Urinary incontinence is the loss of bladder control.  Essentially, it is the inability to hold urine in the bladder.  It is a common problem more among women than men whose primary symptom is the leakage of urine when you don’t want to.  The severity of urinary incontinence depends on the type of incontinence:

Stress Incontinence:  The involuntary release of urine during period of increase abdominal pressure (stress). Such events include laughing, sneezing, coughing or lifting heavy objects.

Urge Incontinence:  Loss of urine due to the frequent, sudden, and intense urge to urinate without control.  Your bladder contracts involuntarily, warning you only a few seconds to a minute to reach the toilet.    

 


Causes:

Urinary incontinence is a symptom to an underlying condition; whether it’s your everyday habits, a physical problem, or a medical condition.  Some conditions cause temporary symptoms that may require you to change your habits or seek the appropriate treatment.  Other conditions cause more severe or persistent urinary incontinence symptoms. 

Temporary Causes:

  • Alcohol
  • Overhydration
  • Caffeine
  • Bladder irritation (from carbonated drinks, tea, coffee, artificial sweeteners, corn syrup, foods and beverages that contain spices, sugar, acid)
  • Medication
  • Urinary tract infection (once infection is treated with antibiotics, symptoms subside)
  • Constipation (once treated, symptoms subside)

Persistent Causes:

  • Pregnancy
  • Aging
  • Hysterectomy
  • Interstitial Cystitis
  • Prostatitis
  • Enlarged Prostate or BPH
  • Prostate Cancer
  • Bladder Cancer or Bladder Stones
  • Neurological Disorders (Multiple sclerosis, Parkinson’s disease, stroke, brain tumor, spinal injury)

 


Workup/ Diagnosis:

Temporary causes are ruled out with a series of questions regarding your everyday habits. 

Tests include:

  • Urinalysis.  Checks for blood and screens for bacteria (infection) in the urine
  • Blood test.  Checks for abnormalities related to causes
  • Bladder Scan.  Measures post-void residual (PVR) or how much urine is left in the bladder after urinating
  • Pelvic Ultrasound.  Checks urinary tract and genital for potential abnormalities
  • Urodynamic Study (UDS).  Study that measures bladder capacity, flow rate and bladder muscles (essentially measures how your bladder functions or works)
  • Cystogram.  X-ray of your bladder to reveal any issues with your urinary tract.
  • Cystoscopy.  Flexible catheter with camera inserted through the urethra into the bladder to check for any abnormalities within the bladder

 


Treatment Options:

Treatment is relative to the type of incontinence, the underlying cause, and its severity.

Non-Invasive Treatment:

  • Fluid and Diet Control.  If your incontinence relates to your daily habits, your doctor will advise you to cut back on these habits to regain control. 
  • Bladder Training.  Prolonging the time between each trip to the bathroom by controlling the urges to urinate.  It involves holding off for about ten minutes at the initial urge until you are capable of urinating ever 2 to 4 hours.
  • Pelvic Floor Muscle Exercise (or Kegal exercise).  Involves working out your Kegal muscles to strengthen your urinary sphincter and pelvic floor muscles responsible for holding in urine.
  • Biofeedback.  Using electronic devices to track when bladder and urethral muscles contract, control over these muscles can be gained. Biofeedback can be used with pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.

Medications:

  • Anticholinergic.  Used to calm an overactive bladder, which can also help with urge incontinence

Interventional Therapy:

  • InterStim Therapy.  A therapy used in treating urinary retention and symptoms of overactive bladder, including urinary urge incontinence and urgency-frequency. Therapy uses a small implanted device to send mild electrical pulses through a thin wire to the sacral nerve, which controls the bladder and surrounding muscles.

Surgery:

  • Sling procedures.  Surgical methods for treating urinary incontinence involving the placement of a sling, made either of tissue obtained from the person undergoing the sling procedure or a synthetic material. The sling is anchored to retropubic and/or abdominal structures.