/or lifting.
• Urine loss when rising from a sitting or lying position to a standing position
• Continuous bladder leakage
• You must change your lifestyle due to bladder control problems

If symptoms like those listed above sound familiar to you, you may have stress urinary incontinence. Some women may make changes to their daily lives or avoid public places due to their urinary incontinence symptoms—limiting the amount of fluids they drink, planning outings around the availability of restrooms, wearing dark clothing, and using adult pads and liners. If you are worried about your condition or you are experiencing inconvenience in your daily life dur to your symptoms, it may be time to meet with a doctor.

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Stress Urinary Incontinence Causes

Urinary incontinence is almost always the result of a change that has occurred in the body, like weakened or damaged pelvic floor muscles and tissues, or nerve damage. Some common causes of stress urinary incontinence include the following:

Pregnancy
Stretching of and strain on the body associated with pregnancy may be tied to temporarily or even permanently weakened or damaged pelvic floor muscles. When weakening or damage to the pelvic floor muscles occurs, the bladder and urethra may shift from their original positions when sudden abdominal pressure is applied, thereby making it difficult for the urethra to close tightly and causing the leakage of urine.

Childbirth
If we consider the demands placed on a woman's body during vaginal delivery, it is undeniable that there is a chance that her muscles and ligaments may be weakened or damaged. That damage may be increased by multiple births, a difficult delivery, or the birth of a large baby. Such changes may lower the bladder and urethra from their original positions and become a cause of the leakage of urine.

Aging
With age, muscle strength and tone may be lost. The changes occurring in pelvic muscles may become one of the causes of urinary incontinence.

Prior pelvic surgery, including hysterectomy
During pelvic procedures, muscles and ligaments that are required for supporting the bladder and urethra may be removed or damaged. Consequently, the bladder and urethra may move from their original positions. The urethra may then be unable to close tightly, and urine may leak.

General health-related causes
Conditions that result in loss of muscle tone or which place greater strain on the pelvic floor muscles—like chronic cough, thyroid problems, Parkinson's, Alzheimer's disease, multiple sclerosis, stroke, bladder cancer or stones, interstitial cystitis, urinary obstruction, or spinal cord injury—may lead to urinary incontinence as a result.

Obesity
While not a direct cause of urinary incontinence, added weight places greater strain on a woman's pelvic region, thereby increasing abdominal pressure and damaging supportive tissues, which may in turn cause urinary incontinence.

Trauma and radiation
Other causes of urinary incontinence may also include trauma or radiation.

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Treating Stress Urinary Incontinence

So you can live each day with self-confidence

There are several urinary incontinence treatment options available. In this website, we will describe the treatment options for stress urinary incontinence.

Non-surgical treatment methods
It is not uncommon for women who are just beginning to experience symptoms of urinary incontinence to opt for non-surgical methods as their first step. For women dealing with mild to moderate symptoms, the following methods may be effective.

• Behavior therapies — By introducing simple lifestyle changes—like making frequent visits to the restroom, drinking fewer liquids at night, and refraining from coffee and alcohol—some women are able to minimize the frequency and symptoms of their urinary incontinence. It is also recommended that women change their posture and stance, such as not crossing their legs. Moreover, it seems that there are also instances where it is possible to reduce symptoms of incontinence by eliminating obesity.
• Absorbent products like feminine napkins and, liners — Absorbent products trap leaks away from the body and clothing, while also neutralizing odors. However, even if these products enable the user to manage the symptoms of incontinence, they do not alleviate or eliminate them.
• Pelvic floor exercises — Known to many women as Kegel exercises, this is a method for strengthening the pelvic floor muscles for improved bladder and urethral control. These exervises are easy to learn and perform, and involve simply relaxing and contracting the muscles you would use to halt your flow of urine midstream. However, in order for their effects to be fully manifested, they must be done correctly, regularly, and for an adequate duration.
• Vaginal pessary — When inserted into the vagina, a pessary can provide support to the pelvic floor and help relieve stress urinary incontinence symptoms. Pessaries and other urethral inserts must be inserted by your doctor in order to ensure optimal results.
• Medications — There are prescription medications that strengthen the force with which the urethral sphincter closes or reduce the contraction strength of the bladder as therapeutic agents for stress urinary incontinence.

Minimally invasive procedures
There are several kinds of minimally invasive procedures, but here we describe the TOT procedure, which has become more and more popular around the world in recent years as a minimally invasive procedure with good treatment results. Those persons who would like more detailed information than that provided here should consult their doctor.

