We often take bladder control for granted, so much so that we don’t even think about it. That is why losing this ability can be so devastating, not to mention embarrassing. No one wants to be out in public and lose control of their bladder. This has even happened to famous and successful people, such as Gregg Popovich. This condition, known as urinary incontinence, is a problem that affects over 25 million Americans and can have a serious impact on their quality of life. Although the condition may not cause severe physical damage, the mental and personal consequences are extremely serious. Stem cell therapy has the potential to completely transform a patient’s life who is suffering from urinary incontinence. But before we jump into that, let’s start with the basics.
What is Urinary Incontinence?
Urinary incontinence comes in many forms and has a range of severity. Some patients experience mild, uncontrollable leakage under certain situations, while others may feel the sudden urge to urinate without warning and be unable to make it to a bathroom in time. This range of symptoms stems from the fact that there are so many different types of urinary incontinence, all of which have different causes. It is essential to understand the exact nature of a patient’s particular case to see what is causing the issue and what possible treatments are available.
Types of Urinary Incontinence
Stress Incontinence
The name “stress incontinence” might lead one to think that this type of incontinence is caused by the feeling of strain or tension that we usually associate with the word stress. However, in this case it actually refers to physical stress or pressure on the bladder. An individual suffering from stress incontinence is likely to experience a leakage of urine in situations where the bladder suddenly has a force placed on it. This might be from an involuntary action like a cough or sneeze or from a sudden or extreme physical exertion.
This type of urinary incontinence is most common in women, with over half of all women over the age of 65 experiencing it at some point. One of the main contributing factors is pregnancy – carrying a baby and giving birth can cause a weakening to the muscles in the pelvic floor, making it easier for urine to unintentionally leak.
Urgency Incontinence
The sudden, strong sensation of having to urinate is what is known medically as “urgency”. This is something experienced by everyone at various points throughout their lives. Many completely healthy patients experience this when they arrive home after a long journey and suddenly find they have a strong urge to urinate as soon as they step inside their house. By itself this is not a problem but when someone is unable to make it to the bathroom in time the urgency becomes urgency incontinence. This may happen because the urge to urinate becomes overwhelmingly strong, or because they are physically unable to locate and use a bathroom in time.
Overflow Incontinence
Unlike the sudden onset of a strong desire to urinate experienced by those suffering from urgency incontinence, those experiencing overflow incontinence instead find themselves releasing urine unexpectedly without ever feeling the need to urinate. With this form of incontinence, a person becomes unable to feel the need to urinate even when the bladder is full, which causes it to overflow and release urine without warning. The condition might also be accompanied by a reduced ability to urinate independently.
Thus, a sufferer might at times experience the need to urinate due to a full bladder but be unable to do so. Additionally, even when urination is possible, the sufferer might not be able to fully empty the bladder. This causes feelings of discomfort and a feeling of having a full bladder, even though they are unable to urinate. Other symptoms that may indicate overflow incontinence are an inconsistent flow of urine with a lot of starting and stopping during urination, or a leakage of urine when asleep.
Functional Incontinence
A person may have full control of their bladder and have no difficulty knowing when they need to urinate, yet are still unable to make it to a bathroom in time to urinate. This is because some other physical or mental condition prevents them from acting on their urges and get to a bathroom. This could be due to the fact that they experience severe physical difficulties, which makes movement challenging. Examples would include someone who is confined to a wheelchair and has difficulty getting around and someone who suffers from extreme pain when moving in certain ways.
Other possible sufferers of functional incontinence are those who might be physically capable of making the trip to the bathroom but are unable to process the physical sensation of needing to urinate and subsequently form a plan of getting to or using the restroom. This is often the case in those suffering from degenerative mental disorders such as Alzheimer’s, or from developmental disorders. Here the individual would often be able to make it to the bathroom, with or without assistance, but are either unable to decide to make the trip or forget about the purpose of the trip once it has started.
Causes of Urinary Incontinence
Clearly urinary incontinence has many different types of presentation, and equally many different causes and contributing factors. Because of the wide range of presentations, it is necessary to understand what the various causes are to be able to understand which treatments are feasible. There are two broad classes of causes for urinary incontinence. One class contains the causes that lead to temporary incontinence, where a sufferer will experience incontinence only occasionally or only for a short term. This kind of incontinence is still embarrassing but fortunately will usually pass by itself or with minor medical intervention.
The other class of causes include those that will lead to persistent incontinence. This is more serious since incontinence caused by these triggering factors is likely to have a much greater impact on an individual’s life and will likely need more serious medical intervention to relieve.
