What Is Giggle Incontinence? – Incontinence and Overactive Bladder Center

Giggle incontinence strikes mostly young girls and involves the loss of urine during laughter. Kids usually outgrow this bladder problem eventually, but these steps can help in the meantime.

By Kristen StewartMedically Reviewed by Pat F. Bass III, MD, MPH

Reviewed: March 20, 2014

Medically Reviewed

When most people think of bladder accidents, their minds probably jump to toddlers during potty training or elderly people with problems such as stress or urge incontinence. However, this problem is not solely the territory of the very young and very old. Take, for example, giggle incontinence.

“Giggle incontinence is involuntary wetting during giggling or laughter, typically seen in young girls,” says Courtenay Moore, MD, a urologist at the Glickman Urological and Kidney Institute at the Cleveland Clinic. “Leakage is typically a large volume, often amounting to complete bladder emptying. ”

The condition generally appears in girls younger than 18, often around 10 to 12 years old, but experts aren’t sure why. “The causes are unclear,” says Elizabeth Kavaler, MD, director of urogynecology at Lenox Hill Hospital in New York. “However, it may be related to an incompletely developed urinary sphincter,” the circular muscle that surrounds the urethra.

In most cases, girls will simply grow out of giggle incontinence. But while they’re going through it, it can be very upsetting both for them and for parents concerned about their kids’ health.

How Parents Can Help Girls Cope

“The fear of losing control of bladder function can be very embarrassing to a child,” says Lane S. Palmer, MD, chief of pediatric urology at Cohen Children’s Medical Center in New Hyde Park, N.Y. “Humiliation by one’s peers or fear of such humiliation because of wet clothes and odor may lead to aversion behavior and interfere with social integration. This may lower the child’s self-esteem. ”

However, there are steps parents can take to help their kids better manage this bladder problem, both mentally and physically. First and foremost, it’s important to address your child’s emotional concerns. Continue to reinforce that this type of accident is out of her control and that it is not at all her fault. Also, make sure young girls realize they are not alone in having problems with bladder control.

There are some proactive physical steps parents can take, too. When possible, kids should empty their bladders before activities where giggling is likely to happen, such as getting together with friends and riding on the school bus. They should also avoid drinking caffeinated beverages, which could irritate their bladders.

Talk with your child’s doctor if these steps aren’t effective. Other techniques that may help girls become more aware of their bodies are also available. “Biofeedback or pelvic floor training can be a very effective treatment for giggle incontinence,” says Dr. Palmer. “First, children are taught to identify the muscles responsible for keeping them dry. Then they are taught to strengthen these muscles and to contract these muscles very quickly and effectively when the bladder starts to empty in inappropriate situations.”

Ultimately, giggle incontinence should resolve itself, but in the meantime, these simple steps can make everyone’s lives easier.

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Giggle incontinence – ERIC

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True giggle incontinence is complete or almost complete emptying of the bladder caused by a detrusor contraction in response to laughter, with no other lower urinary tract dysfunction.

In other words, the stretchy-squeezy muscles squeeze when then shouldn’t, causing the bladder to empty.

It is more common in girls than boys, and most prevalent in the pre-pubertal years. There doesn’t appear to be a specific cause – and there is no specific treatment.

It is important to note that daytime wetting is often attributed to Giggle Incontinence. Before reaching this conclusion therefore, a full Continence Assessment should be undertaken and steps taken to promote a healthy bladder:

• Treat any constipation
• Rule out Urinary Tract Infection (UTI)
• Get the drinking right (see our factsheet Advice for Children with Daytime Bladder Problems)
• Practise relaxed voiding, sitting on the toilet with a well-supported bottom and feet, and taking time to allow the bladder to empty.
• If wetting persists after several weeks of healthy bladder management, then the detail of the wetting should be looked at to diagnose the exact cause and identify optimum treatment.

