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Urinary Incontinence

Urinary Incontinence, or UI, isn’t unusual.

The National Association for Continence estimates that more than 25 million adults in the U.S. experience temporary or chronic bladder leakage daily. While UI is more common in women over 50 than in other segments of the population, it can happen to anyone.

And unfortunately, people with UI deal with daily bladder control issues that can negatively impact life.

What Causes Urinary Incontinence?

The urinary system consists of the bladder, kidneys, ureters, and urethra. When the system runs smoothly, these parts filter, store, and remove waste from your body. Kidneys are the filters, removing waste products from your blood and creating urine, which moves through two thin tubes called ureters to your body’s storage tank, the bladder.

A full bladder signals to your brain that it’s time to urinate—so you head to the bathroom, a sphincter muscle opens, and urine flows freely out of your body through the urethra. Urinary Incontinence occurs when your urinary system is compromised.

While it’s not an inevitable result of aging, it is widespread in older adults. UI could also be a temporary issue resulting from an underlying medical condition, medication use, or an illness’s onset. Women are most likely to develop urinary incontinence during pregnancy and after childbirth or after the hormonal changes of menopause.

Anatomical and descriptive illustration of the bladder with urine - Urinary Incontinence

The Four Types of Urinary Incontinence

UI as a medical condition is the umbrella term for several types of incontinence. Each of the four versions of UI has varying characteristics and an array of causes that lead to urine leakage.

To properly diagnose and find the best treatment plan, TUCC specialists believe in the importance of pinpointing the type of incontinence you’re experiencing.

Stress Incontinence

Those with stress incontinence experience a leaky bladder caused by increased abdominal pressure. The increase in pressure may be caused by coughing, laughing, sneezing, jogging, lifting, or increased body strain.

Urge Incontinence

Also referred to as overactive bladder, patients suffering from urge incontinence may experience a sudden urge to urinate, seemingly out of nowhere, and are unable to make it to the toilet.

Mixed Incontinence

A combination of stress and urge incontinence, this type is a combination of several leakage problems. With Mixed Incontinence, it’s crucial to identify what triggers incidents of incontinence to manage it.

Overflow Incontinence

This is characterized by frequent urination caused by the bladder’s inability to empty completely, resulting in small amounts of urine dripping out over time. Overflow incontinence is more common in people with chronic conditions like multiple sclerosis, stroke, diabetes, or in men with an enlarged prostate.

Diagnosis

Understanding the root causes of UI is the best way to set a pathway for treatment. Your urologist may ask you to keep a bladder diary for several days to document the amount of liquid you drank, how often you urinated, how much you urinated, and the number of incontinence episodes. 

In addition to a bladder diary, urinary incontinence and an overactive bladder can be diagnosed during a physical examination. They may require several tests, including a urinalysis, post-void residual measurement, cystoscopy, or video urodynamic testing.

Male Diagnosis 

Diagnosing male incontinence begins with an examination of medical history and a thorough physical. While most men can be diagnosed by observing symptoms, additional tests may be required to plan treatment. 

These tests can include urodynamic studies—which measure the pressure within the urinary system—and diagnostics testing bladder and sphincter function, presence of overactive bladder, and bladder capacity. In addition, your doctor may order the insertion of a camera into the bladder.

Female Diagnosis

As with male incontinence, diagnosing female UI starts with a medical history and a physical examination, including a pelvic exam.

Your doctor will observe your symptoms and, if necessary, order a battery of tests to plan treatment further. These tests mirror those performed on male patients, including urodynamic studies and bladder and sphincter function testing.

Signs & Symptoms

The signs and symptoms of UI typically depend on which type of incontinence you’re experiencing. Key signs and symptoms include:

  • Stress Incontinence: Leakage when active.
  • Urge Incontinence: A sudden, strong urge to urinate.
  • Mixed Urinary Incontinence: Leakage combined with a strong urge.
  • Overflow Incontinence: Frequent small urinations and constant dribbling.

Persistent Urinary Incontinence In Men and Women

Urinary Incontinence caused by an underlying physical problem or changes to the body is known as Persistent Urinary Incontinence. Some of these causes are exclusive to men or women, while both share some. These underlying problems or bodily changes include:

Pregnancy
Fluctuating hormones and the increased weight of the fetus can lead to stress incontinence.

Vaginal Childbirth
This can weaken muscles needed for bladder control and damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor.

Changes with Age
The bladder’s capacity to store urine decreases with age as your bladder muscle ages with you.

Menopause
Following menopause, women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy.

Enlarged Prostate
In older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.

Prostate Cancer
Incontinence is often a side effect of treatments for prostate cancer. In some cases, stress or urge incontinence may be associated with untreated prostate cancer.

Obstruction
Urinary stones can sometimes cause urine leakage. Also, a tumor along the urinary tract can lead to overflow incontinence.

Neurological Disorders
Any condition that interferes with the nerve signals involved in bladder control can cause UI. This includes multiple sclerosis, a stroke, Parkinson’s disease, a spinal injury, or a brain tumor.

Treatments

There are several non-surgical treatment options for mild cases of urinary incontinence.

Pelvic Floor Exercises
Helping to strengthen the bladder and pelvic muscles, Pelvic Floor Exercises typically include kegel exercises—which both women and men can do. This involves tightening the pelvic muscles and holding the contraction for five to 10 seconds at a time.

