Urinary Incontinence

Urine is produced by the kidneys and stored in the bladder. When there is an urge to urinate, the sphincter muscles relax, and the bladder contracts, allowing urine to exit the body via the urethra.

Loss of bladder control, or leaking urine, is referred to as urinary incontinence. Incontinence can occur when the bladder muscles contract suddenly and the sphincter muscles cannot close the urethra. This generates an intense urge to urinate that may be uncontrollable. You may leak a small amount or release a large amount all at once with urinary incontinence.

Types of Urinary Incontinence

There are different types of incontinence, and each causes various symptoms.

Stress incontinence

Stress incontinence occurs when urine leaks when pressure is put on the bladder during activities such as running, jumping, or lifting. Many people experience leakage when they laugh, cough, or sneeze.

If pelvic muscles are weak, urine leakage is more likely to occur. Women who have given birth are prone to stress incontinence. Stress incontinence is also a possibility for men who have undergone prostate surgery.

One item to note is that stress incontinence name for the problem being related to mechanical stress (pressure) and not psychological stress.

Urge incontinence

Urge incontinence is defined by a strong desire to urinate immediately. This frequently happens so suddenly that it’s not easy to reach the bathroom in time. Overactive bladder (OAB) is a condition that can cause urge incontinence.

OAB is caused by various factors, including weak pelvic muscles, infection, nerve damage, menopause, and being overweight. Alcohol and caffeine consumption and some medications can also lead to urge incontinence.

Overflow incontinence

Overflow incontinence can occur if the bladder is not empty after urinating. Because their bladders are never completely empty, people with overflow incontinence are prone to urine leaks.

Overflow incontinence typically results in small amounts of urine leaking out over time rather than a single large quantity. Overflow incontinence is more common in those who have chronic conditions such as diabetes, multiple sclerosis, or an enlarged prostate.

Post-void dribbling

Post-void dribbling (PVD) is the leaking of urine remaining in the urethra after emptying the bladder. It causes wetness shortly after the person finishes urinating but not at other times.

Mixed incontinence

Stress incontinence and an overactive bladder can be present at the same time, which is known as mixed incontinence. It is essential to pay close attention to what activities or circumstances cause leakage problems. Identifying its causes is often the most effective treatment for mixed incontinence.

Risk Factors for Urinary Incontinence

Risk factors that increase your risk of developing urinary incontinence include:

• Pregnancy and childbirth
• Nerve damage, from pelvic or back surgery, or herniated discs
• Parkinson's disease, multiple sclerosis, or a stroke
• Medications, alcohol, and caffeine
• Urinary tract infection (UTI)
• Overweight and obesity
• Estrogen deficiency after menopause
• Diabetes
• Prostate surgery
• An enlarged prostate (benign prostatic hyperplasia)
• Uterine prolapse

Diagnosis of Urinary Incontinence

Although it can be challenging to discuss, talking about urinary incontinence with your doctor is the first step toward getting treatment. Your doctor will want to know certain things, such as:

• How long you have experienced urine leakage
• If leaking occurs after a sudden urge, with sneezing or coughing, or without warning
• What medications you are taking
• If symptoms are worsening, or if you are experiencing bladder or back pain or blood in the urine

Tests can be performed to assess urinary incontinence and may include:

• Bladder stress test: You will cough or bear down while the doctor monitors for urine loss.
• Urinalysis: Evaluation of urine and a urine culture to screen for bacteria, blood, or other problems.
• Cystoscopy: The doctor uses a small camera to examine your urinary tract.
• Urodynamic testing: Tiny catheters assess how much urine your bladder can hold, what causes you to leak urine, and whether you have problems emptying the bladder. It also measures how much urine is left over after you urinate.

You may also be asked to keep a bladder diary for two to three days to track fluid consumption, bathroom visits, and urine loss.

Treatment for Urinary Incontinence

Treatment options depend on what type of incontinence you have.

Bladder Retraining

With this method, a prescribed urination schedule is followed to help the bladder coordinate itself. The time between bathroom breaks is gradually extended until a more normal schedule is achieved.

Pelvic Floor Physical Therapy

Strengthening weak pelvic floor muscles can help improve incontinence symptoms. Also called Kegel exercises, when performed regularly, they can be enough to treat some types of incontinence on their own.

Medications

Depending on the cause of urinary incontinence, medications may help. Some are prescribed to relax the bladder muscle and prevent them from contracting when it’s not time to urinate.

In men who have urinary incontinence due to prostate problems, medications may help improve urine flow.

Botox injections

Botox bladder injections are a minimally invasive treatment for urge incontinence. It keeps the bladder from contracting like medications but without side effects. This may be most helpful for women who cannot tolerate certain medications.

Surgery

Surgery can be performed to support the bladder, improve urine flow, and repair muscles that control urine flow. For example, a sling made from synthetic material or your own tissue can be placed to lift up and support the bladder to treat stress incontinence.

Percutenous Tibial Nerve Stimulation (PTNS)

PTNS is a non-surgical, in-office procedure that uses electrical stimulation of a nerve in the lower leg. The tibial nerve that is targeted is connected to the nerves that control bladder function. Stimulation of these nerves can help regulate improper nerve function that causes an overactive bladder.

InterStim

Interstim is a type of PTNS where a small device is permanently implanted to stimulate the nerves that control bladder function. This is a good treatment option for women who have not had successful outcomes with other types of treatments.