Why are you leaking urine - what is urinary incontinence?

Women of all ages and backgrounds face the challenge of urinary incontinence. But it's important to know that this shouldn’t (I repeat SHOULDN’T) be seen as a regular part of getting older.

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There are several effective treatments for urinary incontinence, but before you jump at the first life raft to get off the proverbial urinary incontinence titanic, it’s VERY important to diagnose your specific situation. 

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Now, before you dive into this exhaustive list of potential diagnosis protocols, know that the majority of women are struggling with stress incontinence, which is easily treatable through natural remedies or simple in-office procedures.

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We highly recommend visiting a healthcare provider to discuss a professional diagnosis.

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Your provider might do some simple tests to figure out why you're having trouble controlling your bladder. They could ask you to cough while you stand to see if urine comes out. If they think there might be more than one reason for the issue, the next step would be a series of basic assessments and tests.

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Assessments and tests to identify urinary incontinence:

• Medical History Assessment: Understanding your medical history is a crucial first step. This involves discussing past health issues, surgeries, and medications to gain insights into potential contributors to urinary incontinence.
• Comprehensive Physical Examination: A thorough physical examination is conducted, encompassing a pelvic exam. These examinations help assess the condition of pelvic muscles and identify any structural or functional abnormalities.
• Urine Sample Analysis: Providing a urine sample allows for laboratory testing to check for infections, blood traces, or other irregularities. This diagnostic step helps determine if an underlying urinary tract issue contributes to incontinence symptoms.
• Neurological Exam: A brief neurological examination is performed to detect any potential problems with pelvic nerves. This evaluation aids in understanding the neural factors that may be influencing urinary incontinence.
• Urinary Stress Test: The urinary stress test involves the healthcare provider observing urine loss during specific actions such as coughing or bearing down. This practical assessment helps gauge the impact of external stressors on bladder control, contributing valuable information to the overall diagnosis process.

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In some cases, your healthcare provider might order tests to check how well your bladder, urethra, and sphincter are working (urodynamic tests).

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Bladder function tests that can be conducted if necessary include:

• Measurements of post-void residual urine: This test checks if you can empty your bladder completely. An ultrasound or a thin tube (catheter) may be used to measure how much urine is left in your bladder after you pee.
• Measuring bladder pressures (Cystometry): This test measures the pressure in your bladder and the surrounding area as it fills. It's recommended to check for stress incontinence if you have had a neurologic disease of the spinal cord. A catheter is used to fill your bladder slowly with warm fluid, and you may be asked to cough or bear down to test for leaks.
• Creating images of the bladder as it functions (Video urodynamics): This test uses imaging to create pictures of your bladder as it fills and empties. Warm fluid mixed with a dye is instilled in your bladder, and the images are recorded.
• Cystoscopy: This test uses a scope to look into the bladder for blockages or abnormalities. It's usually done in the doctor's office.

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Are you experiencing stress or urge urinary incontinence?

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Stress Incontinence:

Stress incontinence occurs when pressure is exerted on the bladder during activities such as coughing, sneezing, laughing, exercising, or lifting heavy objects.

Urge Incontinence:

With urge incontinence, individuals experience a sudden and intense urge to urinate, often followed by an involuntary loss of urine. This condition may lead to frequent urination, even disrupting sleep patterns. Normally, your bladder muscle contracts when it's full, signaling the urge to urinate. However, in urge incontinence, the bladder muscle contracts too soon, before the bladder is full. This can be due to abnormal nerve activity, muscle spasms, or other causes, whether known or unknown. When the bladder has a spasm, this is when you may experience peeing your pants.

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How to identify the difference between stress and urge incontinence:

If you're dealing with incontinence, there are several common tests to check and understand your condition. Here are some tests your provider might use:

• Urinalysis
• Bladder stress tests
• Ultrasound
• Cystoscopy
• Urodynamics

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You also might be asked to keep a pee diary. This means noting how often you leak urine, how often you pee, and how much you drink. This diary helps identify any patterns in your symptoms and habits.

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How to treat urinary incontinence?

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Traditional treatment options for urinary incontinence

Your healthcare provider may suggest different ways to help with incontinence, such as:

• Pelvic floor exercises
• Fluid management (NOT recommended)
• Lifestyle changes
• Bladder training
• Medications
• Vaginal pessary
• Urethral inserts
• Sling procedure
• Injectable bulking agent
• Retropubic Colposuspension
• Inflatable Artificial Sphincter

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How to naturally treat (or cure) urinary incontinence:

• Pelvic Floor Exercises: These are workouts for the muscles that help control urine flow. A healthcare provider or physical therapist can guide you through exercises, known as Kegel exercises, to strengthen these muscles.
• Fluid Management: Your provider might advise on when and how much you should drink during the day. However, it's important not to reduce fluid intake too much, as dehydration is not good.
• Lifestyle Changes: Making healthy choices like quitting smoking, losing extra weight, or treating a chronic cough can reduce the risk of incontinence and improve symptoms.
• Bladder Training: If you have mixed incontinence, your provider may suggest a schedule for using the bathroom. Going more often might reduce urge incontinence episodes. We understand that this is not always possible for women with responsibilities such as meetings, client services, and more.

