What is urinary incontinence?
Urinary incontinence is the uncontrolled loss of urine.
Under normal conditions, the bladder stores urine until it is voluntarily released. This involves a complex interaction between the brain, spinal cord, bladder and support structures in the pelvis. Anything that interferes with this interaction or causes damage to the support tissues can result in a person developing urinary incontinence.
This condition is much more common than most people think occurring in greater than 40% of American women. The condition should not be considered a normal part of the aging processes and occurs in all age groups. In fact recent studies show that urinary incontinence is becoming quite prevalent among younger women.
Although not a life-threatening problem, urinary incontinence does have negative social implications. You may be obsessed by fear of urine loss, concerned about urine odor and worried about being excluded socially. You may feel you are no longer attractive and even lose your sense of sexuality. You may stop exercising or fail to start a weight loss program because of fear of losing urine while exercising. Feeling alone and isolated, some women may distance themselves from their spouses, family members and relatives. Some individuals may restrict or avoid excursions outside the home, social interaction with friends and family. Others will avoid sexual activity because of the fear of loss of urine.
If you suffer from bladder control issues the following sections will help inform you on the different types of urinary incontinence. This information will allow you to better understand the type of urinary incontinence you suffer from. Being better informed will help guide you in deciding what type of treatment would be best for you. In the great majority of situation urinary incontinence can be corrected or significantly improved. Physicians that specialize in the diagnosis and treatment of urinary incontinence have the training and knowledge to help you with this condition.
Types of urinary incontinence
Stress, urge and mixed are the most common types of urinary incontinence. Less-common types are overflow and functional
- Stress incontinence happens during certain activities, like coughing, sneezing, laughing or exercise.
- Urge incontinence involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate.
- Mixed incontinence contains components of both stress and urge incontinence.
- Overflow incontinence happens when you experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
- Functional incontinence is when a physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough to get to the bathroom.
Diagnosing your condition
You may feel uncomfortable discussing urinary incontinence with your doctor, but if incontinence is frequent or affects your quality of life, it's essential to seek medical advice. Urinary incontinence may:
- Cause you to restrict your activities and limit your social interactions
- Negatively impact your quality of life
- Increase the risk of falls in older adults as they rush to the toilet
- Indicate a more serious underlying condition
Your physician will review your medical history and symptoms and ask various questions about what you are experiencing. You may have a physical exam where your doctor examines your pelvic floor muscles and evaluates your ability to control them. The physical exam may also include a rectal or vaginal examination to help determine the proper urinary incontinence treatment.
Your physician may choose to run other evaluations, including urodynamic tests to determine how well certain muscles work together or a cystoscopy to examine the lining of the bladder and urethra.
Non-surgical urinary incontinence treatments
For many, surgery isn't required to treat urinary incontinence successfully.
Behavioral methods
One type of urinary incontinence treatment involves behavioral methods. Techniques including bladder training, timed urination, pelvic floor exercises and relaxation techniques, like meditation and warm baths, can all contribute to better control of pelvic floor muscles.
Injections
Botox can treat an overactive bladder, and calcium can treat urinary incontinence by narrowing the urethra.
Lifestyle modification
Weight loss and dietary changes—such as reducing caffeine consumption and increasing the amount of water you drink—and adopting a regular exercise routine that includes targeted pelvic muscle exercises can lead to better pelvic health and lessen the impact and longevity of pelvic floor disorders, which may cause urinary incontinence.
Medication
Certain oral medications, including anti-diarrheal medications, muscle relaxants and other prescription drugs, can help alleviate symptoms of urinary incontinence.
Oxybutynin (ditropan), Vesicare, Myrbetriq, Tofranil (imipramine), Levsin SL, B and O suppositories for overactive bladder. Flomax, Tenex (guanfacine) and Valium for overflow incontinence caused by urinary retention.
Pelvic floor therapy
Pelvic floor therapy effectively corrects weak muscles and joint alignment problems that often cause pelvic floor disorders. It can help alleviate the pain, pressure and discomfort associated with urinary incontinence.
Physical therapists will introduce exercise and therapy to help strengthen weak pelvic floor muscles, decrease urinary frequency and allow better control over urinary and bowel functions.
Support devices
Devices, such as a vaginal pessary, can help keep pelvic organs in place when prolapse occurs, and they can also help women with stress urinary incontinence.
A pessary is inserted into the vagina to help support the uterus, vagina, bladder or rectum as a type of urinary incontinence treatment.
Surgical treatment options for urinary incontinence
Surgery is typically reserved for when non-surgical techniques have not improved your condition.
When recommending surgery as an option to treat urinary incontinence, your doctor will consider your medical history, personal preferences and general health. In many cases, less-invasive surgical options are available, such as laparoscopic or robotic surgery, which often support faster recoveries.
Surgical options to treat urinary incontinence include:
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Transvaginal sling
Strips of synthetic mesh or your own tissue are surgically inserted to create a sling under the urethra or under the muscle where the bladder connects to the urethra. The sling helps to support the urethra and keep it closed to prevent urine leakage.
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Sacral neuromodulation
This surgically implanted device treats overactive bladder and urinary incontinence. A neurostimulator is inserted just above the waistline that sends electrical pulses to an electrode inserted in the lower back, which controls the bladder and bowel control nerve.
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Vesicovaginal fistula removal
A vesicovaginal fistula is an abnormal connection between the bladder and the vagina that allows urine to leak. With this kind of urinary incontinence treatment, the surgeon removes the fistula and closes the opening.