Managing Urinary Frequency

Help for Urinary Incontinence is Available

We all want to laugh as much as possible, right? Maybe not if you’re dealing with urinary incontinence, a form of bladder weakness that prompts urine leakage while you’re doing everyday things such as coughing, sneezing, lifting heavy items, exercising or even erupting in laughter. Women are mainly affected by stress incontinence.

Overactive bladder — when the bladder is triggered to release at the wrong time, sometimes resulting in embarrassing leaks — is another common form of urinary incontinence, affecting about 10% of American adults and millions of people worldwide. If you need to visit the bathroom eight or more times a day and wake up at least twice at night to use the bathroom, you likely have overactive bladder. For people with overactive bladder, it may seem your frequent need to use the toilet is running (or ruining) your life. But there’s hope — and help. Experts at Inova explain conditions that contribute to stress urinary incontinence, overactive bladder and measures necessary to take back control.

Q: What causes overactive bladder?
Normally, urinating is a pretty straightforward process: As our bladder starts to fill, nerve signals to the brain tell us to use the bathroom, and the pelvic floor again relaxes when we are done. Overactive bladder happens when the bladder’s muscles start to tighten outside of normal urination.  This may happen when there isn’t a lot of urine in the bladder, according to Lauren Scott, MD, a urogynecologist board-certified in female pelvic medicine, reconstructive surgery, and obstetrics and gynecology. While a specific cause might never be found, certain conditions or factors can contribute to symptoms. These include:

• Diabetes
• Neurological disorders such as stroke or multiple sclerosis
• Medications that trigger a quick rise in urine production or require lots of fluids
• Too much caffeine or alcohol
• Bladder abnormalities such as bladder stones or tumors
• In men, an enlarged prostate gland
• Aging  

Q: What causes stress incontinence?
With stress incontinence, activities or movements such as coughing, sneezing and lifting place greater pressure on the bladder. When the abdominal pressure exceeds bladder pressures, urinary incontinence ensues.

A number of things can contribute to stress incontinence. For instance, it can result from weak muscles in the pelvic floor or a weak sphincter muscle at the neck of the bladder. A problem with the way the sphincter muscle opens and closes can also result in stress incontinence. Chronic coughing, smoking and obesity may also lead to stress urinary incontinence.

Things that can cause stress incontinence in women include:

• Pregnancy
• Vaginal childbirth
• Menstruation
• Menopause
• Problems with muscles in the bladder or the urethra
• Weakened muscles around the bladder

Q: When is it time to see a doctor?
Many people with stress urinary incontinence or overactive bladder wait much longer than necessary before even considering talking to their doctor about it. Very often shame and embarrassment keep them from getting help, causing them to stay home more and avoid activities they would otherwise enjoy. In general, it is never late too to see a board certified urogynecologist to address what may seem minor to the patient. Do not wait until symptoms cause major disruption in your everyday life and possibly contribute to problems such as anxiety, depression, disturbed sleep and sexual issues. A thorough medical exam along with special tests can point the way toward a treatment strategy that gets you back to doing all your favorite things.           

Q: How are bladder leakage issues treated?  
Dr. S. Abbas Shobeiri, vice chair of Gynecology at the Inova Women’s Hospital, states that for stress incontinence, a combination of pelvic floor physical therapy after evaluation of pelvic floor muscles is effective. For overactive bladder, a combination of lifestyle changes, medications, nerve stimulation and other medical treatments spell relief. Severe cases are sometimes treated with Botox injections into the bladder, nerve stimulation implants or surgery.

General lifestyle tactics include:

• Kegel exercises: These pelvic floor exercises can strengthen muscles in both the pelvis and urethra, helping stem any leaks. A doctor or physical therapist can teach the technique.
• Scheduled toilet trips: Using the toilet at the same time every day, such as every two to four hours, can help train your bladder. You also can add small delays in heading to the bathroom when you feel the urge.
• Weight control: Losing excess pounds means less stress on the bladder, especially if you have stress-related incontinence.

These days, clinicians are paying greater attention to pelvic floor disorders such as urinary incontinence, vaginal prolapse and perineal injury in labor in women, disorders that often have their origins in childbirth and its weakening effects on the pelvic floor. Inova Urogynecology provides treatment options for patients dealing with different types of pelvic floor disorders. Women have many options for overcoming debilitating and sometimes embarrassing conditions.

For more information about urogynecology care or to schedule an appointment, call 571.419.5645.