• Pregnancy, Childbirth, Pelvic Surgery- Weakened or damaged pelvic floor muscles and associated tissue can be the result of pregnancy and childbirth, causing the bladder and urethra to relax and descend from their normal positions. Pelvic surgery, hysterectomy in particular, can weaken the normal pelvic organ structural supports. The bladder and urethra must be well supported by the pelvic muscles and tissue to allow them to work properly.
• Pelvic Organ Prolapse - prolapse of the bladder, rectum, or small intestines through the vagina can contribute to incontinence by altering the normal anatomic relationships between these structures. It can also interfere with bowel and sexual functions. Many women develop prolapse years after hysterectomy has alterered the normal pelvic support structures.
• Aging and Genetic Factors - Aging tends to worsen all forms of muscular injury. Changes in pelvic muscles can contribute to urinary incontinence.
• Medical Conditions - some medical and neurological conditions, such as spinal cord problems (e.g., spina bifida, spinal cord injury, malformation of the lower spine), multiple sclerosis, Parkinson's disease, stroke and diabetes can make incontinence worse.
• Infections and medications - urinary tract infections can cause temporary incontinence, and certain medications may increase the likelihood of temporary incontinence.
• Obesity - while obesity does not cause incontinence, it can exacerbate leakage due to the increased abdominal pressure pushing down on the bladder.
• Smoking - While not a direct cause, smoking may aggravate incontinence through progressive tissue injury.

Evaluation of Urinary Incontinence

• History and Physical Exam - Your urologist will take a detailed history related to your urine leakage and pelvic health, including number of pregnancies, vaginal deliveries, cesarian sections, and pelvic surgery. A pelvic exam is part of the standard evaluation of incontinence and pelvic organ prolapse.
• Voiding Diary - You will likely be asked to complete a voiding diary, which provides objective information about fluid intake, frequency of urination and incontinent episodes, as well as severity of leakage.
• Urodynamics - This is the most objective study of bladder function and urinary incontinence. It can be thought of as an "EKG for the bladder." A catheter is placed in the bladder and another is placed for abdominal pressure monitoring, after which the bladder is filled and emptied while graphing pressure changes and observing for leakage. While somewhat invasive, urodynamics can provide useful information that can not be obtained by other means and can affect treatment decisions.

Treatment Options for Urinary Incontinence

Depending on severity, a variety of options are available for managing urinary incontinence. It is important that you understand all the treatment options available to you, and that you share your thoughts and any concerns with your doctor.

• Behavior Therapies
  • Decreasing fluid intake
  • Prompted or timed voiding
• Pelvic muscle exercises - These exercises are commonly called Kegel exercises and are used to strengthen the pelvic floor muscles.
• Protective Undergarments - Products such as pads, undergarment liners and absorbent underwear are worn to absorb urine that has leaked from the bladder.
• Catheter - Some women require an indwelling catheter, which is left in place 24 hours a day to continually collect urine in an external drainage bag.
• Pessary - Some women with urinary incontinence and/or vaginal prolapse may benefit from use of a pessary. The passive compression device is inserted into the vagina where it presses against the wall of the vagina and the urethra. The pressure helps reposition the urethra, preventing leakage.
• Bulking Injections - A bulking agent, such as collagen, can be injected into the urethral lining to narrow the passageway and improve closure, thereby decreasing leakage. These types of procedures often need to be repeated.
• Medication - Several medications are FDA approved to help bladder control problems due to overactivity. There are, however, no medicines currently available to treat stress incontinence, which remains primarily treatable with surgery. Patients with mixed (stress and urge) incontinence may find drug therapy helpful in addressing the urge component of their incontinence.
• Surgery - A variety of surgical options are available to treat urinary incontinence and pelvic orgran prolapse. The appropriate procedure depends on the diagnosis and the evaluation. Stress incontinence is most often treated with a sub-urethral sling. Urge incontinence that has failed to respond to medications can often be improved by neuromodulation.