Urinary Incontinence

Urinary incontinence is the loss of bladder control, and one in three women will suffer from this pelvic floor disorder. This type of pelvic floor disorder is common and affects women across all ages. Unfortunately, many women are embarrassed and don’t discuss their symptoms, even with their doctors. 

Types of Urinary Incontinence

• Stress urinary incontinence: Urine leakage occurs during exercise, coughing, sneezing, laughing, lifting heavy objects, and/or other body movements that put pressure on the bladder. This type of incontinence is the most common and it occurs when the muscle that keeps the urethra closed during times of increased abdominal pressure isn’t functioning well and allows urine to leak.
  
  
• Urgency urinary incontinence (overactive bladder): Urine leakage is associated with an urgency to urinate. Some women feel this urge and others do not. This type of urinary incontinence occurs when the bladder contracts suddenly, often as the patient is moving toward the bathroom but before she can get there, causing urinary leakage.
  
  
• Mixed incontinence: This is a combination of stress urinary incontinence and urgency urinary incontinence.
  
  
• Functional incontinence: Urine leakage occurs in patients who may have normal bladder function and sensory cues but cannot reach a restroom in time because of physical or medical conditions that limit their ability to get to the bathroom.
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• Overflow incontinence: Urine leakage occurs when the bladder does not empty properly. As a result, the bladder stores too much urine at any given time, and some leaks out. ​

​Symptoms

Urinary incontinence is not dangerous but many women find it is embarrassing, costly and bothersome and it negatively impacts their quality of life. Most commonly, women experience symptoms related to urgency incontinence, stress incontinence, or a combination of both (mixed urinary incontinence). If you feel that your symptoms are impacting your quality of life, you should seek medical evaluation and treatment.
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Stress urinary incontinence symptoms may include:

• Leakage when you cough, laugh, or sneeze
• Leakage with physical activity such as running and jumping
  
  

Urgency urinary incontinence symptoms may include:

• Leakage associated with a strong urge to urinate, often without enough warning to get to the bathroom. In some women, these episodes occur without their noticing a strong urge. Urgency incontinence is often associated with several “triggers” including the sound of running water, cold temperatures, and the anticipation of voiding.

​Causes and Diagnoses

At your visit, your urogynecologist may:

• Ask questions about when and how often you experience incontinence
• Conduct a physical examination that can help identify other conditions that may influence your bladder, such as pelvic organ prolapse    
• Ask you to cough with a full bladder to see if you leak urine
• Ask you to keep a bladder diary, in which you would record what you drink, as well as how much and how often. You will also measure the amount you urinate
  
  

Your urogynecologist may also order diagnostic tests, including:

• Urodynamic testing to gain information about your bladder and urethra
• Urine analysis and culture to detect a urinary tract infection or any blood in your urine
• 3D ultrasound to evaluate the status of your pelvic floor muscles
• Cystoscopy to examine the inside of the bladder and urethra

Treatments 

Treatment for urinary incontinence varies depending on the cause of an individual woman’s symptoms and her goals for treatment. We offer surgical, non-surgical, and medication-based treatments options, and many women choose to pursue several complementary treatment options to alleviate their symptoms. Your specific treatment will be determined after a thorough evaluation and discussion between you and your pelvic health team of providers.

Stress Urinary Incontinence Treatment Options:

Most therapies for reducing symptoms related to stress urinary incontinence focus on compensating for the decreased function of the urethral sphincter and pelvic floor muscles.

• Lifestyle Changes
  Some lifestyle changes can help reduce symptoms of stress urinary incontinence
  • Keep your bladder empty by urinating every two to three hours
  • Maintain a healthy weight or lose weight, if overweight
  • Quit smoking: Use of tobacco doubles the risk for developing pelvic floor disorders
  • Treat constipation and avoid straining with bowel movements
    
    
• Pelvic Floor Physical Therapy
  Pelvic floor physical therapy helps rehabilitate and restore the pelvic floor muscles to their normal function. Your urogynecologist will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary. Learn about our Pelvic Floor Physical Therapy Program.
  
  
• Pessary
  A pessary is a small silicone device that is inserted into the vagina to provide slight pressure on the urethra, which helps to keep it closed. This will allow you to control leakage of urine and still be able to urinate normally when you want to. Pessaries are usually used temporarily to avoid surgery in women who have not completed their families or have medical problems that make surgery risky. Learn more about pessary therapy. 
  
  
• Urethral Bulking Agents
  Your urogynecologist may also recommend injecting a substance to help “bulk up” the inner lining of your urethra. The physician will evaluate you to determine if you are a good candidate for this procedure. There are several different types of bulking agents, and these can be administered in the office one to three times a year. Bulking agents allow you to be active immediately but will wear off after several months. This is an attractive management option for women with stress incontinence who would like a procedural option but are unable to tolerate a minimally invasive surgical procedure due to other medical problems.

• Surgery
  Surgery for urinary incontinence is intended to compensate for the weakened sphincter muscle and support around the urethra. These procedures have a high cure rate, but as with all procedures, there are also risks involved. Your urogynecologist will help you weigh the risks and benefits of the different surgical procedures and help you choose the best option for you.
  