Wetting could for instance be caused by:

• Overactivity, when the stretchy-squeezy (detrusor) muscles squeeze when they shouldn’t, leading to urgency, frequency and small voided volumes as well as possible wetting
• Vaginal pooling, leading to low volume wetting immediately after voiding
• Dysfunctional voiding, when the two sets of bladder muscles misbehave leading to a range of symptoms usually including incomplete bladder emptying, often leading to UTI, and difficulty initiating a void as well as wetting.

So a child with Giggle Incontinence will be over five years old, and will have;

• No history of constipation or UTI
• Normal volume voids (age+1 x 30) (this formula is for children aged 4–12 years)
• Normal frequency voids (4–7 each day)
• No urgency
• Large volume wetting solely associated with laughter
• No incontinence with coughing or physical activities

What can be done?

It is important to reassure children and young people with this condition that it is not their fault – it is due to a completely involuntary bladder contraction.

It is also important to reassure the family that it is usually self-limiting – symptoms tend to resolve as the child gets older.

In the meantime though, whether or not to embark upon any specific treatment will depend on how often the wetting occurs – if it is once or twice a month then families may prefer to avoid daily medication. The problem is, there is no good evidence to recommend any specific treatment.

Various things may be suggested:

• Education regarding pelvic floor strengthening exercises to encourage ‘bracing’ of the pelvic floor at time of laughter;
• Consider trial of anticholinergic medication if other symptoms present such as urgency;
• Methylphenidate (Concerta/Ritalin) can be considered but this is a controlled drug and unlicensed for the treatment of giggle incontinence.

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Treatment of urinary incontinence. How to treat urinary incontinence in women

Treatment of urinary incontinence

• Description
• Video
• Organization of treatment
• Cost of treatment

Description

Urinary incontinence in women is a serious ailment that affects the quality of life and causes severe moral discomfort. If the fair sex has problems with this disease, the doctors of our clinic are ready to help her.

Our specialists know the methods of not only surgical, but also conservative treatment of incontinence.

What is cough incontinence?

Cough incontinence, or in other words, stress incontinence (stress incontinence) is a condition in which involuntary leakage of urine occurs with any increase in intra-abdominal pressure: lifting weights, coughing, sneezing, playing sports.

In mild forms of incontinence, leakage can occur only with excessive, extreme stress. In more severe cases, even normal walking or a change in body position can provoke incontinence, requiring mandatory treatment.

What causes urinary incontinence?

The main reason is a dysfunction of the anatomical structures that support the urethra. In this case, provoking factors are birth trauma, hormonal changes during menopause, heavy physical work, overweight, chronic cough and other conditions associated with increased intra-abdominal pressure.

Can pelvic floor exercises cure urinary incontinence?

Pelvic floor muscle training (Kegel exercises) may be beneficial for young patients who have begun to experience urinary leakage after childbirth.

In this case, it is important to start training no later than 6 weeks after giving birth, to train daily for at least 6 months, preferably under the supervision of a specialist. In the case of a long-term disease, as well as with a pronounced degree of urine leakage, exercises are ineffective.

What are the treatments for urinary incontinence?

The main treatment for stress urinary incontinence is surgery. To date, the “gold standard” and at the same time the most studied operation is the installation of a synthetic mid-urethral sling.

Other existing methods, such as the introduction of volume-forming substances under the urethra, Birch colposuspension, plastic surgery of the anterior vaginal wall, etc., are less effective and can lead to serious side effects, the main of which is a violation of normal urination.

How is the middle urethral sling (TVT, TOT) surgery performed?

This operation is performed under intravenous anesthesia. Through a small (1-1.5 cm) incision on the anterior wall of the vagina, a synthetic sling is placed under the middle third of the urethra.

The sling replaces damaged structures that support the urethra, creating the necessary conditions for urinary retention. The ends of the sling are brought out through small punctures in the skin in the inguinal folds or above the womb. The duration of the operation, as a rule, does not exceed 10-15 minutes.

How many days does hospitalization take? How is the postoperative period?

The standard hospital stay is 2-3 days. The next day after the operation, the doctor evaluates the effectiveness of the treatment and, if necessary, adjusts the tension of the sling, setting it in such a way as to achieve complete retention of urine without disturbing the quality of urination.

