Urinary incontinence at a glance
- Urinary incontinence is the uncontrollable loss of bladder function resulting in urine leakage.
- Urinary incontinence affects around 15 million Americans, with women accounting for about 85 percent of cases.
- Urinary incontinence may be the sign of an underlying issue.
- Many cases of urinary incontinence respond to lifestyle changes, including maintaining a healthy weight, exercising pelvic floor muscles, proper diet and bladder-control training.
- Medications and surgery can be used to treat more difficult cases of incontinence.
What is urinary incontinence?
Urinary incontinence is loss of bladder control that causes leakage of urine. Some experience minor to mild incontinence, for example small leaks of urine during a sneeze. Others have more severe forms and may wet their clothes frequently, inhibiting lifestyle and daily activities.
Urinary incontinence is very common, with about 15 million Americans experiencing some symptoms. Many people feel too embarrassed to talk to their doctor about it, so the 15 million estimate is probably low.
Women have urinary incontinence more often than men and account for 85 percent of cases. Age also plays a role in urinary incontinence, as the bladder may hold less urine and bladder and urethra muscles weaken.
Urinary incontinence is broken down into different types, based on the symptoms the patient experiences (read more about symptoms below).
Urinary incontinence is not an inherent part of aging and does not mean that an individual needs to wear a pad or an adult diaper. Knowing what causes incontinence helps develop a baseline understanding and treatment plan.
Causes of urinary incontinence
Urinary incontinence is an indicator of a larger bodily issue and is not a disorder in itself. Issues that increase the likelihood of urinary incontinence include:
- Urinary tract infections
- Constipation, which can affect bladder function
- Pregnancy and childbirth
- Weakened pelvic floor muscles in women caused by menopause and hysterectomies
- Menopause causes a drop in women’s levels of estrogen, a hormone that maintains healthy bladder tissues
- An obstruction of the urinary tract, for example a tumor or urethral stricture
- Neurologic issues, such as stroke, spinal cord injury, etc.
- Enlarged prostates and prostate cancer in men.
- Men undergoing prostate cancer radiation treatment or after a prostatectomy may experience stress incontinence as a side affect.
Symptoms and types of urinary incontinence
There are several common types of incontinence, based on the extent of the loss of control over urinary functions. These include:
- Stress incontinence. This occurs when the bladder is pressured from an unrelated action such as sneezing, exercising or laughing.
- Urge. Sudden and un-ignorable urges to use the bathroom day or night, followed by involuntary urination.
- Overflow. When the bladder fails to empty fully and causes frequent future trips to the bathroom. This is caused by something blocking the urine from leaving the bladder normally.
- Functional. A patient with functional incontinence experiences a physical or mental block that is unconnected to the urinary tract. Diseases, such as Parkinson’s or Alzheimer’s, may cause functional incontinence.
- Mixed. Urinary incontinence due to a combination of a couple of symptoms.
Diagnosing urinary incontinence
A physical exam and review of complete medical history is the usual first step in diagnosis. Other diagnostic efforts include:
- Urinalysis can reveal infection or indicate other abnormalities
- Voiding measurements involve the patient emptying the bladder, and the physician using ultrasound or a catheter to measure urine left in the bladder
- Daily diary recording how often the patient urinates, how much urine is produced, and notes about urges and accidents
- Cystoscopy, viewing the urinary tract with a tiny camera inserted through the urethra
- Cystogram involving dye and x-ray images to evaluate urinary tract problems
- Urodynamic testing to evaluate bladder strength and urinary sphincter.
Treating urinary incontinence
Treatment of urinary incontinence depends on the type of incontinence diagnosed. Most treatment plans will begin with the least invasive efforts and focus on non-medical behavioral changes. If these do not work or if the initial diagnosis calls for more aggressive treatment, other procedures, medications or surgery may be used.
Patients may make several daily activity changes that will likely improve their incontinence, including:
- Re-training the bladder by waiting to go to the bathroom for about 10 minutes after the urge presents. The patient then slowly increases the time of delaying urination, with the goal of urinating every 2-4 hours.
- Double voiding, which is urinating, waiting a minute or so, then trying to empty the bladder once more. This helps to more completely empty the bladder.
- Scheduling urination for preset times rather than waiting for the urge.
- Exercising pelvic floor muscles with Kegel exercises to strengthen muscles that control urination
- Intake management and exercise, including maintaining a healthy weight, general exercise, drinking fewer fluids, and restricting intake of alcohol, caffeine and acidic foods.
Specific recommendations for stress incontinence
- Behavioral therapy and pelvic floor training (+/- biofeedback) noted above.
- Occasionally a provider will prescribe medications to tighten the urethral sphincter.
- Bulking injections add synthetic matter to tissues around the urethra to help support it and reduce urinary leakage.
- If pelvic organ prolapse is noted, the doctor may recommend using a pessary, which is a ring used all day that a woman inserts into the vagina to hold up the bladder and prevent leakage.
- Surgical options (see below).
Specific recommendations for urge urinary incontinence
- Behavioral therapy as noted above
- Medications: common medications prescribed to treat urinary incontinence might include:
- Anticholoingergics to help with overactive bladder
- Mirabegron for urge incontinence
- Alpha blockers relax the bladder and prostate muscles in men experiencing overflow or urge incontinence
- Topical estrogen cream for women can reduce some symptoms.
- Nerve stimulation: a pacemaker-like device can be inserted under the skin to stimulate nerves that control the bladder.
- Botox: Botox injections may also be used for people who have an overactive bladder.
When less invasive treatments for incontinence fail to provide results, surgery may be an option for some patients with stress urinary incontinence.
A common surgery performed to correct stress incontinence is a sling insertion. Body tissue, mesh or synthetic material creates a sling surrounding the urethra that ensures the urethra remains closed during non-urinating actions, such as laughing and sneezing.
For extensive urinary incontinence, an artificial urinary sphincter for men may be placed. This is a small ring filled with fluid and surgically placed around the bladder. When the patient would like to empty his bladder, he presses a valve placed under the skin that will cause the ring to deflate and allow urine to flow from the bladder.
Other surgical treatments include, prolapse surgery for women with pelvic organ prolapse (an organ drops out of proper position) and suspension of the bladder neck to provide support for the bladder neck and the urethra.