Urinary Incontinence

Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom. Incontinence can range from the discomfort of slight losses of urine to severe, frequent wetting. Millions of people experience incontinence and it can have a profound impact on their quality of life.

Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that can result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection.

Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.

Types of Urinary Incontinence

• Urge incontinence, the inability to hold urine long enough to reach a restroom, is associated with a sudden, intense desire to urinate that cannot be resisted. It can be caused by neurological conditions such as stroke, dementia, Parkinson's disease, and multiple sclerosis, but it can also develop in patients without neurological diseases. Problems with bowel movements can also cause urge incontinence.
• Stress incontinence involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is one of the most common types of incontinence, particularly in women. In men, surgery on the prostate can cause stress incontinence.
• Overflow incontinence is leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold it. This type of incontinence generally develops when a person is unable to empty completely on a regular basis. Patients often complain of persistent dribbling, or urinating small amounts but not feeling empty.
• Mixed incontinence usually refers to both stress and urge incontinence, but can refer to any combination of types of incontinence.
• Functional incontinence is a medical condition that prevents a person from making it to the bathroom in time to urinate, resulting in incontinence. Common examples include physical impairments such as arthritis, which make it difficult to move quickly enough to reach a restroom in time, or mental impairments such as dementia, which prevent a person from realizing when they need to urinate.
• Total incontinence is persistent, continuous incontinence that can occur as a result of anatomic abnormalities or injuries that develop during surgery.

Evaluation of Urinary Incontinence

Incontinence is a common condition but one that should not be ignored. Individuals suffering from incontinence should see a doctor because there are a number of treatment interventions that can dramatically improve their urinary control. Doctors often ask patients to fill out a voiding diary, or a frequency/volume chart, to establish urinary patterns. They may perform a urinalysis to rule out an infection or other problems. They may perform a bladder ultrasound or scan after voiding to ensure that the patient is emptying his/her bladder completely. They may perform a cough stress test to investigate whether stress incontinence exists. More sophisticated testing includes video-urodynamics (also called a bladder function test). This highly sophisticated evaluation allows the doctor to determine bladder capacity; whether the bladder is spasming while it is filling; whether incontinence is present; and whether bladder pressures are appropriate. They can also analyze the voiding pattern analyzed with this test, and get an X-ray of the bladder.

Treatment for Urinary Incontinence

Our urologists tailor treatment for each type of diagnosed incontinence.  Treatment approaches include:

• Behavioral therapies to help people regain control of their bladder. Therapies include bladder retraining to teach people to resist the urge to void and to gradually expand the intervals between voiding; routine or scheduled toileting; habit training schedulesl; and prompted voiding to help people empty their bladders regularly to prevent leaking.
• Pelvic muscle rehabilitation to improve pelvic muscle tone and prevent leakage, including Kegel exercises. If done regularly, these exercises of the pelvic muscles can improve, and even prevent, urinary incontinence. Biofeedback used in conjunction with Kegel exercises helps people gain awareness and control of their pelvic muscles. Pelvic floor electrical stimulation is electrical stimulation using mild pulses to spur muscle contractions. This should be performed in conjunction with Kegel exercises.
• Medication, including antimuscarinic agents to treat urge incontinence (Detrol LA, Ditropan XL, Enablex, Oxytrol, Sanctura, and Vesicare). In postmenopausal women, estrogen may be used to help control urge incontinence.
• Surgery,  including implantation of bulking agents to support the bladder neck for stress incontinence; implantation of InterStim - a pacemaker-like device to control the bladder- for urge incontinence. In women, vaginal sling procedures are used to support the urethra and bladder, and to treat stress incontinence.
• Dietary modifications, including eliminating caffeine in coffee, soda, and tea, and/or eliminating alcohol.