Urinary Incontinence

There are two types of urinary incontinence: stress and urge. While the former is caused by weakness of the bladder sphincter, and manifests with urinary leakage during increased intra-abdominal pressure (such as with cough, sneeze, laughter, physical activities, etc.), the latter is caused by involuntary contractions of the bladder muscle, and usually manifests with urinary frequency and urgency, night-time urination, and urinary leakage associated with a strong urge.

Both types of urinary incontinence may have a substantial detrimental effect on women's well-being and quality of life, and may even cause depression, lowered self-esteem, social isolation, as well as professional and sexual dysfunction.

Urinary incontinence is more common in women than in men, and its prevalence increases with age. About one in every three women over the age of forty suffers from urinary incontinence. Some women suffer from a combination of stress and urge urinary incontinence, a condition known as mixed incontinence. This condition is associated with the most detrimental effect on women's quality of life.

One of the most important causes of stress urinary incontinence (SUI) is damage to the bladder sphincter inflicted by vaginal birth. There is also a genetic background for this disorder, as it runs in families.

Overactive bladder (OAB), on the other hand, is not related to vaginal birth or to genetic background, but is closely related to women's age, menopause, diabetes, and central nervous system disorders (such as stroke, Parkinson's disease and multiple sclerosis).

May sometimes include urodynamic testing, where the bladder is being filled with water and pressures inside the bladder and urethra are being measured.

Conservative treatment of urinary incontinence disorders includes medications that reduce the contraction of the bladder, behavioral therapy and physiotherapy treatments that comprise of pelvic floor muscle training, biofeedback, bladder training, dietary changes, and electrical or magnetic stimulation. Medical treatment of overactive bladder evolved considerably in recent years and currently there are slow-release preparations which need to be taken only once or twice a day, and the extent of their side effects are considerably lower than those of older drugs. The side effects are mainly dry mouth and sometimes constipation.

Pelvic floor training is based on the principle according to which, exercising our body voluntary muscles can improve their performance over time. According to this principle, exercising pelvic floor muscles might strengthen them and thus will also improve the function of the bladder sphincter. A Biofeedback device (biofeedback) is a computerized device that assists women to master, fast and effectively, the technique of training the pelvic floor muscles.

The device enables the patient and the staff to obtain quantitative information about the contractility of the pelvic floor muscles, namely the duration and intensity of the contraction, and whether the correct muscles are activated. Strengthening the pelvic floor muscles can also be achieved quite effectively by inserting specially designed cones of increasing weight into the vagina for defined periods of time.

Bladder training includes emptying the bladder at regular intervals around the clock (not including the night hours), through which a patient learns to regain bladder control. Electrical stimulation is another means to treat overactive bladder and is an additional instrument to train pelvic floor muscle. Recommended dietary changes refer mainly to refrain from various diet components that may irritate the bladder and / or significantly increase urine

output, such as caffeine and alcohol. Women who are bothered by nighttime urination should limit drinking before bedtime.

Surgical treatments of urinary incontinence include minimally invasive sling surgery during which a synthetic tape is inserted under the urethra, supporting it during an increase in intra-abdominal pressure.

In the majority of cases, the synthetic tape is accepted well by the body and is not rejected. Blood vessels and then connective tissue grow gradually into the tape and further strengthen the support of the urethra.

Consequently, sling surgery success rates are high (about 90%), the rate of complications is low, and it can be performed as an outpatient procedure, under regional or local anesthesia.

Injecting botulinum toxin into the bladder via cystoscopy is another novel and promising treatment for overactive bladder.