What is urinary incontinence?
Urinary incontinence is the loss of bladder control. Some people experience urinary incontinence when coughing or sneezing, while others have an urgent need to urinate and can’t get to a toilet in time.
Urinary incontinence doesn’t cause severe symptoms but can greatly impact quality of life.
Urinary incontinence is a very common condition that affects more than 25 percent of Americans at some point in their lives.
Causes of urinary incontinence
Some people will experience temporary urinary incontinence from drinks, foods or medications that stimulate the bladder and increase urine production. Alcohol, caffeine, chocolate, chili peppers, artificial sweeteners or carbonated drinks can cause this to occur.
Treatable conditions that can cause urinary incontinence include:
- Urinary tract infection
Urinary incontinence can be a symptom of an underlying condition or changes including:
- Vaginal childbirth can weaken the muscles needed for bladder control or damage nerves in the bladder
- Aging bladder muscles can reduce the organ’s capacity to store urine
- After women go through menopause, they produce less estrogen, which keeps the bladder and urethra healthy
- The pelvic floor muscles can be damaged during a hysterectomy, which can cause incontinence
- An enlarged prostate can lead to urinary incontinence
- Untreated prostate cancer can cause stress or urge incontinence
Symptoms of urinary incontinence
Leaking urine is the primary symptom of urinary incontinence. Some people have mild incontinence, while others have severe incontinence.
Types of urinary incontinence include:
- Stress incontinence — urine leakage caused by coughing, sneezing, laughing, exercising or heavy lifting.
- Urge incontinence — intense urge to urinate followed by sudden urine loss. Urge incontinence can be caused by infection, diabetes or a neurological condition.
- Overflow incontinence — constant dribbling when bladder does not empty completely.
- Functional incontinence — physical impairment that reduces likelihood of getting to the toilet on time.
- Mixed incontinence — mixed incontinence occurs when you have multiple types of incontinence.
Diagnosis of urinary incontinence
Urinary incontinence can be diagnosed in an exam with your doctor. During the exam, your physician will perform a physical exam, take your medical history and order diagnostic procedures.
Your doctor may ask you to keep a voiding diary (log of when you went to the bathroom) to understand your situation.
Other tests include:
- Pad test — determines if the fluid loss is urine and not other fluids.
- Urine studies — studies, such as a urinalysis, cytology or chemistry 7 profile, may indicate conditions that may cause urinary incontinence.
- Post-void residual volume — determines how much urine is left in the bladder after urination.
- Cough stress test — your doctor may simulate coughing to determine how much fluid leaks when you cough.
Treatment for urinary incontinence
Treatment for urinary incontinence depends on the severity of your condition. If you have an underlying condition, your doctor will treat your condition first before moving to other treatments.
Before moving to more advanced treatments, your doctor will educate you on techniques that can help alleviate symptoms including:
- Bladder training
- Double voiding
- Scheduled toilet trips
- Fluid and diet management
- Pelvic floor muscle exercises
A variety of medications can be used to treat incontinence including:
- Anticholinergics — medications to calm an overactive bladder.
- Mirabegron — relaxes bladder muscle to increase amount of urine the bladder can hold.
- Alpha blockers — relaxes bladder and prostate muscles to allow bladder to empty.
- Topical estrogen — rejuvenates tissues in the urethra and vagina.
If medications and behavioral techniques are not effective, your doctor may recommend treatment with a medical device. Medical devices, such as a urethral insert or pessary, can help prevent urine leakage in women.
For severe cases of urinary incontinence, your doctor may recommend interventional therapies such as bulking material injections, botulinum toxin type A (Botox) or nerve stimulators. There are risks and benefits from these procedures, so your doctor will weigh all the options and develop a treatment plan for your case.
The most advanced cases of urinary incontinence may need surgical intervention.
Surgeries that can correct urinary incontinence include:
- Sling procedures — helps to keep urethra closed to treat stress incontinence.
- Bladder neck suspension — provides support to urethra to relieve symptoms
- Prolapse surgery — women with incontinence and pelvic organ prolapse may need prolapse surgery to correct damaged organs.
- Artificial urinary sphincter — men may experience symptom relief with this procedure meant to shut the urinary sphincter until you are ready to urinate.
Recovery from urinary incontinence
Recovery from urinary incontinence treatment will depend on the treatment protocol. Many patients experience life-long symptom relief with behavioral and medical therapies.
For those who have more advanced procedures, symptom relief can be achieved, but there could be major side effects.