Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine. It is not a disease but rather a symptom that can be caused by a wide range of conditions. Incontinence can be caused by diabetes, a stroke, multiple sclerosis, Parkinson's disease, some surgeries or even childbirth. More than 15 million Americans, mostly women, suffer from incontinence. Although it is more common in women over 60, it can occur at any age. Most health-care professionals classify incontinence by its symptoms or circumstances in which it occurs.

What are the various types of urinary incontinence?

Stress incontinence: Stress urinary incontinence is the most common type of leakage. This occurs when urine is lost during activities such as walking, aerobics or even sneezing and coughing. The added abdominal pressure associated with these events can cause urine to leak. The pelvic floor muscles, which support the bladder and urethra, can be weakened, thus preventing the sphincter muscles from working properly. This can also occur if the sphincter muscles themselves are weakened or damaged from previous childbirth or surgical trauma. Menopausal women can also suffer from small amounts of leakage as a result of decreased estrogen levels.

Urge incontinence: Also referred to as "overactive bladder," urge incontinence is another form of leakage. This can happen when a person has an uncontrollable urge to urinate but cannot reach the bathroom in time and has an accident. At other times, running water or cold weather can cause such an event. Some people have no warning and experience leakage just by changing body position (e.g., getting out of bed). Overactive bladder is also associated with strokes, multiple sclerosis and spinal cord injuries.

Overflow incontinence:This type of incontinence occurs when the bladder is full, is unable to empty and yet leaks. Frequent small urinations and constant dribbling are symptoms. This is rare in women and more common in men with a history of surgery or prostate problems.

Functional incontinence:This type of incontinence is the inability to access a proper facility or urinal container because of physical or mental disability.

Mixed incontinence: Mixed incontinence refers to a combination of types of incontinence, most commonly stress and urge incontinence.

How is urinary incontinence diagnosed?

As with any medical problem, a good history and physical examination are critical. A urologist will first ask questions about the individual's habits and fluid intake as well as their family, medical and surgical history. A thorough pelvic examination looking for correctable reasons for leakage. Usually a urinalysis and cough stress test will be conducted at the first evaluation. If some findings suggest further evaluation, other tests may be recommended such as a cystoscopy or even urodynamic testing. This outpatient test is usually done with a tiny tube in the bladder inserted through the urethra and with a small rectal tube, as well. The bladder is filled and evaluation of bladder done via measurement of pressures.

Treatments

In most cases of incontinence, minimally invasive management (fluid management, bladder training, pelvic floor exercises and medication) is prescribed. However, if that fails, surgical treatment can be necessary.

Stress incontinence: Stress incontinence in the female is treated at the beginning with behavior modification and pelvic exercise. Sometime techniques like biofeedback or electrical stimulation of the pelvic muscles can help. But when the symptoms are more severe and conservative measures are not helping the treatment is surgery. In selected cases bulking agents can be used to increase continence. The operation is done under local anesthesia and is minimally invasive but the cure rates are lower compared to open surgical procedures.

The most common and most popular surgery for stress incontinence is the sling procedure. In this operation a strip of tissue is applied under the urethra to provide compression and improve urethral closure. The operation is minimally invasive and patients recuperate very quickly. The tissue used to create the sling can be a segment of the patient's abdominal wall, specially treated fascia, skin from a cadaver or a synthetic material.

Urge incontinence: For urge incontinence there is a large array of treatment options available. The first step should be behavior modification drinking less fluids; avoiding caffeine, alcohol or spices; not drinking at bedtime and urinating around the clock and not at the last moment. Exercising the pelvic muscle (Kegel exercises) also helps. It is important to keep a log on the frequency of urination, number of accidents, the amount lost, the fluid intake and the number of pads used if required. The mainstay of treatment for overactive bladder is medication. This consists of the use of bladder relaxants that prevent the bladder from contracting without the patient's permission. The most common side effect of the medication is dryness of the mouth, constipation or changes in vision. Sometimes, reduction of medication takes care of the side effects.

Other alternatives can be considered in patients who fail to respond to behavior modification and/or medication. A new and exiting technology is the use of a bladder pacemaker to control bladder function. This technology consists of a small electrode that is inserted in the patient's back close to the nerve that controls bladder function. The electrode is connected to a pulse generator and the electrical impulses control bladder function. In more difficult cases, the bladder can be made bigger using a segment of small intestine. This operation, called augmentation cystoplasty, is very successful in curing incontinence but its main drawback is the need in 10 to 30 percent of the patients to perform self-catheterization to empty their bladder.

Overflow incontinence:For overflow incontinence, the treatment is to completely empty the bladder and prevent urine leakage. Patients with diabetic bladder or patients with prostatic obstruction often develop this type of incontinence. Overflow incontinence due to obstruction should be treated with medication or surgery to remove the blockage. If no blockage is found, the best treatment is to instruct the patient to perform self-catheterization a few times a day. By emptying the bladder regularly the incontinence disappears and the kidneys are protected.

Learn about Urinary Incontinence in men.

Learn more about Kegel Exercises.

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