This procedure is performed under local anesthesia. The ability to adjust the tension significantly reduces the risk of postoperative urinary retention and helps to achieve an optimal result.

What is the effectiveness of surgical treatment of urinary incontinence?

The efficiency of the operation is up to 90%. There are diseases, the presence of which aggravates the course of the disease and may reduce the effectiveness of treatment – these are concomitant bladder overactivity (the so-called mixed form of urinary incontinence), diabetes mellitus, chronic lung diseases (COPD, bronchial asthma), chronic constipation, obesity.

In patients with a complicated form of stress urinary incontinence (urethral hypomobility, urethral sphincter insufficiency, previous pelvic surgery), the effectiveness of treatment may also be lower.

What are the risks and side effects of surgery?

Complications associated with the installation of a suburethral sling are extremely rare in expert clinics. Among them are damage to nearby organs (bladder, urethra, abdominal organs), trauma to large vessels, pain syndrome, functional disorders (hyperactivity or atony of the bladder, difficulty urinating), discomfort during intercourse, erosion of the vaginal mucosa.

In specialized centers, due to the high qualification of surgeons and the use of modern materials, the number of complications is minimized (less than 1%)

What are the restrictions after the operation?

As a rule, within 5-7 days after discharge from the hospital, women can return to daily activities – go to work, do housework. Within 1-1.5 months after the operation, patients are advised to lead a sparing lifestyle: avoid lifting weights, active sports, sexual activity, and also refrain from visiting saunas, swimming pools, and taking baths.

It is recommended to pay attention to behavioral habits: avoid smoking, eat a balanced diet, normalize body weight.

Will the operation help if the leakage of urine occurs at rest, with the urge to go to the toilet, the sound of running water, etc.?

Such complaints require a more thorough follow-up examination, tk. indicate the presence of an overactive bladder (OAB). According to the results of the examination, treatment is selected: OAB is treated with medications that block the nerve endings in the wall of the bladder.

Sling implantation in OAB is not effective. With a combination of urinary incontinence when coughing and OAB, the treatment should be combined: surgical and medical.

I have urinary incontinence and uterine prolapse, what should I do?

With a pronounced degree of pelvic organ prolapse, the prolapse is always eliminated as the first step. Surgery for stress incontinence can be performed as early as 1.5-2 months after surgical reconstruction of the pelvic floor using mesh implants.

Is it possible to treat urinary incontinence and pelvic organ prolapse at the same time?

Simultaneous surgeries carry an increased risk of postoperative complications such as postoperative urinary retention and overactive bladder. In addition, in this case, the risk of recurrence of urinary incontinence increases. We do not recommend simultaneous surgical treatment of pelvic organ prolapse and urinary incontinence.

Is it possible to install a midurethral sling if I am planning a pregnancy?

After implantation of the prosthesis, you can safely plan pregnancy and give birth through the natural birth canal. At the same time, the risk of recurrence of the disease does not exceed 20% (regardless of whether a Cesarean section was performed or the birth went through natural routes).