Some women choose to undergo the TOT procedure as their first choice when they become incontinent with SUI. The TOT procedure is a viable option for women who are not able to see good improvement with exercise or medical treatments, or who wish to choose an option other than the long-term and continuous coping/treatment methods. Please discuss with your doctor whether the TOT procedure is appropriate for your symptoms and condition.

What is TOT procedure?

The TOT procedure is usually completed within an hour. It is in fact a simple procedure that only requires three small incisions (one vaginal and two inguinal incisions).

In women with stress urinary incontinence, the pelvic muscles and tissue have been weakened by pregnancy, childbirth, trauma, radiation, prior surgery, muscle damage or hormonal changes, thereby causing the bladder and urethra to relax from their normal positions. As a result, the sudden increased pressure in abdomen from motions such as coughing, sneezing, laughing or simple lifting can cause accidental loss of urine.

The aim of the TOT procedure is to ameliorate the symptoms of stress urinary incontinence by placing inside the body a narrow strip (sling) of polypropylene mesh to cradle your urethra from the bottom. The indwelling mesh sling naturally anchors itself in the body due to the fact that the surrounding tissue gradually grows into small pores of the mesh.

BEFORE BECOMING STRESS URINARY INCONTINENT (NORMAL CONDITION)

CONDITION WITH STRESS URINARY INCONTINENCE

CONDITION AFTER TOT PROCEDURE

Cautions for TOT procedure

Although the TOT procedure is relatively simple, as with any surgical procedure, inherent risks related to the procedure exist. Choose your treatment option AFTER fully obtaining information from your doctor and understanding the risks.

The following are the general precautions related to the TOT procedure. Ask your doctor for details.

• Caution is required for women who are pregnant or planning to become pregnant. Please be sure to consult with your doctor. Depending on the case, you may not be able to undergo the TOT procedure.
• Immediately contact your doctor if dysuria, bleeding or other problems occur post-operatively.
• You should refrain from heavy lifting, sexual intercourse and exercise for a minimum of four weeks after the surgery.
• If your doctor instructs you to use catheter and/or medication, please be sure follow their instructions.

Other Treatment options

For some patients, there are cases where a treatment option other than those presented up to now may be chosen. It is important for you to fully understand the characteristics and risks of each treatment option.

• Biofeedback — Used to treat stress, urge, and mixed urinary incontinence, this therapy uses electrodes for emitting visual or auditory signals when the pelvic muscles are being contracted. Using these cues, women may learn to control muscle contractions and maintain continence. Results reportedly differ depending on the type and condition of the incontinence.
• Burch Colposuspension — This surgery elevates the urethra and bladder neck (where the bladder and urethra are connected) to a higher anatomical position than sling procedures, thereby alleviating stress urinary incontinence symptoms. The characteristics of this option are a more invasive surgery, which often necessitates a long recovery period post-operatively.
• Treatment option of Bulking injections — This procedure involves thickening the urethral lining by injecting collagen, which helps the urethra close more tightly. Although bulking agents reduce the condition of urine leakage from stress urinary incontinence, the effectiveness of the injection decreases over time as the collagen is absorbed in the body, and re-injection may be necessary after 1-2 years. The most common complications are pain during the injection, as well as a potential for transient voiding dysfunction, e.g. difficulty in urinating, after the procedure

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Precautions

No one option is suitable for all urinary incontinence patients. It is important to choose the treatment option best suited to each individual patient. Please discuss your treatment options with your doctor.

Remember — It may not be possible to recommend the TOT procedure to patients to whom the following apply:

• Are pregnant or plan to become pregnant in the future
• Have blood coagulation disorders
• Suffer from immune function impairment
• Suffer from kidney failure
• Have an upper urinary tract obstruction

It may not be easy for you to discuss your urinary incontinence. However, it may be possible to ameliorate your symptoms. There are many treatment options for urinary incontinence. If you are suffering from urinary incontinence, take the next step and consult a doctor.

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Urinary Incontinence–Frequently Asked Questions

The more you know about urinary incontinence, the easier it is to discuss it with your family, your friends, and most importantly, your doctor. Read through this series of questions and answers to gain a deeper understanding of urinary incontinence.

Questions about urinary incontinence and its symptoms

Simply click the to view answers to these questions.

• 

  Is urinary incontinence difficult to treat?

