Diagnosing and Treating Urinary Incontinence in New Jersey

All types of urinary incontinence can be helped with behavior and lifestyle changes rather than medical intervention. This includes: 

• Adjusting the length of time between trips to the toilet
• Learning to fully empty your bladder
• Managing the amount and types of fluids you drink

Your doctor may recommend exercises to strengthen the muscles of your pelvic floor. Hackensack Meridian Health's specially trained nurses or physical therapists will teach you the proper exercises and monitor your progress. Pelvic floor therapy will not reverse prolapse but can help prevent it from getting worse.

Medication

A number of oral medications are effective for treating urge incontinence and overactive bladder by relieving pain, relaxing your bladder muscle and protecting your bladder from irritation.

Botox®

Botulinum toxin type A can help your bladder relax and allow it to fill with more urine before you have the urge to go. The urologist uses a cystoscope to enter the bladder and inject Botox directly into the bladder wall. The procedure takes about 5 minutes under local anesthesia in your doctor’s office. Injections often need to be repeated two to four times per year.

Percutaneous Tibial Nerve Stimulation 

Percutaneous tibial nerve stimulation (PTNS) can be effective for treating overactive bladder. The majority of patients experience significant improvements in frequency and urgency. We offer PTNS in one of two forms. 

• Percutaneous: A small electrode that looks like an acupuncture needle is inserted near the tibial nerve in your lower leg. Impulses are sent to the tibial nerve via an electrical stimulator. This non-surgical approach takes about 30 minutes in your doctor’s office, once a week over 12 weeks and then monthly for maintenance. 
• Implant: Newer PTNS methods are evolving. We are among the centers that will soon be offering a small implant the size of a coin surgically implanted in the ankle alongside the tibial nerve. The implant provides continuous therapy, avoiding frequent visits to your doctor’s office.

Sacral Neuromodulation

Sacral neuromodulation (SNM) can be effective for treating urinary retention, overactive bladder, urge incontinence and certain types of overflow incontinence. A type of “bladder pacemaker,” SNM stimulates the sacral nerve which controls the muscles and other nerves responsible for your bladder.  

• During a procedure under conscious sedation, a small device is implanted under the skin near your buttocks. It is connected to wires placed near the sacral nerve, just above the tailbone. 
• Once implanted, the SNM device sends painless electrical pulses to the sacral nerve.
• Newer devices can be rechargeable or recharge-free and last 15-20 years.
• It is MRI safe.
• It can be controlled by a remote control, though most patients do not need to regularly change the settings on the device. 

Many surgical and non-surgical options exist for the treatment of stress incontinence. Our specialists in female pelvic medicine and reconstructive surgery are recognized nationally and internationally for their expertise in stress incontinence and offer you the latest treatments for this bothersome condition.

Bulking Agents

Medications can be injected into the lining of the urethra to bulk it up and prevent loss of urine due to cough, sneeze or activity. A novel treatment recently approved by the FDA, a hydrogel called Bulkamid can be delivered using a cystoscope in the office under local anesthesia. Some women may require follow-up injections, but the majority of women experience significant improvements in their stress incontinence.  

Midurethral Sling Surgery

Midurethral sling surgery offers a high cure rate for stress incontinence. 

• During outpatient surgery performed under conscious sedation or general anesthesia, a small strip of material is placed through a small vaginal incision under the urethra.
• Material may be synthetic (surgical mesh), biologic (cadaver tissue) or autologous (your own muscle tissue).
• The type of surgery is catered specifically to your needs and preferences. 

Urinary incontinence can range from leaking urine to complete loss of bladder control. While problems with bladder control can affect both men and women, women are twice as likely to experience it due to pregnancy, childbirth, or as a result of hormone changes with menopause. Certain medications and medical conditions also can contribute. 

Three main types of urinary incontinence are:

• Stress incontinence: Pressure on your bladder from activity such as coughing, sneezing or heavy lifting causes you to lose urine. 
• Urge incontinence or overactive bladder: You feel a strong need to urinate and lose urine before you can get to the toilet. 
• Overflow incontinence: Your bladder becomes too full and you lose urine.

If you experience any of those symptoms and suspect you have urinary incontinence, the urologists at Hackensack Meridian Health can diagnose the cause and offer a treatment plan.

The urologists at Hackensack Meridian Health treat urinary incontinence in a variety of ways, including: 

• Bladder Training
• Pelvic Floor Physical Therapy
• Medication
• Botox®
• Percutaneous Tibial Nerve Stimulation 
• Sacral Neuromodulation
• Bulking Agents
• Midurethral Sling Surgery

Depending on what type of incontinence you have, it may go away on its own. Some people have temporary incontinence caused by pregnancy, childbirth, or a urinary tract infection and once the underlying cause is over, it may resolve on its own.

Others with chronic incontinence conditions, like stress incontinence, urge incontinence, and overflow incontinence, do not go away on their own, but treatments can help manage symptoms and improve bladder control.