Bibliography

1. Centers for Disease Control and Prevention. (2014). Prevalence of Incontinence Among Older Americans (PDF, 1.3 MB). National Center for Health Statistics. Vital Health Statistics; 3(36).
2. Reddy, J., & Paraiso, M.F.R. (2010). Primary Stress Urinary Incontinence: What to Do and Why. Reviews in Obstetrics & Gynecology; 3(4): 150–155.
3. Stewart, W.F., et al. (2003). Prevalence and Burden of Overactive Bladder in the United States. World Journal of Urology; 20(6): 327–336.
4. American College of Obstetricians and Gynecologists. (2016). Urinary Incontinence (PDF, 84 KB). (link is external)
5. Altman, D., Granath, F., Cnattingius, S., & Falconer, C. (2007). Hysterectomy and Risk of Stress-Urinary-Incontinence Surgery: Nationwide Cohort Study. (link is external) Lancet; 370(9597): 1494–1499.
6. Gleason, J.L., Richter, H.E., Redden, D.T., Goode, P.S., Burgio, K.L., & Markland, A.D. (2013). Caffeine and Urinary Incontinence in Women. International Urogynecology Journal; 24(2): 295–302.
7. Sangsawang, B., & Sangsawang, N. (2013). Stress Urinary Incontinence in Pregnant Women: A Review of Prevalence, Pathophysiology, and Treatment. International Urogynecology Journal; 24(6): 901–912.
8. Kim, D.K., & Chancellor, M.B. (2006). Is Estrogen for Urinary Incontinence Good or Bad? Reviews in Urology ; 8(2): 91–92.
9. Health Resources and Services Administration, Agency for Healthcare Research and Quality. (2012). Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (PDF, 12.9 MB). Comparative Effectiveness Review ; 36.
10. U.S. National Library of Medicine. (2017). Kegel exercises – self-care.
11. Institute of Medicine. (2004). Dietary References Intakes: Water, Potassium, Sodium, Chloride, and Sulfate (link is external).
12. Rosinger, A. and Herrick, K. (2016). Daily water intake among U.S. men and women, 2009–2012. National Center for Health Statistics Data Brief ; 242.
13. American College of Obstetricians and Gynecologists. (2017). Surgery for Stress Urinary Incontinence (PDF, 85 KB). (link is external)
14. Food and Drug Administration. (2018). Considerations about surgical mesh for SUI.

Video

Treatment organization

Hospitalization for the purpose of surgical treatment is carried out according to the principle “one window” . It is enough for the patient (or the person representing him) to write a letter with the wording of his question. At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

CHI and VMP treatment

Citizens of the Russian Federation can receive free treatment under the CHI program for most diseases

No matter where you live

80% of patients come to us from the regions of the Russian Federation and countries near and far abroad

Many years of experience

Every year more than 3000 operations of any complexity are performed in the Department of Urology

At any time (both before hospitalization and after), you can ask questions of interest to the staff of the department.

1. Online consultation with a specialist

The organization of hospitalization for the purpose of surgical treatment is carried out according to the principle of “one window”. To do this, it is enough for the patient (or the person representing him) to write a letter with the wording of his question.

Write a letter

2. Appointment of the date of hospitalization

After the consultation, our administrator will contact you within a few days to make an appointment for hospitalization.

3. Examination before hospitalization

Preoperative examination should be carried out only after the approval of the date of hospitalization. You can get most of the examinations at the antenatal clinic or polyclinic at the place of residence free of charge, under the CHI policy.

If in your locality there is no opportunity to be adequately examined – do it in the regional center, if everything cannot be done within the framework of compulsory medical insurance (under the policy) – do it in paid laboratories (clinics).

NO LATE THAN 14 DAYS before hospitalization, you must send SCANS (not photos) of the test results to the email address: [email protected]

4. Hospitalization in the department

10 days before surgery withdrawal of drugs that affect blood clotting (aspirin, Plavix, warfarin, etc.) is NEEDED unless otherwise agreed with the attending physicians.

It is highly desirable to arrive for surgical treatment with pre-selected and purchased surgical compression stockings (white stockings, antithrombotic 2nd class of compression or as recommended by the vascular surgeon).

Cost of treatment

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Treatment of urinary incontinence free of charge under compulsory medical insurance

The need to wear pads everywhere, change underwear, avoid the slightest load – all this makes a woman a hostage to her own bladder. It can be embarrassing to admit to urinary incontinence, but in fact there is nothing to be ashamed of the problem: both mature women and young girls face it. And most importantly, the disease has surgical treatment options.

Expert: Yuri Aleksandrovich Kupriyanov, PhD, urologist of the highest category S.I. Spasokukotsky, Associate Professor of the Department of Urology, MGMSU named after A.I. A.I. Evdokimov.