Temporary Urinary Incontinence Causes
Urinary Tract Infections
This is the most common cause of temporary urinary incontinence. As well as the general symptoms associated with infections (low energy, fevers or chills, nausea, etc.) urinary tract infections can increase the need to urinate and cause urgency, the sudden and strong desire to urinate. As well as urgency incontinence, sufferers may also experience pain when urinating or a discolored urine that may contain blood. Fortunately, urinary tract infections are easily treatable by a doctor and are unlikely to have long term consequences.
Diet
There are many possible foods that might cause an increased production in urine that can cause the bladder to become unusually full and might turn an underlying weakness in the urinary tract to turn into incontinence. Some of the most common examples of foods that act this way are caffeine, alcohol and any foods high in salt, sugar, acids or spices.
As well as foods, some medications increase the production of urine or reduce bladder control. These include antidepressants, muscle relaxants, sedatives and blood pressure medications. It is always important to be aware of possible side-effects of any new medication and inform the prescribing doctor of any and all underlying conditions.
Persistent Urinary Incontinence Causes
Pregnancy
Pregnancy causes a change in the levels of various hormones throughout the body, including estrogen which plays a role in the health of the bladder and urethra. The pressure applied by the fetus to the bladder can also lead to stress incontinence. Other hormonal changes to the body, such as menopause, can also lead to incontinence.
Aging
Getting older leads to a general deterioration of the tissues that make up and support the bladder and urethra. The weakening of bladder muscles can lead to a reduced capacity and an inability to control urination. These patients are often left with no ability to control their bladder. The symptoms will only get worse with age.
Enlarged prostate or Urethral Obstructions
The enlargement of the prostate gland can apply pressure to the bladder and make it difficult for urine to leave, causing urge incontinence. The symptoms will generally persist as long as the prostate remains in an enlarged state. Any obstruction in the urinary tract can lead to problems fully emptying the bladder, causing overflow incontinence. Urinary stones are a common cause of obstruction, but occasionally tumors can also be present.
Urethral sphincter damage
This is the most common cause of urinary incontinence in both women and men. It happens when the important muscles and nerves that control urination become damaged through disease or other means. The extent of the damage and the cause affect the severity of the subsequent incontinence and the possibility of a cure.
What is the Urethral Sphincter?
Urine is stored in the bladder and expelled through the urethra, a long thin tube that allows urine to pass through it to leave the body. The urethral sphincter is the mechanism that controls when urine may leave the bladder to be expelled. The urethral sphincter consists of two muscles – the internal urethral sphincter and the external urethral sphincter. Together they control urination through preventing urine from leaving the bladder and entering the urethra. These two muscles play different but equally important roles in urination and damage to either of them can lead to persistent urinary incontinence.
The Internal Urethral Sphincter
This muscle is located where the bladder meets the urethra and is not under voluntary control – it opens and closes automatically depending on the signals it receives from the body. This is the muscle that provides involuntary control over urination. It allows patients to prevent urination without having to think about it directly, for example while asleep.
The External Urethral Sphincter
This muscle’s location varies between biological males and females. It is found further along the urethra than the internal sphincter and is under conscious control of the individual. This is what allows most individuals to urinate at will when there is urine present in the bladder.
Damage to either of these muscles or the nerves that control them can cause different types of urinary incontinence and are difficult to repair.
What can cause Urethral Sphincter Damage?
Prostate surgery
In men, prostate surgery can sometimes cause damage to the surrounding area, including the urinary sphincter. The surgery may be successful in its original goal, but leave the patient with urinary incontinence. While an enlarged prostate or prostate cancer can sometimes lead to stress incontinence, they rarely cause damage to the surrounding tissues.
Childbirth
In women, childbirth is an extremely common cause. This is most common with natural childbirth but can also occur during c-sections. Hysterectomies can also cause this type of damage. The urethral sphincter is damaged and there is little that can be done to prevent it.
Pelvic surgery
Damage can also occur to any gender during any form of pelvic surgery. Cutting through the abdominal muscles can weaken the muscles that support the urethral sphincter and reduce the ability to control the bladder. The surgery may be successful, but leave the patient with less control of their bladder.
Nerve damage
The last common cause is damage to the nerves that allow control of the sphincter. In patients who suffer from spinal cord injuries or a neuro-degenerative disease such as Parkinson’s, the muscles may be fully capable of contracting but the nerves that send the signals are damaged which prevents them from being able to do so.
Typical Urinary Incontinence Treatments
Given the variety of different causes of urinary incontinence, there are also different types of treatment. They vary in success rate and so far, there are few options available to treat damage to the urethral sphincter, the most common cause of incontinence.
Behavioral techniques
There are various techniques that seek to solve the problems associated with incontinence without directly treating the source of the problem. As well as altering diet to reduce the intake of problematic foods, a physician may suggest making a bathroom schedule to ensure that urine levels in the bladder remain low at all times. They may also suggest resisting the urge to urinate for a few minutes after the need has been identified, to increase bladder control.
