Ask the experts

Is Incontinence Permanent and Does it Require Surgery?

Urinary incontinence is leakage of urine you cannot control. It is a problem that can keep you from enjoying life, because you are afraid to be too far from a bathroom.

Urinary incontinence is not just a normal part of getting older. It can be managed or treated. There are many types of incontinence. Two of the most common are associated with stress urinary incontinence (SUI) and overactive bladder (OAB).

Stress urinary incontinence is leaking that occurs with coughing, laughing, jumping or exercise.

Overactive bladder is a constant “got to go” feeling sometimes associated with leaking or peeing before you get to the bathroom.

For some people, lifestyle changes may help ease your symptoms. These changes may involve:

  • Weight loss and/or limiting caffeine and alcohol
  • Retraining your bladder. The goal is to retrain your bladder to hold urine for three to four hours, with less urgency and leaking.
  • Learning to do Kegel exercises. These can often help improve your bladder control. The trick is to learn how to do Kegels the right way. A physical therapist can offer tools, like biofeedback, to teach you how to use and strengthen the right muscles.

When lifestyle changes and Kegel exercises do not help enough, your doctor may ask you to try other treatments based on your type of incontinence.

For SUI, your doctor may ask you to try an anti-incontinence pessary or a disposable vaginal device. If those are not good options for you, surgery may help. The most common surgical treatment is mid-urethral sling. This treatment helps close the urethra when you cough, sneeze, bend, lift, jump or run. This is a simple and short outpatient procedure.

For OAB, your doctor may ask you to try prescription medications. If both lifestyle changes and medicine are not working, surgery may help. One surgical option is nerve stimulation to help control bladder function. It can be done through a pacemaker-like device that is placed through surgery under the skin in the lower back area. This treatment can last several years and can also be done in short 30-minute procedures in the doctor’s office once per week for 12 weeks.

Another office based option is bladder Botox® (onabotulinumtoxinA) treatment. With this treatment, the bladder wall muscles relax, which then limits or removes the urgency-related bladder spasms, the “got to go” feeling and leaking that occurs before reaching the bathroom. The treatment needs to be repeated about twice a year.

It is always best to talk with your doctor to find the best choices for your type of incontinence. These options will vary from person to person, and there may be a trial and error period before finding the best treatment for you. Stick with it!

­­­­­Dr. Ekene Enemchukwu, a urologist at Stanford University Medical Center, focuses on management of male and female pelvic floor conditions, voiding function and urinary incontinence.

If I Have Incontinence, Should I Drink Less Water to Stop Leaking? 

It may seem like a good idea to limit what you drink when you have bladder problems such as uncomfortable urine leakage. Most people want to try anything to prevent an accident! While this may help a little, it can also cause dehydration. Drinking less water makes your urine more concentrated. Dark, concentrated urine can irritate your bladder and make urinary frequency, urgency and leaks worse. With concentrated urine, leaks smell worse too, which can be even more embarrassing.

The trick is to drink enough water to stay hydrated, but be smart about when you drink. Most people need about eight, eight-ounce cups of fluid per day. That’s about two liters. If you drink a lot more than this, you will have to go to the bathroom more often, which will also increase the chances of having an accident. You can use the color of your urine as a guide: your urine should be light yellow. If it is, that means you are well hydrated. If your urine starts to look dark golden yellow, it’s a sign you’re not drinking enough, and are pretty dehydrated. Dehydration can lead to other problems too, such as kidney stones and recurrent urinary tract infections.

Rather than cutting back on fluids, consider when and what you drink. The goal is to spread out your fluids evenly throughout the day to stay hydrated on a regular basis. Limiting fluids an hour or more before bedtime will help prevent unwanted trips to the bathroom during the night. Also, some beverages can stimulate the bladder, such as caffeine and alcohol, and can lead to more bladder problems and leaks. Water is great, but you can drink other healthy beverages too. Generally, at least half of the liquids you drink during the day should be water.

Keeping a bladder diary can help you to see where some habits might be making things harder for you. It can help you pay attention to your fluid intake and voiding pattern, and help you to see where you can make changes that can help.

Dr. Suzette E. Sutherland, the Director of Female Urology at the University of Washington Pelvic Health Center, focuses on female urology to include urinary incontinence and voiding dysfunction, pelvic prolapse and reconstructive surgery, pelvic floor disorders and female sexual dysfunction.

What is Cystitis (UTI)?

Cystitis is the name for bladder inflammation. This can happen when bacteria enters the urinary tract and leads to a urinary tract infection (UTI). Before menopause, a common risk factor for getting a UTI is sexual intercourse. This is often called “Honeymoon Cystitis”. UTIs are the type of honeymoon no one looks forward to! Sometimes after menopause women can get frequent UTIs. Kidney stones can also lead to UTIs and so can the use of catheters.

About 20-40 percent of women get recurrent UTIs. This means they get at least two UTIs in a six-month period or three in a year. Burning when passing urine is the most common sign of a problem.

In many cases, extra water is all that is needed to treat a UTI, but often times an antibiotic is needed. The key is to use the right antibiotic for your type of infection.

To stop UTIs before they start, stay well hydrated and drink plenty of fluids (at least 60 ounces of water a day!). The goal is to increase how often you are able to pass urine. Some over-the-counter supplements can help such as cranberry pills, vitamin C and d-mannose, but make sure to check with your doctor before starting a new supplement. For post-menopausal women, vaginal estrogen creams may reduce UTI risk. For pre-menopausal women, it may help to avoid spermicidal foams. In some cases, an antibiotic may be used to prevent UTIs caused by sex. Talking to your doctor about your situation can help them suggest the best course of action to prevent UTIs.

Dr. Casey G. Kowalik, a urologist at the University of Kansas Health System, focuses on female urology, pelvic medicine and reconstructive surgery.  |  FALL 2021  |  UROLOGYHEALTH extra