Big Causes of a Small Problem

To talk about treatment options for incontinence, it’s important to understand the types of incontinence. There are three most common types in women:

1. Stress incontinence

A portion of urine is involuntarily released during exertion: coughing, sneezing, running, lifting weights, with a sudden change in body position and even during sexual intercourse. All these actions cause an increase in intra-abdominal pressure. It leads to involuntary relaxation of the sphincter – the muscle that blocks the exit from the bladder. Normally, she relaxes only when she goes to the toilet, but for some people this happens uncontrollably.

The main cause of stress urinary incontinence is weakness of the pelvic floor muscles. Most often it occurs with age, due to hormonal changes during menopause. The problem also occurs in women who have recently given birth, who have a sprain of the ligamentous apparatus in the pelvic area. Normally, stress incontinence goes away after a few months after birth, but sometimes it persists and requires treatment. Multiparous women are at risk.

2. Urgent or imperative incontinence

This is a sudden and irresistible desire to empty the bladder, in which the person does not have time to run to the toilet. Sounds of running water can provoke urination. The excretion of urine in such cases is quite plentiful. The main reason is an overactive bladder, that is, its contraction even before filling.

3. Mixed type

Combination of stress and urge incontinence. This is the most difficult option for diagnosis and treatment, but it can also be treated.

Much less common are functional incontinence (due to psychological or neurological problems during normal urinary tract function) and overflow incontinence (usually caused by damage to the nerve fibers in the pelvic area; occurs after trauma and surgery).

Questioning, tests, analyzes: how the diagnosis is made

Urinary incontinence impairs the quality of life, and this in itself is the basis for treatment. Do not listen to experts who say: be patient, you can live with this.

If a woman is forced to give up sports and activities with a child, if you have to constantly change absorbent pads, you need to go to the doctor. It is not worth wasting time, because in the course of life incontinence increases, plus a urinary tract infection can be added.

The type of urinary incontinence can be determined at the first appointment. The doctor asks the patient to fill out a questionnaire and performs an examination in the chair. It is advisable to come to the appointment with a full bladder so that the specialist can conduct a cough test – to assess the release of urine during coughing.

An ultrasound is also performed and a general urinalysis is given. It allows you to exclude acute inflammatory processes: for example, acute cystitis can be mistaken for urgent urinary incontinence.

Surgery or injection?

The main treatment for stress urinary incontinence in women is the insertion of a special vaginal sling. It acts as a brace under the neck of the bladder and urethra and prevents the leakage of urine.

The sling is a loop prosthesis. This is a strip of synthetic material 1 centimeter wide, which is inserted through a small incision into the vagina. The operation is performed under spinal anesthesia. From hospitalization to discharge, on average, it takes 2-3 days. Within a month after the operation, you can not lift weights, change weight.

Slings are more likely to be fitted for life, but the sling can sometimes be dislodged after childbirth, strong weight gain or weight loss. Then a second operation is performed.

Urge incontinence is treated first with medication: drugs that “regulate” the frequency of bladder contractions. But sometimes they are ineffective, or the person does not want to constantly take pills. Botulinum toxin A is then injected into the wall of the bladder. It blocks neuromuscular impulse transmission and relaxes “overactive” muscles. The duration of the injection is from 3 months to a year, on average – six months. The drug is administered endoscopically, that is, through a small puncture in the abdomen under local anesthesia.

Mixed urinary incontinence is more difficult. First we insert the sling and then move on to medical therapy or botulinum toxin A injections.

Non-surgical methods: effective or not?

Physical therapy and biofeedback therapy (Kegel exercises, gymnastics and pelvic floor exercises)

Good for preventing incontinence, especially if performed before childbirth. They can help after childbirth, but the effectiveness is not so high. However, 75% of women report improvement with regular exercise. The maximum effect is achieved after 3-6 months.

Medical therapy

Indicated for forms of urge incontinence. It is quite effective, but individual selection of drugs is necessary because of their abundance. Sometimes addiction occurs, and then an injection of botulinum toxin A is used.

Behavioral therapy

This implies a change in the schedule for visiting the toilet, a special drinking regimen, reduced consumption of tea and coffee, and, if necessary, work with a psychologist. Effective only as adjuvant treatments.