Pelvic Floor Muscle Exercises
These exercises focus on strengthening the urethral sphincter by exercising the associated muscles. They usually take the form of repeatedly contracting and relaxing the muscles used to control urination. The exact form and number of repetitions that are appropriate would be determined by a doctor. The exercises will generally not improve the urethral sphincter, but the muscles around it.
Medication
Medication can be successful in treating urge incontinence. The medications typically work by relaxing muscles in and around the bladder, which can prevent the bladder spasms that are the cause of sudden urine loss. Some are also able to increase the amount of urine the bladder can hold, while others can make the act of urination easier, treating overflow incontinence.
Medical devices
A number of devices exist for treating urinary incontinence in women. One is a urethral insert which is placed into the urethral opening temporarily, preventing the accidental loss of urine. This is typically used for a short-term period of activity and is then later removed to allow urination. Women experiencing vaginal prolapse leading to stress incontinence can also use a pessary. This is a strong ring that is inserted into the vagina for a long period of time to provide support and reduce pressure on the urethra.
Surgery
A number of surgical options exist to strengthen the urethral sphincter or provide support to supplement the weakness. To provide added support, surgeons can either add a “sling” that helps hold the urethra up and keep it closed when the body is moving around, or by providing additional support to the area where the bladder connects to the urethra. These techniques don’t directly increase bladder control but add support to prevent accidental leakage Another option for men is to have an artificial urinary sphincter implanted. This keeps the urethra closed to prevent urine loss but can be opened by pushing a button implanted into the patient to allow urination.
Stem Cell Therapy
Despite the wide variety of treatments used to treat urinary incontinence, traditional techniques are not always successful. Many patients who undergo these treatments are left slightly better off than they were before. Moreover, some of these treatments require a significant amount of time before success can be judged, while the patient is still suffering. Others require invasive surgery with a long recovery time and still have an uncertain success rate.
Fortunately, scientists have discovered a new potential treatment involving the use of stem cells for damage to the urethral sphincter. Given the cutting-edge nature of this new technology, there are many different ways in which stem cells are being used to treat this kind of damage. Clinical trials are showing how successful these kinds of treatments can be even where conventional treatments have been unsuccessful.
Stem Cell Therapy Can Lead to Urethral Sphincter Regeneration
In the early 2000s, scientists began looking at animal models of urethral sphincter damage to see how successful stem cell treatments may be in this area. These studies involved extracting different kinds of adult stem cells from the mice, processing them in some way, and then carefully re-inserting them into particular locations around the urethral sphincter.
These studies demonstrated how different kinds of stem cells could repair damage or replace damaged cells and improve the function of the urethral sphincter. An encouraging early study in 2005 showed that stem cells obtained from the fat cells of the mice were able to repair and regenerate damaged tissue. A later study in 2010 showed that stem cells obtained from bone marrow could also be used to improve sphincter function.
These exciting advances show that different kinds of stem cells can have different kinds of restorative properties. The stem cells from fat cells were able to help repair the damaged cells, while the stem cells from bone marrow were able to differentiate into the same type of cell that had been damaged and replace the damaged ones. Scientists followed up on this to perform further studies that showed how combining different types of stem cells in the same treatment could improve the effectiveness of the treatment.
Soon after the safety and success of using stem cells to treat urinary sphincter damage in mice was proved, clinical trials in humans were started in the hope of relieving suffering. Researchers knew that this condition did not yet have a treatment that would be successful in many cases and saw the potential of stem cell therapy.
Several groups began to investigate using stem cells to treat stress incontinence. This is a particularly common form of incontinence that can occur when the urinary sphincter and surrounding tissues are damaged and bladder control is weakened. A new treatment for this type of urinary incontinence would be a huge breakthrough.
One group began looking at using stem cells from umbilical cord tissue to treat the damaged urinary sphincter muscles. The results of the first trial were so successful that a second trial soon began on a larger scale where patients received two treatments three months apart. Over 90% of the women in the group that received the largest dosages had their incontinence reduced by more than a half, with both studies showing no side-effects more severe than minor pain or bruising where the stem cells had been injected.
Another group showed that using stem cells derived from umbilical cord Wharton jelly could reduce stress incontinence in men who had undergone prostate surgery that left them with urinary sphincter damage. Participants had their level of incontinence reduced by 60% while also reducing the frequency of their incontinence and improving their quality of life.
Clearly these techniques are able to help men and women recover successfully from urethral sphincter damage while being minimally invasive. Moreover, they are easily combined with other treatments which may lead to even greater successes. This is a new and exciting time in treating urinary incontinence with the use of stem cells. Where other treatments have reached their pinnacle, stem cell treatments are constantly being refined and improved as research advances. This is leading to greater successes with patients who are now able to live their lives again freely and without embarrassment.