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Healthy habits to help with urinary incontinence:

• Lose extra weight: If you're carrying too much weight, shedding some pounds can ease the pressure on your bladder and pelvic muscles. Consult your doctor (or schedule an appointment with us at Epiphany Women’s Health) for weight loss advice.
• Eat more fiber: Keep bowel movements regular and soft to reduce strain on your pelvic floor muscles. Include high-fiber foods like whole grains, legumes, fruits, and veggies in your diet to prevent constipation.
• Decrease sugar and caffeine: Some foods and drinks can irritate your bladder: chocolate, coffee, tea, and carbonated beverages can make you urinate more.
• Quit smoking: Smoking can cause a chronic cough, worsening stress incontinence symptoms. It's also linked to bladder cancer, so quitting can improve your overall bladder health.

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Can medications be used to treat urinary incontinence?

There are over 20 prescription medications available to treat urinary incontinence. Some of these medications cause dehydration and drowsiness. At Epiphany Women’s Health, we do not recommend the use of medications for urinary incontinence. There is a far more effective treatment option that does not involve the risk or symptoms that can be caused by medication taken for urinary incontinence.

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Although this is our opinion, every woman has unique circumstances and should consult her healthcare provider.

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Devices used to treat urinary incontinence in women:

• Vaginal Pessary: A specialized ring-shaped device is placed by your provider to support the bladder base, preventing leaks during activities. It's a good non-surgical option but needs regular cleaning.
• Urethral Inserts: This tampon-like device inserted into the urethra acts as a barrier to prevent leakage. It's usually used for specific activities but can be worn throughout the day.

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Surgery and procedures to treat urinary incontinence

• Sling Procedure: The surgeon creates a sling or hammock using the person's tissue, synthetic material, or donor tissue to support the urethra. This common procedure is also used for men with mild stress incontinence.
• Injectable Bulking Agents: Polysaccharides or gels such as Bulkamid are injected to bulk up tissues around the urethra, improving sphincter closure.
• Retropubic Colposuspension: Sutures attached to ligaments lift and support tissues near the bladder neck. This surgery can be done laparoscopically or with an abdominal incision.
• Inflatable Artificial Sphincter: This surgically implanted device, mainly for men, replaces the function of the sphincter. It includes a cuff, tubes, and a pressure-regulating balloon, providing better control.

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The most effective way to treat urinary incontinence

The O-Shot® (Platelet-Rich Plasma injection) for urinary incontinence

Traditionally, surgical procedures were common for managing stress incontinence, but the O-Shot® offers an alternative approach. Developed over a decade ago, the O-Shot® involves injecting platelet-rich plasma (PRP), derived from the patient's blood, back into her body. PRP, containing highly active growth factors, stimulates cell and tissue regeneration, benefiting the area around the urethra (pee tube) causing stress incontinence.

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How the O-Shot® works:

Platelet-rich plasma is obtained by separating blood into its components, plasma, platelets, and red blood cells. A centrifuge (spinning device) is used to separate the blood. The plasma and platelets are removed with a syringe and used in the treatment. The injection, administered near the urethra, prompts the bone marrow to create new blood vessels and tissues. Over several days, weeks, and months, this new tissue develops, potentially treating urinary incontinence.

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Urinary incontinence is caused by weakening tissue around the urethra. If your muscles, ligaments, and tissues that support the bladder have lost strength or tension, the bladder and urethra are unsupported, leading to leakage.

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The O-Shot® helps create fresh, revitalized tissue that supports the bladder and urethra. This gives women better control and helps reduce urinary incontinence.

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FAQs About O-Shot®:

Is the O-Shot® FDA approved? 

Procedures are not approved or disapproved by the FDA. The FDA (Food and Drug Administration) monitors the safety of foods and drugs produced in the United States. 

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Since the O-Shot® is neither a food nor a drug the FDA is not involved, in the same way, that hysterectomies, c-sections, and PRP injections for sports-related injuries are not “approved by the FDA”. With that in mind, the procedure itself is not FDA-approved, but the kits used for the O-Shot® contain FDA-approved components.

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Can anyone administer the O-Shot®? 

No. Proper training and certification are required to administer the O-Shot® safely. Every provider at Epiphany Women’s Health is certified to administer the O-Shot®. You can verify this by visiting the Cellular Medicine Association.

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Next steps to treat urinary incontinence

If you find it uncomfortable to talk about incontinence, remember that more than 50% of women are struggling with urinary incontinence. You’re not alone. When you’re at Epiphany Women’s Health, you’re in a judgment-free zone. We are here to get you back on top of your game and living your best life. No more peeing your pants!

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If you’re ready to take the first step toward treating urinary incontinence, please book an appointment with one of our female nurse practitioners.