Information and Treatment for Urinary Incontinence
What Is Urinary Incontinence?
Urinary incontinence is the loss of urine control, or the inability to hold your urine until you can reach a toilet. Urinary incontinence may be a temporary condition, resulting from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting. Urinary incontinence falls into six categories: stress incontinence, urge incontinence, incontinence without sensory awareness, overflow incontinence, mixed incontinence, and functional incontinence.
How Common Is Urinary Incontinence?
The American Urological Association estimates that as many as a quarter to one-third of adults in the United States – both men and women – have urinary incontinence. Incontinence is more common in women and prevalence increases with age, but it can happen in every age group. According to the National Association for Continence, approximately 25 million adult Americans experience temporary or chronic urinary incontinence.
What Are the Signs and Symptoms of Urinary Incontinence (UI)?
Among the most common symptoms of UI are:
- inability to urinate, which can cause overflow incontinence
- progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying
- more frequent urination without a proven bladder infection
- needing to rush to the restroom or losing urine if you do not get to a toilet in time
- abnormal urination or changes related to stroke, spinal cord injury, or multiple sclerosis
- urine leakage that interferes with daily activities
- leakage of urine that starts or continues after surgery or childbirth
- leakage of urine that causes embarrassment or decreased quality of life
- frequent bladder infections
The symptoms of UI may resemble other conditions or health problems. Always see your health care provider for a diagnosis.
What Causes Urinary Incontinence?
Common causes include:
- aging – while not an inevitable result of aging, incontinence is particularly common in older people
- changes in body function that result from diseases, use of medications, and/or the onset of an illness
- a urinary tract infection (incontinence may be the first and only symptom)
- pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles
- being overweight, which boosts pressure on the bladder and the muscles that control it
- nerve damage from spinal cord injuries, diabetes, Parkinson’s disease, and multiple sclerosis
- overactive bladder (the bladder squeezes at the wrong times and without warning)
What Are Some of the Different Types of Urinary Incontinence?
- Urge incontinence is the inability to hold urine long enough to reach a restroom. It can occur in people who have conditions such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis, but may be an indication of other diseases or conditions that would also warrant medical attention.
- Stress incontinence. The most common type of incontinence, this is leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other movements that put pressure on the bladder.
- Functional incontinence is leakage due to difficulty reaching a restroom in time because of physical conditions such as arthritis, mobility or dementia.
- Overflow incontinence, which is leakage that occurs when the quantity of urine produced exceeds the bladder's capacity. This can happen in patients with urinary retention.
How Is Urinary Incontinence (UI) Diagnosed?
To determine what kind of UI you have, your health care provider can use a variety of tests, including:
- blood tests
- measuring how much urine your bladder can hold
- checking the condition of your sphincter
- testing the pressure in your urethra
- measuring the amount of urine left in the bladder after you urinate
For people with urinary incontinence, it is important to consult a health care provider for a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and analysis of urine samples. In many cases, patients will then be referred to a urologist, a doctor who specializes in diseases of the urinary tract.
What Can I Do about Urinary Incontinence?
If you are a woman with stress incontinence, you can help control your condition by doing Kegel exercises to make the muscles around the neck of the bladder stronger. To do this exercise, you squeeze the muscles you use to control the flow of urine, hold for up to 10 seconds, then release. Aim to do three sets of ten each day.
The best way to handle urge incontinence is to use the bathroom on a regular schedule. This might be a half-hour after a meal, two to three times between meals, and before going to bed.
Special products and equipment are available. Absorbent underwear, which is no more bulky than normal underwear, can be worn easily under everyday clothing. Incontinence may be managed by routinely inserting a catheter into the urethra and collecting the urine in a container.
What Treatment Is Available for Urinary Incontinence?
Treatment for urinary incontinence depends on what type it is and what’s triggering it, as well as your age, your overall health and medical history, how well you can tolerate medicines or therapies, and other factors. Your physician will take all this into account when prescribing a course of action.
Among the approaches available are special exercises, biofeedback, bladder training, vaginal weight training, pelvic floor electrical stimulation, and surgery.
- Behavioral therapies
- Bladder training teaches people to resist the urge to urinate and to gradually extend the intervals between visits to the toilet.
- Toileting assistance uses routine or scheduled toileting, habit-training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
- Pelvic muscle rehabilitation
- Kegel exercises. Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. To do this exercise, you squeeze the muscles you use to control the flow of urine, hold for up to 10 seconds, then release. It is recommended to do at least three sets of ten repetitions every day for at least eight weeks.
- Biofeedback. Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
- Vaginal weight training. Small weights are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes twice daily for four to six weeks.
- Pelvic floor electrical stimulation. Mild electrical pulses stimulate muscle contractions; should be performed in conjunction with Kegel exercises.
- There are specific medications to treat incontinence, as well as estrogen therapy, which may be helpful in conjunction with other treatments for postmenopausal women who have urinary incontinence.
- Surgery is indicated if the incontinence is related to structural problems such as an abnormally positioned bladder, weak bladder, or a blockage.
- Diet modifications
- Incontinence may be lessened by eliminating bladder irritants such as caffeine in coffee, soda, and tea, and/or eliminating alcohol.
When Should I Make an Appointment with a Specialist?
For people with urinary incontinence, the most important step is talking to a health care provider about the problem so that you can get a precise diagnosis and an effective treatment plan. A urologist or urogynecologist can help you. The Women’s Medicine Collaborative has specialists who can help.