Urinary Incontinence

More than 11 million American women of all ages suffer from urinary incontinence. Often caused by a weakening of the pelvic floor muscles following childbirth, urinary leakage can be emotionally debilitating, yet many women suffer in silence, unaware of recent breakthroughs in correcting this and other symptoms caused by pelvic floor disorders.
The urination process

Urine is stored in the bladder until it is eliminated from the body through a tube called the urethra. Urine flow and leakage is normally controlled by sphincter muscles, which tighten and close around the neck of the bladder and urethra. When urination begins, bladder muscles contract to squeeze urine out of the bladder and sphincter muscles relax to allow the urine to pass. When urination is completed, the bladder relaxes and the sphincter contracts.

Types of incontinence

Stress incontinence
Stress incontinence is the most common form of incontinence. It occurs when the internal sphincter muscles do not close completely around the bladder neck and/or when there is a lack of support to the urethra. Activities such as running, coughing, sneezing, laughing, or lifting heavy objects apply pressure to a full bladder and cause urine to leak. Women are more prone to stress incontinence during pregnancy, after childbirth, and during menopause.

TVT/TOT Procedure for stress incontinence
Tension Free Vaginal Tape (TVT) or Transobturator Tape Surgery (TOT) is a minimally invasive surgical procedure to treat urinary stress incontinence. This type of procedure uses permanent synthetic tape to make a tiny "sling" that supports the urethra in its natural position. The sling cradles the urethra and cushions it from sudden jolts, thus controlling the loss of urine. The procedure requires just three tiny incisions and can be done on an outpatient basis, typically taking just 30 minutes. The TVT or the TOT has an 85-90% success rate.

Urge incontinence
Urge incontinence involves a strong, sudden need to urinate immediately followed by a bladder contraction, resulting in an involuntary loss of urine. Urge incontinence is basically a storage problem in which the bladder muscle contracts inappropriately. Often these contractions occur regardless of the amount of urine that is in the bladder. Urge incontinence may result from neurological injuries (such as spinal cord injury or stroke), neurological diseases (such as multiple sclerosis), infection, bladder cancer, bladder stones, bladder inflammation, or bladder outlet obstruction.
Treatment: There are several different approaches that may be used in managing and treating urge incontinence. If evidence of infection is found in urine culture, antibiotics will be prescribed. The choice of a specific treatment will depend on the severity of the symptoms and the extent that the symptoms interfere with lifestyle. There are four main approaches to treatment: medication, bladder retraining, physical therapy, and surgery.

Mixed Incontinence
Mixed incontinence is a combination of both urinary stress incontinence and urge incontinence.Treatment: The treatment of mixed incontinence will vary by patient depending on the predominant symptoms the patient is experiencing, and depending on the medical history and findings from the physical exam. Although the treatments will be similar to the treatment listed above for each type of incontinence, the treatment of mixed incontinence will be tailored to the needs of each individual patient.

Anal Incontinence
Anal Incontinence is the loss or leakage of gas or stool.
Treatment: The treatment of anal incontinence is dependent on the etiology of the disorder. Most patients may be managed using conservative treatments such as medication and pelvic floor physical therapy. Some patients may require a surgical procedure to treat this condition.

Nocturia is urinary frequency that occurs more than once during the night.