• Urinary incontinence is a common condition seen in many women around the world. Nowadays, a variety of treatment options is available for different conditions or patient preferences, and many women returned to the daily lives they had before they started experiencing incontinence. However, the wetness and odor associated with urinary incontinence could dramatically impact your quality of life. Studies have shown that incontinence is, in some cases, linked to depression, anxiety, and stigmatization as a result of the potentially embarrassing symptoms. Although urinary incontinence may not be a serious disease, it often has an adverse effect on our lives. If you are concerned about your symptoms, it may be a time to consult a doctor.

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  Isn't urinary incontinence just a natural part of aging or childbirth?

• Yes, the stresses on the body due to pregnancy and childbirth may weaken or damage your pelvic floor muscles. Likewise, muscle strength and tone may be lost due to aging. In many cases, the change in the body is one of the causes of urinary incontinence. You do not need to worry too much, but incontinence may impair your quality of life. If you have symptoms that are a source of worry, it may be a good idea to have them checked.

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  Is a surgical treatment necessary to treat incontinence?

• Symptoms and severity of urinary incontinence vary. Each patient feels differently about their condition as well. Owing to this, one cannot claim that all patients require surgical treatment, but if your symptoms have not improved after non-surgical methods such as pelvic floor exercises and/or medications, OR your symptoms worsen, it may be time to consider a surgical procedure. Talk to your doctor about your options as it is important to choose the one that is appropriate for your symptoms and condition.

• 

  If I do not undergo treatment for urinary incontinence, will it get worse over time?

• Unfortunately, there is no clear answer to this question. Some women may experience infrequent leaks initially that progress over time to a point where some treatment is necessary. Some may notice symptoms after childbirth or surgery in the pelvic area that improve as their muscle tone returns to normal.

  It is said that recording your symptoms is helpful for future treatment, whether you are just beginning to experience urinary incontinence or you've been coping with it for some time. Take notes in as much detail as possible about when you experience symptoms and how severe they are.

Questions about treatments/surgery for urinary incontinence

Simply click the to view answers to these questions.

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  What are my options other than surgery?

• Depending on the severity of your symptoms, you may be able to minimize or eliminate your urinary incontinence symptoms by making simple changes to your lifestyle. By simply planning frequent visits to the restroom, limiting your fluid intake at night, and performing pelvic floor (Kegel) exercises every day, you may begin to see some improvement. Some women use absorbent products (e.g., pads and liners) or are prescribed medications.

  There is also a method for alleviating the symptoms by using a device called a pessary. This is a silicone ring that, when inserted in the vagina, provides additional support to the pelvic floor muscles.

• 

  If the medications are not effective, what should I do?

• Treatment that is matched to your respective symptoms may be necessary, so if you have questions about the effect of your prescribed medications, please consult your doctor,.

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  If I am pregnant or plan to have children in the future, is there anything I should be careful of?

• If you are pregnant, you cannot undergo a sling procedure, for example. If you expect to have children, there is a chance that you will be advised against a sling procedure. This is because the stress placed on your pelvic floor muscles during pregnancy could offset the effects of the procedure. Discuss the incontinence treatment options with your doctor and inform him if you are pregnant or have plan to have children.

• 

  If I treat my urinary incontinence surgically, will it be painful?

• Some surgical procedures for urinary incontinence are more invasive than others. In the case of a highly invasive procedure, the recovery period is generally longer and the pain and discomfort also increase. In the case of a minimally invasive surgical sling procedure, the incisions are smaller and women can expect less discomfort and a shorter recovery period.

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  I am considering a sling procedure, but I am concerned about the surgical mesh. Will I be able to feel it inside my body? Could it ever fall out?

• Since 1965, mesh has been used extensively in surgery and implanted in millions of patients. The material allows your body's tissues to grow into the pores of the mesh, thereby anchoring it safely inside your body. Because the mesh is also light and flexible, patients are almost completely unaware of the presence of the mesh after the procedure.

  Ask your doctor about the details, such as the success rates and complications in procedures with mesh.

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  What things should I be careful of after a sling surgery?

• A sling procedure is a relatively simple surgery. However, as with any surgical procedure, inherent risks related to the procedure exist. Be sure to choose your treatment option AFTER fully obtaining information from your doctor and understanding the risks. The general cautions associated with the procedure are: you should refrain from heavy lifting, sexual intercourse and exercise for a minimum of four weeks after the surgery. In addition, immediately contact your doctor if you experience voiding difficulty, bleeding or other problems post operatively.

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