Urgency Urinary Incontinence

If you have urgency incontinence symptoms, your evaluation will begin with a comprehensive history and exam to assess pelvic floor support and strength, gross neuromuscular function, urinalysis and screening for voiding dysfunction. You may be asked to complete a voiding diary. Occasionally, urodynamic studies and/ or cystoscopy are also needed.

Pelvic floor rehabilitation

Many patients notice that their incontinence symptoms started when their pelvic floor muscle strength began to weaken. Improvement and regaining continence is commonly seen when patients begin doing their "Kegel exercises" at home. Additional improvements can be achieved with the rehabilitation approach when a specialist in pelvic floor physical therapy assesses the patient and assists in personalizing the exercise routine to meet the patient's specific needs. Sometimes biofeedback is also introduced by the therapist to assist the patient in isolating and strengthening the weakened pelvic floor muscles. Pelvic floor physical therapy can benefit both urinary urgency incontinence, but also stress urinary incontinence.

Medical treatment - overactive bladder medications

Oral/transdermal medications for overactive bladder remain a first line treatment with the primary difference between drugs being the differing side effects. Most drugs show their efficacy after one month. Occasionally, a drug will be less efficacious over time and dose modification or switching from one medication to another can improve results. The sympathomimetics are the newer products on the market with good control of the overactive bladder symptoms. If the overactive bladder medications do not adequately treat incontinence, or patients experience side effects from the drug, other options include sacral neuromodulation and Botox bladder injections.

Surgical treatments

  • Sacral neuromodulation for overactive bladder management
When overactive bladder medication does not adequately manage incontinence symptoms, sacral neuromodulation is another option. We test the nerve that controls the bladder initially and if your symptoms and leakage improves by at least 50%, then we can proceed with the actual placement of the pacemaker. This is an FDA suggested treatment for overactive bladder that has not responded well to oral treatments. Through a very short outpatient procedure that only involves mild sedation, a bladder pacemaker and wire lead are placed. Once activated, the pacemaker re-educates the nerve that controls bladder activity. The bladder pacemaker is placed under the skin in a concealed area through an incision often smaller than an inch in size above the buttock where no one can see it. The pacemaker battery requires replacement only every 5-7 years. You can adjust the pacemaker using a remote control so that it matches your needs and comfort level. Like other pacemakers such as for the heart, this equipment is not MRI compatible yet, although newer models are to be released that will be MRI compatible. This treatment option may not be appropriate for you however if you have a spinal cord lesion or have to have frequent MRIs on a regular basis.
  • Botulinum toxin for overactive bladder management (BOTOX┬«)
When overactive bladder medication does not adequately manage incontinence symptoms, injection of Botox into the bladder is another option. Botox is a chemical that inhibits the activity of the muscle. When injected into a specific location of the bladder in small measured doses, the result is often resolution of urinary urgency incontinence. This FDA approved procedure is commonly performed on an outpatient basis. The results last six to nine months and may require repetition. There is less than 10% incidence of urinary retention reported with Botox use in the bladder. Learning self-catheterization may be necessary for transient retention.

The Women's Health Urogynecology and Female Pelvic Medicine fellowship-trained physicians are highly experienced with managing overactive bladder and develop a care plan just for you.