  Commonly performed procedures include midurethral slings, pubovaginal slings, and ​retropubic colposuspension:​
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  • ​​​Midurethral sling: ​This is the most common procedure for stress incontinence because of its high cure rates and quick recovery time. A synthetic mesh (permanent medical grade plastic material called polypropylene) is placed under the urethra through a tiny incision made in the anterior vaginal wall. The sling helps to lightly support/compress the urethra during times of increased abdominal pressure (e.g., laughing, running, jumping). This procedure has been extensively studied and continues to demonstrate high efficacy with few complications and side effects. It has largely replaced more traditional surgical options for managing stress incontinence owing to its minimally invasive approach (small incision in the vagina), the ability to be performed under sedative anesthesia, and quick recovery time.

Transobturator sling

Retropubic sling  ​

• ​​Pubovaginal sling: Pubovaginal slings are similar to midurethral slings; however, instead of using synthetic material to compress the urethra, your urogynecologist uses your own strong tissue, called “fascia” to compress the urethra. In addition to the vaginal incision, this procedure requires a small incision on your abdomen. It takes longer to recover and has more risks, but it may be the best option for women with specific risk factors.​
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• Retropubic colposuspension: ​Retropubic colposuspension (or Burch procedure) uses stitches to support the urethra. It is typically done through an incision on your abdomen but can be done using laparoscopy or robotics.

Urgency Urinary Incontinence/Overactive Bladder Treatment Options: 

Most therapies that address urgency urinary incontinence focus on decreasing the abnormal contractions in the bladder that lead to urinary leakage.

• Lifestyle changes
  Some lifestyle changes can help reduce symptoms of urgency urinary incontinence, including:
  • Keep your bladder empty by urinating every two to three hours
  • Limit fluids which worsen incontinence including alcohol, caffeinated beverages, and high-sugar beverages
    
    

• Pelvic Floor Physical Therapy
  Pelvic floor physical therapy helps rehabilitate and restore the pelvic floor muscles to their normal function. Your urogynecologist will evaluate your pelvic floor muscles at your initial consultation and provide a referral if necessary. Learn about our Pelvic Floor Physical Therapy Program. 
  
  
• Medications
  Medications are especially useful for treating an overactive bladder associated with urgency urinary incontinence; however, many patients with mixed incontinence will benefit from medical therapy as well.
  
  Some medications that may help with urinary incontinence include:
  • Local vaginal estrogen: Low-dose topical application of estrogen to the vagina may help rejuvenate and tone tissues in the urethra, reducing some symptoms of urinary incontinence.
    
    
  • Anticholinergic oral medications:  Oxybutynin, Solifenacin, Fesoterodine, Tolterodine, Darifenacin, and Trospium are daily oral medications used to treat urgency incontinence or overactive bladder.
    
    
  • Beta-3-agonists: Mirabegron is an oral medication that relaxes the bladder muscle and decreases abnormal or unwanted contractions. 
    
    
• Procedures
  If lifestyle changes and medications do not adequately improve a woman’s symptoms of urgency urinary incontinence, there are several minimally invasive procedures that are low risk and effective at treating refractory (non-responsive) urgency urinary incontinence.
  
  • Sacral Neuromodulation: This is a minimally invasive procedure, which can treat both urinary and anal incontinence. A thin wire is placed through the skin in the lower back, close to the nerve that supplies the bladder. This wire is connected to a neurostimulator (similar to a pacemaker) and delivers small impulses to the nerves that control the bladder. Learn more about sacral neuromodulation. 
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  • Percutaneous Tibial Nerve Stimulation: Percutaneous tibial nerve stimulation is another way to regulate the nerves to the bladder. This procedure is less permanent than sacral neuromodulation and ideal for women who want to avoid a procedure in the operating room. Percutaneous tibial nerve stimulation utilizes a tiny acupuncture needle placed in the skin over the ankle to deliver electrical pulses to the tibial nerve. The procedure is done in the office weekly for about three months. It is painless and does not have any risks or side effects.
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  • Botox®: Injections of onabotulinum toxin A (Botox®) into the muscle in the wall of the bladder reduces urinary leakage episodes in women with urgency incontinence. Learn more about Botox injections.​​

Why Choose Us

The urogynecologists at Northwestern Medicine Women’s Integrated Pelvic Health Program (IPHP) offer individualized care, comprehensive evaluations and both conservative and surgical treatment options for women with urinary incontinence. Our urogynecologists are all fellowship-trained and board-certified specialists in the field of Urogynecology and Reconstructive Pelvic Surgery and they serve on the faculty of Northwestern University Feinberg School of Medicine.
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Our pelvic health program is nationally recognized in clinical care and research for women with urinary incontinence, and our transdisciplinary team works together to create new treatments and innovations to address each woman’s pelvic floor symptoms.

To Request an Appointment

If you're suffering from a pelvic floor disorder, you don't have to live with the symptoms. To learn about treatment options, call 312.694.7337 to schedule an appointment with one of our urogynecologists. 

CALL FOR APPOINTMENT

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YOU DON'T HAVE TO LIVE WITH URINARY INCONTINENCE

It can be embarrassing, but treatments are effective. 

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LISTEN NOW: TREATING URINARY INCONTINENCE

Dr. Teni Brown talks to WGN Radio about urinary incontinence and the surgical and non-surgical treatment options available that are customized for each patient based on their goals.

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LISTEN NOW: OVERACTIVE BLADDER MEDICATIONS AND DEMENTIA

Dr. Emi Bretschneider discusses the link between dementia and medications used to treat overactive bladder. 

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Treatment Options

Learn about common treatment options for urinary incontinence: 

• Pelvic Floor Physical Therapy
• ​Sacral Neuromodulation
• Botox®​
• ​Pessary
• Other Non-Surgical Treatments
• Other Surgical Treatments

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LEARN ABOUT URODYNAMIC TESTING

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