What is incontinence?
Urinary incontinence is the inability to stop urine leakage. Incontinence can be so embarrassing that it interferes with living a normal, full life. Men and women can suffer from incontinence.
Why is incontinence common?
If you have trouble controlling your bladder, you are not alone. Loss of bladder control is a common problem, shared by millions of Americans. Incontinence can rob you of sleep and leave you exhausted. It can make travel awkward and keep you from enjoying physical activity. Despite these frustrations, fewer than half the people with incontinence seek help. Many feel too embarrassed, while others don’t realize that help is available or rely on pads and reduced social activities.
Is incontinence treatable?
Yes. It is not normal to leak urine at any age and a wide range of effective treatments are available. The successful treatment of incontinence begins with an accurate diagnosis. Then you and your doctor can discuss your treatment options. These may include certain medications, exercises and other therapy to help strengthen muscles, procedures to help stop leakage, or surgery. Incontinence can be controlled and, in many cases, completely cured.
What tests are needed?
The first thing you need to do is talk to a urologist, who will ask you about your medical history and urinary habits. It’s important to understand when and under what conditions you experience loss of bladder control. You may be asked to keep a voiding diary to record when your bladder empties.
Next, you’ll have a physical examination that may include all or some of the following tests:
- Urinalysis – Examines urine for signs of infection, blood, or other abnormalities.
- Flow Rate Measurement – Voiding into a specialized commode.
- Post Void Residual (PVR) Measurement – Measures the amount of urine left in the bladder after urinating. (Done with painless ultrasound in our offices.)
- Cystoscopy – Using a flexible telescope to examine the bladder.
- Urodynamic Testing – Examines bladder and urethral sphincter function and pressures by inserting a small tube into the bladder.
- Xrays – may be used to see the bladder and kidneys.
What types of incontinence are there?
Incontinence occurs when the bladder is unable to relax and store urine, or when the bladder fails to empty totally, or when the sphincter muscle does not work properly. The main types of incontinence are Urge, Stress, and Overflow. There is also Mixed Incontinence, which is a combination of Urge and Stress. Each type of incontinence has a typical pattern of signs and symptoms, but the symptoms can overlap so appropriate testing and accurate diagnosis are essential to effective treatment.
Urge incontinence – Leakage associated with an uncontrollable urge to urinate due to a strong bladder contraction. If you don’t get to a bathroom in time, you may wet yourself. Often associated with frequent urination or “Overactive Bladder”.
- Stress incontinence – Leakage due to a weak sphincter muscle. Thus abdominal straining during cough, sneeze, or physical activity results in leakage, usually without an urge to urinate.
- Overflow incontinence – Leakage from a bladder that does not fully empty and dribbles out urine, or “overflows”. Usually no sense of urge to urinate and may mimic stress incontinence.
A note about bedwetting:
Bedwetting (nocturnal enuresis) is a common childhood condition that has its own set of evaluation and treatments. In very few cases it can continue into adulthood. Bedwetting can also be part of a more global incontinence problem such as those discussed in this section.
What causes incontinence in men or women?
There are many things that can prevent the urinary sphincter muscle and bladder muscles from doing their jobs.
- In men, blockage from an enlarged prostate can cause high bladder pressures or poor bladder emptying resulting in urge or overflow incontinence. A weak sphincter after prostate cancer surgery can cause stress incontinence.
- In women, a weak sphincter or dropping bladder can cause stress incontinence.
- In men and women of all ages problems with inflammation, infection, or poorly developed voiding reflexes can result in lifelong symptoms. Sometimes the individual thinks of these as “normal” for them or gives up seeking treatment.
Neurological disorders such as Multiple Sclerosis, strokes, and spinal cord injuries can disrupt the nerves that tell the muscles what to do. Anatomical abnormalities, congenital malformations, fistulas, and diseases of nearby pelvic organs can all lead to incontinence.
What can be done to treat incontinence?
The key to successful incontinence treatment is an accurate diagnosis of the underlying cause. Some of the treatment modalities that may be helpful include:
- Behavioral Therapy – Bladder retraining, time voiding, prompted voiding, and pelvic floor muscle exercises may decrease the frequency of incontinence in some individuals.
- Pelvic Floor Therapy – Monitored pelvic exercises and muscle stimulation can improve bladder and sphincter control in many situations.
- Medications – to aid in bladder or sphincter function
- Injectable Materials – Injections of a bulk-producing agent such as collagen may help close off a weakened sphincter.
- Surgery - If the incontinence is due to a blockage such as a stricture or enlarged prostate, a surgical procedure to correct the blockage may be needed. A prolapsed bladder can be surgically corrected by a number of different procedures. A weak sphincter can be treated with an implanted “sling” which acts as a support to the muscles around the urethra. An artificial urinary sphincter (AUS) can be implanted.
- Catheterization – Intermittent self-catheterization can provide effective emptying of a nonfunctioning bladder. Often reserved for those with permanent neurological disease.
- Neurostimulator Implant – A pacemaker-like device that can improve bladder function in special situations.
What do I do next?
You don’t have to live with incontinence. A visit to a qualified Urologist is a good first step.