Bladder leakage and overactive bladder: options beyond pads
Leaking urine is common in women and men. It is not something you just have to live with. The first step is working out which type you have, because the treatments are different.
- Stress incontinence: leaking with coughing, sneezing, lifting or exercise. The sphincter or pelvic support is weak.
- Urge incontinence / overactive bladder: sudden, strong urges and leaking on the way to the bathroom.
- Mixed: both. Many urologists treat the urge component first.
The workup
Bring a three-day bladder diary to your first visit, recording what you drink, when you void and how much (a measuring cup works). Many "overactive bladders" turn out to be drinking habits. About 2 liters of fluid a day is plenty for most adults. Expect a urine test and a bladder scan. Cystoscopy or urodynamic testing may be added when the picture isn't clear or before surgery.
Treatments
Supervised pelvic floor therapy with biofeedback works much better than doing Kegels alone from a handout.
Medications for overactive bladder include beta-3 agonists (mirabegron, vibegron) and anticholinergics. Some anticholinergics have been linked to memory problems in older adults, so ask which one you're being given.
Bladder Botox is injected through a scope in the office and lasts several months.
Nerve stimulation: percutaneous tibial nerve stimulation (such as Urgent PC) is a weekly office treatment through a fine needle at the ankle. Sacral neuromodulation is a small implanted device for stubborn cases.
For stress leakage: urethral bulking injections are a quick office procedure. Mid-urethral slings are the most durable surgical option for women. Men leaking after prostate surgery may be offered bulking, a male sling, or an artificial urinary sphincter for heavier leakage.
Questions to ask
- Which type of incontinence do I have?
- Do you offer pelvic floor therapy with biofeedback, or refer to someone who does?
- Which office-based treatments do you offer before surgery?