The Jackson Clinic

Incontinence

Incontinence is a non-life threatening but bothersome condition involving leakage of urine. There are two main forms:

Urge incontinence, where your bladder seems to "have a mind of its own" and you are unable to control when it releases.
Stress incontinence, where leakage occurs when coughing, sneezing, exercising, lifting heavy objects and laughing.

Our urology department offers incontinence evaluations, which include a discussion about your symptoms and often a urodynamic study. This study is a computerized, quantitative procedure that gives real-time feedback showing the type and degree of incontinence.

Approximately 17 million women in America have incontinence or “leakage.” Our urologists specialize in female urology and urogynecology - they have trained under some of the pioneers in the field of female urology and incontinence, and continue to incorporate the latest advances and techniques to their practice.

Overactive Bladder (OAB)

Overactive bladder may present with the following symptoms and can be present in both men and women:

Urinary Urgency – Rushing to the restroom to urinate
Urinary Frequency – Urinating very often
Nocturia – Urinating multiple times at night
Urge incontinence – Leakage of urine while rushing to the restroom
Bladder spasms – Pain or feeling of the urge to urinate when the bladder is empty

Treatment Options

Urge incontinence and OAB can be treated with medications and behavioral changes or, in some cases, procedures such as bladder Botox® and Interstim® sacral neuromodulation.

For stress incontinence (SUI), surgical procedures are generally recommended for patients who are healthy enough and wish to have this problem corrected. These are minimally invasive, outpatient procedures, so you can go home about an hour after the procedure.

Most health insurance providers cover the urodynamic evaluation and treatment options that we offer. If you have any questions about your insurance coverage, please call The Jackson Clinic Department of Urology at 731-422-0213 or email us at incontinence@jacksonclinic.com.

Overactive Bladder Treatments

First line treatments for OAB are typically behavioral changes; most men and women with OAB have tried behavioral changes by the time they see a provider. Whether that is the case or not, your urologist will provide suggestions and discuss with you to determine the adjustments that would fit your lifestyle.

If consistent behavioral changes do not result in improvement of your symptoms, you may need to explore medications or other treatment options.

Medications commonly prescribed for OAB include the following:

Ditropan® (Oxybutynin)
Detrol® (Tolterodine)
Enablex® (darifenacin)
Vesicare® (Solifenacin)
Toviaz® (Fesoterodine)
Sanctura® (Trospium)
Mybetriq® (Mirabegron)

Although most patients see significant improvement with these medications, many stop taking the medications due to side effects or they simply do not help their OAB. Patients who fail two medications or are unable to tolerate the medications due to side effects are candidates for sacral neuromodulation (Interstim®) or Bladder Botox®.

Interstim® is a novel therapy for overactive bladder (OAB) patients, fecal incontinence patients or patients with urinary retention (unable to empty bladder) without obstruction.

The treatment involves placing a bladder pacemaker underneath the skin of the gluteal area (depicted below). This is done by making a small incision and placing a soft wire next to the sacrum (bone in lower spine) which gives feedback to the brain to help prevent urgency, frequency, and incontinence related to OAB or may help with bladder emptying or fecal incontinence.

This therapy improves symptoms in most patients who undergo placement. Patients are given a 1-week trial with the device at home, then if improvement is seen, a second procedure is performed to permanently implant this device.

More information regarding Interstim® can be found here.

Urge Incontinence / OAB Treatments

Patient with signs and symptoms of Overactive Bladder (OAB) or Urge Incontinence may be candidates for Bladder Botox®. Once patients have failed behavioral treatments and at least two medications or are unable to tolerate medications, they are eligible to receive this treatment. This is an outpatient procedure with results typically lasting six months or longer until retreatment is needed. Ask your Jackson Clinic Urologist for further details.

More information can be found here.

Stress Incontinence Treatments

For men with severe stress incontinence, an artificial urinary sphincter is recommended. Incontinence may become severe after cases of trauma, prostate surgery or other causes.

This extreme involuntary loss of urine is often only corrected by implantation of a device which has a fluid balloon around the urethra preventing urine loss called and artificial urinary sphincter. Prior to surgery, additional testing with cystoscopy or urodynamics may be required.

Photo Credit: AMS/Boston Scientific

A urethral sling may be used for male or female patients and has a high chance of curing stress incontinence. A sling procedure involves making a small incision in the vagina (women) or perineum (men) to allow placement of the sling to provide support to the urethra.

Click the image below to view and download an informational PDF about this procedure.

For SUI patients with milder leakage or desiring a less invasive treatment option than a urethral sling, a Coaptite® injection may be recommended. It involves placement of a camera in the urethra while asleep and then using a needle to inject microspheres into the tissue to bulk up the urethra to prevent incontinence.