Urinary Incontinence

So, just exactly what is urinary incontinence? Urinary incontinence (UI) is defined as the loss of urine control, or the inability to hold your urine until you reach a restroom. UI is very common, with more than 12 million people in the United States suffering with the condition. It affects both males and females, however postmenopausal women are the most likely to develop the problem. UI can range from the aggravation of slight losses of urine, to severe, frequent wetting.

What causes urinary incontinence? Although age alone is not thought to cause UI, the condition is very common in older people. This is probably because older people have had more time for disease or injury to occur, thus leading to the incontinence. UI can be caused by diseases which alter body function, the use of medications, trauma from childbirth, and/or the onset of an illness. Sometimes, incontinence is the first and only symptom of a urinary tract infection. Women experience incontinence twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, strokes, multiple sclerosis, and physical problems associated with aging.

What are the different types of urinary incontinence? Urinary incontinence has been classified into several types, as follows:

• Urge incontinence - Often referred to as “overactive bladder”, this type of incontinence is the inability to hold urine long enough to reach a restroom. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis, but may be an indication of other diseases or conditions that would also warrant medical attention.
• Stress incontinence - the most common type of incontinence that involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. With this type of incontinence, urine leakage occurs with increases in abdominal pressure (hence, mechanical “stress”)
• Functional incontinence - leakage due to a difficulty reaching a restroom in time because of physical conditions such as arthritis.
• Overflow incontinence - leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold it.
• Mixed Incontinence - When two or more causes contribute to urinary incontinence. Often refers to the presence of both stress and urge incontinence.

How is the cause for urinary incontinence diagnosed? If you are having problems with urinary incontinence, please see one of our physicians for an evaluation. They will perform a physical exam, check your bladder support, and will send a urine specimen to the lab for an analysis. They will often recommend urodynamic testing also, which can be performed right in our office. Urodynamics is a very detailed evaluation of your urinary function to help sort out the cause or causes for your incontinence. Yes, unfortunately, sometimes there is more than one cause for incontinence and it can become confusing to sort it all out.

What are the treatments for urinary incontinence? The treatment for your urinary incontinence will depend upon its cause. If you have poor muscle tone, then special bladder exercises, called Kegel exercises may be helpful. If your bladder is leaking because of bladder spasms, then medications may make a world of difference. If, on the other hand, your bladder is over-filling and you are unaware of this, you will need to have different medications and possibly exercise to help you empty your bladder better. If your bladder is falling down due to support problems, then a surgical bladder lift may fix the problem. If you have a combination of issues, then you will likely need multiple treatment approaches to help keep you dry. Your doctor will evaluate your bladder function very carefully, because if the wrong treatment is provided, it will most likely fail to correct your problem. A summary of the most common treatments is listed below:

• Exercises - Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure stress leakage. Women of all ages can learn and practice these exercises. Your physician can explain how these exercises are done. Most Kegel exercises do not require equipment.
• Biofeedback - Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
• Timed Voiding or Bladder Training - Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning—known as bladder training—can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow incontinence.
• Medications - Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally, as well as stimulate urethral wall growth, leading to increased closing pressure of the urethra.
• Pessaries - A pessary is a stiff ring that is inserted by a physician into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.
• Implants - Implants are substances injected into the tissues around your urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Implants can be injected by a doctor in about half an hour using local anesthesia. Implants have a temporary success rate because the injections must be repeated every few months because the body slowly eliminates the substances.
• Surgery - Most stress incontinence develops when the bladder and bladder neck lose their support and droop down into the vagina. Therefore, the most common surgeries for stress incontinence involve pulling the bladder up to a more normal position. Working through an incision in the vagina your doctor raises the bladder using either your ligaments or with a material to augment your ligaments. Often, the urethra and bladder neck need support too, and for these repairs, you may need a sling-like suspension of your urethra.
• Artificial sphincter - In rare cases, you may need an artificial sphincter implanted. This is a doughnut-shaped sac that circles the urethra. A fluid fills and expands the sac, which squeezes the urethra closed. By pressing a valve implanted under your skin, you can cause the artificial sphincter to deflate. This removes pressure from the urethra, allowing you to urinate.
• Catheterization - If you are incontinent because your bladder never empties completely (overflow incontinence) or your bladder cannot empty because of poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. Catheters may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.
• Other Procedures - Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.

Finally, many women who could be treated, resort instead to wearing absorbent undergarments, or diapers—especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss this with your physician He can help design a treatment program for you or help you get established with a urologist who specializes in bladder related issues.