Treatments for Incontinence
You have been referred to Urology Northwest for evaluation and management of a urological condition. Your symptoms may include urinary urge (strong need to urinate with leaking or wetting), urinary urgency (feeling like you can’t get to the bathroom quickly enough), or urinary frequency (feeling like you have to go to the bathroom all the time). These symptoms are normally referred to as Overactive Bladder or OAB. If you have leakage as well, it is called urge incontinence. Stress incontinence is urinary leakage with activities such as walking, running, coughing or laughing. Having a combination of symptoms is referred to as Mixed Incontinence. You may have seen commercials on TV for a variety of medications to control these symptoms or for continence pads. You may not want to wear pads due to cost or discomfort and you may have already tried medications without success.
Our role is to perform a urological examination and develop an individualized treatment plan for you. In order to do this, we need to gather information and data about your general wellbeing, habits, life style, and medications you’re currently taking or have taken, previous treatments and surgeries.
During your 1st visit to the clinic, we’ll gather a complete history, perform a urological exam, collect some urine and obtain a Post Void Residual (PVR). The PVR tells the doctor how much urine remains in your bladder after voiding. Normal PVR is 0ml.
Sometimes, sensations of urgency and frequency indicate a urinary tract infection. This is why we do the urinalysis. A sample of your urine will be sent to a microbiology lab for analysis of the type of bacteria growing. If you have a UTI you’ll be treated first for the UTI to see if your symptoms go away or improve. You’ll receive an antibiotic that will work for the specific bacteria.
If your PVR and urinalysis are normal, the physician will evaluate the degree of your symptoms and will determine if any additional diagnostics tests are needed. Sometimes a test called Urodynamics is ordered. Urodynamics helps the physician determine what type of incontinence you have and how well your bladder is working. The doctor may want look inside your bladder using a microscope, called a cystoscopy. These additional tests allow the physician to rule out other conditions that might be causing your symptoms. Once the physician has a diagnosis, then a treatment plan can be developed. Treatment plans are based on the information gathered by the physician during the interview and evaluation process. It’s important that you respond honestly and fully to the questions.
Treatment options will vary but may include:
- Bladder Retraining: This refers to increasing the time between when you first need to void to when you do actually void. This can help if the message between the brain and bladder is out of sync and symptoms can be corrected by retraining the brain to send a message to the bladder that it can “wait”.
- Fluid Management: Sometimes symptoms are caused by the amount and type of fluids being consumed. You may be asked to limit or eliminate bladder irritants such as coffee, tea, soda pop, energy drinks or reduce the amount of fluid you’re drinking.
- Medication: If you haven’t tried anticholinergic medication you may be asked to take medication for 3 months before moving onto another treatment option.
- Pelvic Floor Rehabilitation: This is done to help strengthen the muscles that support your pelvic (bladder, uterus, vagina, rectum) organs.
- Neuromodulation: Using slim needle electrodes connected to a generator, non-painful electrical impulses are transmitted from the ankle to the sacrum (part of your low back). This helps activate your sacral nerves which control bladder function, decreasing overactive bladder symptoms. Urology Northwest offers two different treatment settings for neuromodulation: PTNS (single site stimulation) or as part of a complete acupuncture treatment.
- *Coaptite injection therapy: Coaptite® is a bulking agent used to treat stress urinary incontinence due to intrinsic detrusor deficiency.
- **Botox injection Therapy: Botox® is a prescription medication injected into the bladder muscle to treat OAB symptoms; strong need to urinate with leaking or wetting accidents (urge urinary incontinence), strong need to urinate right away (urgency) and urinating often (frequency). Botox injection therapy is used when other medications have failed.
*Both Coaptite® and Botox® therapy will require follow up appointments with your physician. Both treatment options can increase the incidence of UTIs and are not normally recommended for patients who have recurrent UTIs exceeding 2 or more in a 6 month period or are taking antibiotics on a chronic basis unless in the medical opinion of the physician the treatment outweighs the risk.
**Botox side effects may include: urinary retention requiring the patient to be able and willing to do self catheterization. It is recommended that the patient see their physician 2 – 3 weeks post-injection for a PVR, and then periodically over the next 12 weeks.
More invasive options for the treatment of OAB may include Interstim. Stress Urinary Incontinence may require a sling procedure. If the incontinence symptoms are the result of pelvic prolapse, the patient may benefit from invasive surgery known as Pelvic Organ Prolapse (POP) surgery. These surgeries can be done robotically by Karny Jacoby, MD.
Click here for a table of medications normally prescribed for OAB symptoms.