What is Urinary Incontinence?
Urinary incontinence refers to an inability to manage or control urine leakage. Types of incontinence can be small and sporadic or heavy and frequent. Urinary incontinence is a common and, most often, an embarrassing problem. The severity ranges from an occasional leakage of urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time.
Though it occurs more often as people get older, urinary incontinence isn’t just a consequence of aging. If urinary incontinence affects your daily activities and quality of life, don’t hesitate to see your doctor. For most, simple lifestyle changes or medical treatment can ease discomfort or manage, even stop, urinary incontinence.
Urinary incontinence is a symptom, not a disease. It can be caused by everyday habits, underlying medical conditions, or physical problems. A thorough evaluation by your health care doctor can help determine what’s behind your incontinence.
Types of Urinary Incontinence:
Slow, minor leakage of urine after urinating. This can occur when the urethra is blocked or when the bladder muscles fail to completely empty the bladder.
Also known as an overactive or spastic bladder, urge incontinence is a type of incontinence that results from an immediate, strong urge to urinate. This happens when a muscle spasm contracting the bladder overpowers the sphincter muscles that regulate the flow of urine through the urethra.
Stress urinary incontinence
With Stress, Urinary Incontinence, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is most common in older women and less so in men. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.
A physical or mental impairment keeps you from making it to the toilet in time. For example, with severe arthritis, you may not be able to unbutton your pants quickly enough.
You experience more than one type of urinary incontinence.
Symptoms of Urinary Incontinence
Many people experience occasional, minor leaks of urine. Others may lose small to moderate amounts of urine more frequently.
Women with urinary incontinence can experience symptoms beyond the leakage of urine. It’s important to note which symptoms are affecting you so that you can relay the information to your gynecologist. Some symptoms include:
- Frequency – Urinating more often than normal
- Urgency – The urge to urinate, even if the bladder is empty
- Feelings of pressure or discomfort in the lower abdomen
- Dysuria – Pain or burning while urinating
- Nocturia – The need to get out of bed to urinate several times a night
- Enuresis – Urinating the bed while asleep
Causes of Urinary Incontinence
Many different medical conditions may cause urinary incontinence. Some of these conditions are easy to treat, while others may require intensive intervention or have long-lasting effects. Urinary incontinence in women is often with pregnancy. Some of these underlying physical medical conditions include:
- Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
- Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor.
- Aging. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, the older you get, involuntary bladder contractions become more frequent.
- Menopause. Women produce less estrogen after menopause, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
- Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman’s reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
- Enlarged prostate. Incontinence in older men often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
- Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer.
- Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence.
- Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor, or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
Not all incontinence is long term. Some causes are temporary, and incontinence ends when the cause is addressed. Vaginal infections can cause temporary incontinence. Irritation, medications, constipation, and restricted mobility can cause it. Urinary tract infections (UTIs) are a common cause of temporary incontinence and should be addressed immediately.
Some medications have urinary incontinence as a side effect. These drugs are also known as diuretics. Most patients regain control of their bladder once they are off the medication.
Urinary tract infections (UTIs)
Urinary tract infections are fairly common in women. There are some preventative measures you can take to reduce your risk of a bladder infection or a UTI, and they can usually be treated with antibiotics.
Polyps, tumors, and bladder stones may cause urinary leakage, especially urge incontinence. These growths can usually be treated with the help of your doctor.
Abnormalities in the urinary tract
A urinary fistula is an abnormal opening between a urinary organ and another proximal organ. Urine may leak out of this abnormal opening (i.e., through a fistula in the vagina).
Pelvic organ prolapse.
A healthy pelvis contains strong tissue that supports the organs and keeps them in place. In some patients, these tissues and muscles can weaken and cause the bladder, urethra, uterus, or rectum to prolapse, causing urinary leakage and other problems. This condition is sometimes treated with surgery or with a supportive device known as a pessary.
Urinary incontinence is sometimes caused by a lapse in the brain’s ability to communicate with the bladder and urethral muscles.
Diagnosing Urinary Incontinence
Because urinary incontinence could be an indication of several very different medical conditions, diagnosing the cause can be tricky. If you’re having difficulty controlling your bladder during the day or night, make an appointment with your OB-GYN.
It is a good idea to keep a bladder diary of your symptoms, noting the time of day and amount of urine you leaked or voided. If you experienced a leak, write down what you were doing at that time. You’ll also want to take note of your liquid intake and any medications you’re using.
At your appointment, your doctor may conduct a combination of tests, including:
Your doctor will check for physical abnormalities or any other possible causes of your incontinence.
Your doctor will have you cough with a full bladder to observe any leakage.
Postvoid residual volume test
After urinating, your doctor will use an ultrasound or a catheter to measure the amount of liquid left in your bladder.
Your doctor injects a special dye into your bladder and has you wear a sanitary pad. The amount of dye leaked onto the pad can help your doctor diagnose the severity of your incontinence.
Your doctor inserts a narrow, flexible tube into your urethra. The lens at the end allows your doctor to see inside your urinary tract and bladder.
Urinary Incontinence Treatment Options
Depending on the cause of your condition, you may have several options to treat your urinary incontinence.
Some cases of urinary incontinence can clear up with a few lifestyle changes. These include:
- Drinking less fluid, especially caffeinated drinks
- Quitting smoking
- Losing excessive weight (for overweight women)
- Avoiding constipation through diet changes and supplements
- Treating stressors such as chronic coughing
You can also talk to your OB-GYN about therapeutic and medical interventions, such as:
Physical therapy for urinary incontinence can include a few different strategies. You may be asked to change your fluid intake and practice pelvic muscle exercises, such as Kegel exercises to strengthen your pelvic floor muscles. Your physical therapist will also show you techniques for bladder training. This is to reduce the frequency of the urge to urinate to normal levels (about every 4 hours during the day and between 4-8 hours at night). Your therapist may employ a technique called biofeedback to teach you how to monitor your body’s natural signals.
If urinary incontinence is caused by overactive bladder muscles, then there are some medications that can help keep the muscular contractions under control.
Bulking agents are substances that are injected into the tissues surrounding the urethra. They can add support and bulk to the tissue and shrink the urethral opening. This helps stop the flow of urine.
A pessary is a small, doughnut-shaped device that is inserted into your vagina to help provide support for prolapsed pelvic tissue and organs. Some devices can put pressure on the urethra, aiding in the prevention of leaks. A pessary is a good choice for women who may not be good candidates for surgery.
There are a number of procedures that can improve urinary incontinence. Your OB-GYN can discuss the options that are right for you based on the cause of your condition, your age, and your overall health.