Pelvic Floor Disorders

Overactive Bladder, Urinary Incontinence, and Voiding Dysfunction

Overactive bladder is characterized by the sudden need to urinate. It primarily affects women and is a common medical problem. These sudden urges may lead to urinary incontinence, or the involuntary leakage of urine. Voiding dysfunction is a generalized term used to describe issues in the normal function of the bladder. There can be different non-neurogenic or neurogenic factors that can contribute to this condition. Various treatment options are available to treat these conditions.

Types of Incontinence

There are several different types of incontinence, which include the following:

• Gravitational incontinence (involuntary leakage with standing)
• Mixed urinary incontinence
• Overflow incontinence
• Stress urinary incontinence (SUI)
• Total incontinence
• Unaware incontinence
• Urgency urinary incontinence (often associated with an overactive bladder)

Overactive Bladder

Overactive bladder (OAB) is one of the most common pelvic floor disorders globally, affecting both women and men.

Common Symptoms

• Nocturia (nighttime) urination
• Urgency urinary incontinence
• Urinary frequency
• Urinary urgency
• Voiding dysfunction

Voiding Dysfunction

Voiding dysfunction is a condition in which the bladder cannot empty properly because of tight pelvic floor muscles.

Common Symptoms

• Frequent urination (urinating more than eight times per day)
• Inability to empty the bladder
• Urgency to urinate

Treatment Options

There are many options available to treat incontinence, overactive bladder, or voiding dysfunction, depending on the cause. Your physician may try behavioral training, lifestyle changes, pelvic floor exercises, and medicines. If the problem does not resolve, your doctor may recommend medical devices, injections, or surgery.

Behavioral Training

This generally includes bladder training and timed urination. Bladder training teaches individuals how to hold their urine for increasingly more extended periods to prevent emergencies and leaks.

Lifestyle Changes

Avoid drinking too much fluid, including alcohol and caffeine, which can increase urinary frequency and urgency. Losing weight also often helps stress incontinence by relieving pressure on bladder muscles. Identify and avoid foods that can irritate your bladder. If you smoke, try to quit. This may reduce coughing, which can trigger stress incontinence.

Exercises

Pelvic floor muscle exercises, also called Kegel exercises, can help strengthen bladder muscles and help improve any type of urinary incontinence, including overactive bladder. However, women who have difficulty emptying their bladder or have pelvic pain should avoid these exercises.

Medication

There are several medications available that can benefit individuals who experience overactive bladder symptoms. Your physician may recommend the medicine depending on your individual condition.

Medical Devices

Medical devices like pessaries, urethral inserts, and external urethral barriers help treat stress incontinence by keeping urine from leaking.

Injections

There are several injections available that can help treat incontinence, including but not limited to the following:

• Botulinum Toxin Type A (“Botox”): Individuals with urge incontinence (overactive bladder) can receive injections of the medication into the bladder muscle. It relaxes the bladder muscle and improves urinary urgency, frequency, and urgency incontinence.
• Urethral Bulking (Bulkamid, Coaptite, Collagen): This is a minimally invasive, non-mesh option for stress urinary incontinence. The doctor injects the bulking agent through a needle into the wall of the urethra. The bulking agent bulks up the urethral tissue and allows it to close up (“coapt”), preventing urine leakage. This improves leakage with coughing, laughing, exercise, and more.

Minimally Invasive Surgery

There are surgical alternatives available to address different types of incontinence.

• Bladder Reconstruction: The surgeon harvests tissue from the intestine or stomach and uses it to create a larger bladder. The surgeon may also reposition the ureter and urethra when creating the larger bladder.
• Mid-Urethral Sling: The mid-urethral sling is the most common surgery to treat stress urinary incontinence. The surgeon utilizes a small strip of synthetic mesh that he places in an accessible manner underneath the urethra. This allows in-growth of tissue to help build up urethral support. Our surgeons have fellowship training and years of experience implanting synthetic mid-urethral slings and safely performing this procedure.
• Sacral Neuromodulation: This therapy helps to restore the function of the bladder and bowel. It can effectively treat various conditions, including urgency urinary incontinence, urinary frequency, bladder pain syndrome (“interstitial cystitis”), fecal incontinence, and urinary retention. The surgeon implants a bladder pacemaker, which uses mild electrical stimulation of sacral nerves to regulate the behavior of the bladder and pelvic floor muscles. Mount Sinai was the first institution in Miami-Dade to offer an MRI-compatible, rechargeable device for sacral neuromodulation.
• Vaginal Sling: The surgeon introduces a strip of native tissue (“fascial sling”) to support the bladder neck or urethra like a hammock. The sling, which our surgeon secures inside the abdomen, helps treat stress incontinence by keeping the urethra closed during physical activity.