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Incontinence

Video

Richard N. Medley, M.D. on Urinary Incontinence

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Urinary incontinence, or accidental loss of urine, is a relatively widespread problem, affecting as many as 20 million people in the U.S. It is twice as likely to occur in women as in men, due to physical differences between the genders and also to changes caused by pregnancy and childbirth.

The main types of incontinence are:

  • Stress incontinence, caused by actions that put pressure on the bladder, such as coughing, sneezing or laughing
  • Urge incontinence, defined as an overwhelming need to urinate and the inability to stop
  • Overflow incontinence, which is leakage that occurs because the bladder doesn’t empty properly
  • Mixed incontinence, which is a combination of stress and urge incontinence
  • Functional incontinence, due to physical or mental problems

Although incontinence becomes more common as people age, no one should assume that it is part of the normal aging process. There are a number of treatments, ranging from simple lifestyle changes to surgery, that can benefit most patients.

Causes

Stress incontinence
Stress incontinence is usually caused by weakening of the structures supporting the bladder, so that it moves downward to a position where the muscles that ordinarily keep the urethra closed cannot always maintain the necessary pressure.

Urge incontinence
Urge incontinence generally results when abnormal nerve signals cause the bladder to contract at inappropriate times. This can be caused by damage to the nervous system or to the nerves and muscles of the bladder, due to multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke or spinal injury or disease.

Overflow incontinence
Most common in men, overflow incontinence occurs when the bladder doesn’t empty completely and the remaining volume of urine overcomes the muscles used to retain it. This may be caused by a urinary tract blockage or weakened bladder muscles. It is often seen in diabetics and some patients with spinal cord injuries.

Mixed incontinence
A combination of stress and urge incontinence, mixed incontinence is the most common type for women. The combined causes include weakened muscles as well as abnormal nerve signals.

Functional incontinence
Usually occurring in physically or mentally disabled patients with normal bladder function, this type of incontinence is caused by their impairment, which makes it difficult to use the toilet appropriately without assistance.

Diagnosis

Your doctor will ask about your symptoms and medical history, and will examine you for signs of medical conditions that could cause incontinence. You may be asked to keep a diary of the times you urinate and to measure the amounts of urine.

Other tests may also be used to determine the type of incontinence you have. These include urine analysis; ultrasound imaging of the bladder, kidney and urethra; cystoscopy, which uses a microscopic camera to view the inside of the urethra and bladder; and urodynamic testing, which measures pressure in the bladder and the mechanisms that control the flow of urine.

Treatment

Treatment of incontinence depends on the type and severity of the problem. Simple lifestyle changes may help to improve some types of incontinence. These include limiting fluids at certain times or retraining the bladder by developing a schedule for trips to the bathroom. Kegel exercises are often recommended, to strengthen the pelvic muscles that help hold urine in the bladder.

Medication is sometimes prescribed to block the nerve signals that cause urgency and frequent urination, or to relax bladder muscles and prevent spasms. Your doctor will probably also review the medicines you already take, to find any that may contribute to bladder control problems and suggest changes that could solve the problem.

For patients who did not benefit from medication or lifestyle changes there is InterStim therapy. InterStim therapy modulates the sacral nerves with mild electrical pulses. This helps the brain and the nerves communicate so the bladder and related muscles can function properly.

Women whose incontinence is caused by weak pelvic muscles may benefit from injections of collagen or carbon spheres into the tissues around the bladder opening. The added material thickens the tissues and helps the urethra close more tightly. This type of incontinence may also be treated with a stiff ring called a pessary, which is inserted into the vagina to help support the urethra and pelvic muscles.

Surgery may offer relatively permanent relief from some types of incontinence. One technique involves implantation of a sling, or strip of material, anchored to bone to support the bladder, bladder opening and urethra to prevent urine leakage.

Women can use a catheter, either occasionally or long-term, to drain urine when the bladder does not empty properly for various reasons. Urinary diversion is a final resort if the bladder must be removed, or if bladder function is entirely lost due to disease or nerve damage. In this procedure, the ureters are redirected to a reservoir constructed from a piece of small intestine and urine is drained through an opening in the abdomen.

FAQ

What are some of the risk factors for incontinence?
The likelihood of developing urinary incontinence increases with age, and incontinence in general is most common in women. The exact causes vary, and are most often related to underlying conditions or diseases.

Are there any steps I can take to help prevent urinary incontinence?

  • Start a regimen of Kegel exercises to strengthen pelvic muscles
  • Maintain a healthy weight to reduce pressure in the abdomen
  • Don’t smoke
  • Stay physically active with moderate exercise
  • Increase the fiber in your diet
  • Avoid liquids that can be irritants, such as caffeine