Urinary Incontinence
Urinary Incontinence
What is urinary incontinence?
- Leakage of urine
- Some women leak small amounts of urine
- At other times, leakage of urine is frequent or severe
Are there different types of urinary incontinence?
- There are several types of urinary incontinence:
- Stress urinary incontinence
- Loss of urine when a woman coughs, laughs, or sneezes
- Leaks also can happen when a woman walks, runs, or exercises
- It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra
- Urge incontinence
- Leakage of urine caused by overactive bladder muscles that contract too often or problems with the nerves that send signals to the bladder
- Mixed incontinence
- A combination of both stress and urge incontinence symptoms
- Overflow incontinence
- Steady loss of small amounts of urine when the bladder does not empty all the way during voiding
- It can be caused by an underactive bladder muscle or blockage of the urethra
- Stress urinary incontinence
What are the symptoms of urinary incontinence?
- In addition to leaking urine, a woman with incontinence also may have other symptoms:
- Urgency
- A strong urge to urinate whether or not the bladder is full, often with pelvic pressure
- Frequency
- Voiding more often than she considers usual
- Nocturia
- The need to void during hours of sleep
- Dysuria
- Painful voiding
- Enuresis
- Bed-wetting or leaking while sleeping
- Urgency
What causes urinary incontinence?
- Urinary incontinence can have short-term causes and long-term causes
- Short-term causes are easier to treat and include the following:
- Urinary tract infection
- Loss of bladder control may be caused by an infection of the urinary tract
- Infections of the bladder (cystitis) are common in women
- These infections are treated with antibiotics
- Medications
- Loss of bladder control may be a side effect of medications, such as diuretics
- Abnormal growths
- Polyps, bladder stones, or less commonly, bladder cancer, can cause urinary incontinence
- Abnormal growths often cause urge incontinence and may be associated with blood in the urine
- Urinary tract infection
- Short-term causes are easier to treat and include the following:
- If you see blood in your urine, or if you are unsure about the source of any bleeding, it is important to alert your health care provider right away
- Long-term causes include the following:
- Pelvic support problems
- The pelvic organs are held in place by supportive tissues and muscles
- These supporting tissues may become torn or stretched, or they may weaken because of aging
- If the tissues that support the urethra, bladder, uterus, or rectum become weak, these organs may drop down, causing urine leakage or making it hard to pass urine
- Urinary tract abnormalities
- A fistula is an abnormal opening from the urinary tract into another part of the body, such as the vagina
- It can allow urine to leak out through the vagina
- Neuromuscular problems
- These disorders can interfere with the transmission of signals from the brain and spinal cord to the bladder and urethra
- Pelvic support problems
How is urinary incontinence diagnosed?
- A number of steps may be needed to find the cause of urinary incontinence
- In some cases, there may be more than one cause
- You may be asked to keep a voiding diary for a few days in which you record the time and amount of urine leakage
- Also note how much liquid you drank and what you were doing when a leak occurred
- A pelvic exam will be done to detect physical conditions that might be linked to the problem
- Lab tests may also be done to detect a urinary tract infection
- Other tests that assess how your bladder functions include the following:
- Urodynamic tests
- The bladder is filled through a catheter
- These tests check the function of the urethra and bladder
- Postvoid residual volume test
- The amount of urine that is left in the bladder after urinating is measured with an ultrasound device or by placing a catheter in the bladder
- Stress test
- You are asked to cough a few times with a full bladder
- Any loss of urine is recorded
- Cystoscopy
- A thin, lighted tube with a lens at the end is used to look inside the bladder and urethra
- Dye test
- A pad is worn after a nontoxic dye is put in the bladder
- If the pad gets stained with the dye, there was a loss of urine
- Urodynamic tests
How is urinary incontinence treated?
- There are many options for treatment
- Often treatments are more effective when used in combination
- Treatment options include:
- Lifestyle changes
- Bladder training
- Physical therapy
- Devices, medications
- Bulking agents
- Surgery
What are some of the lifestyle changes that are used…
- Making the following changes in your lifestyle, if they apply to you, may help the problem:
- Lose weight
- In overweight women, losing weight has been shown to decrease the frequency of urine leakage
- Avoid constipation
- Repeated straining may damage the pelvic floor
- Drink less fluids and limit intake of caffeine, which is a diuretic
- Seek treatment for chronic coughing
- Stop smoking
- Lose weight
What is bladder training?
- It’s a procedure used to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3-4 hours during the day and every 4-8 hours at night)
- After a few weeks of this training, leakage may occur less often
What types of physical therapy are used to treat urinary…
- There are many types of physical therapy that can be done to treat urinary incontinence
- Kegel exercises can help strengthen the pelvic muscles
- Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in treating stress incontinence and urge incontinence
- If you have trouble doing Kegel exercises, you may want to see a physical therapist who specializes in women’s pelvic health
- Biofeedback is a training technique that may be useful if you have problems locating the correct muscles
How are Kegel exercises done?
- Kegel exercises tone your pelvic muscles
- Here is how they are done:
- Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating)
- Hold for up to 10 seconds, then release
- Do this 10-20 times in a row at least 3 times a day
- Do not squeeze the muscles of the leg, buttock, or abdomen
- Do these exercises on a regular basis
- It may take 4-6 weeks to notice an improvement in urinary incontinence symptoms
What devices are used to treat urinary incontinence?
- A pessary is a device that is inserted into the vagina to treat pelvic support problems and urinary incontinence
- Pessaries support the pelvic structures, and some compress the urethra
- They come in all shapes and sizes
- They are useful for women who do not want or cannot have surgery to correct their incontinence
What medications are used for treatment?
- Drugs that help control muscle spasms or unwanted bladder contractions can help prevent leaks associated with urge incontinence
- These medications also can help reduce the frequency of urination
- Your health care provider will help you decide which drug is most likely to work best for you
What are bulking agents?
- These agents may be used when the muscle surrounding the urethra is very weak and extensive surgery is not an option or has not worked
- A substance is injected into the tissues around the urethra to add bulk
- The urethra becomes narrowed, decreasing leakage
- This procedure can be done in a doctor’s office or clinic
What types of surgery treat urinary incontinence?
- Several surgical procedures have been developed to treat stress urinary incontinence
- You and your health care provider should discuss many factors, including your age, lifestyle, and general health, before choosing to have surgery