Medicine
Your doctor might prescribe medications for UI. This includes anticholinergics, calming overactive bladders, and assisting patients experiencing urge incontinence. For women, topical estrogen may reinforce tissue in the urethra and vaginal areas and lessen some symptoms.

Lifestyle Changes
You can employ certain everyday practices to lower your risk of UI. For starters, you can avoid food or drinks that irritate the bladder. These include caffeine, citrus, alcohol, and chili peppers. For example, you can also schedule your fluid intake, avoiding fluids three hours before bed. Losing weight could also potentially help you have fewer episodes of stress incontinence leaks. Meanwhile, special urine collectors and pads can be incorporated into daily life to catch any urine leakage.

In more severe overactive bladder cases, urologists may recommend:

InterStim
A sacral neuromodulation therapy—or medical electrical stimulation treatment—InterSim is prescribed when pads and bladder exercises prove unsuccessful in treating UI. At TUCC, providers Elias Hsu, M.D. and Juan Montoya, M.D. are highly trained in utilizing InterStim for overactive bladder patients. The sacral nerves, located near the tailbone, control the bladder and muscles related to urinary function. In many overactive bladder cases, the brain and sacral nerves do not communicate correctly, impacting normal bladder function.

InterStim modulates the sacral nerves with mild electrical pulses, similar to what a pacemaker does for the heart. If the therapy successfully eliminates overactive bladder symptoms, the wire is eventually connected to a small implant placed under the skin. InterStim has the potential to give patients desired bladder control and greatly improved quality of life.

Botox Injections
Botox injections may also be recommended as a treatment option for overactive bladder. An overactive bladder is marked by a sudden, uncontrollable urge to urinate, which can lead to the involuntary loss of urine, otherwise known as a leaky bladder. Botox injections relax the bladder muscle, decreasing involuntary bladder contractions and leakages. These injections are performed as outpatient procedures at TUCC.

Surgery

In severe cases of UI, surrey is an option. Standard surgical procedures for UI include:

Sling Procedures
A sling or hammock is created using body tissue, synthetic material, or mesh and is placed around the bladder, neck, and urethra to help control urine flow and minimize the occurrence of stress incontinence.

Bladder Neck Suspension
This procedure supports the urethra and bladder neck.

Artificial Urinary Sphincter
During this procedure, a small, fluid-filled ring is implanted around the neck of the bladder to keep the sphincter shut until the patient is ready to urinate. When ready, a valve implanted under the skin is pressed, causing the ring to deflate and opening the sphincter to allow urine to flow from the bladder.

How to Prevent Urinary Incontinence

Watch What You Eat
Maintaining a healthy diet may prevent factors that increase your chances of developing UI. Avoiding factors contributing to obesity and diabetes, for example, could help maintain bladder health. What’s more, some food and beverages could increase the risk of UI. These include spicy foods, chocolate, artificial sweeteners, citrus, carbonated and caffeinated beverages, and high-acid foods such as tomatoes.

Stay Hydrated
It’s essential to drink enough water to urinate every few hours. If you are drinking a sufficient amount of liquids, your urine should be pale yellow,

Maintain a Healthy Weight
Losing weight could improve your UI while keeping your weight healthy could prevent UI occurrences altogether. If you’re overweight, talk with your health care professional about how to lose weight by eating healthy and being physically active.

Recalibrate Your Bathroom Habits
People often hold in their urine because it’s inconvenient to go to the bathroom. Instead, go to the toilet when you feel the need! Holding in your urine can wear out your bladder muscles and lead to an infection, which can contribute to UI.

Quit Smoking
Kicking cigarettes to the curb is excellent for your overall health, but smoking raises your chances of developing stress incontinence. This is because smoking causes coughing, which triggers stress UI. Smoking could also lead to bladder cancer, which also causes UI.

Avoid Constipation
Constipation can make urinary tract health worse and can lead to UI. To prevent constipation, eat plenty of high-fiber foods such as whole grains, vegetables, and fruits. Also, drink plenty of water and increase physical activity.

Try Pelvic Floor Exercises
Pelvic floor exercises, also called Kegel exercises, can strengthen bladder muscles and help keep urine from leaking when coughing, laughing, sneezing, or lifting a heavy object.

FAQ

Urinary Incontinence FAQs

UI encompasses different types of urinary leakage or loss of bladder control. It occurs when urine leaks out before you can reach a bathroom.

It is usually caused by problems with muscles and nerves that help to hold or pass urine.

There are four main types of Urinary Incontinence: Stress Incontinence, Urge Incontinence, Mixed Incontinence, and Overflow Incontinence.

Yes. UI is twice as common in women as in men. Primary reasons for this include pregnancy, childbirth, and menopause.

Schedule a visit with your doctor. Your doctor will ask you about your symptoms and take a medical history, including how often you urinate, how and when you experience leakage, and how much urine you leak.

Your doctor will help you find the best treatment for your situation. Treatments include lifestyle changes, medicines for bladder control, nerve stimulation, surgery, catheterization, and more.

Most Urinary Incontinence cases can be significantly reduced or cured altogether.

We’re here to help.

For appointments at any TUCC location, request an appointment online.

Elias Hsu, M.D.

Eight questions you may – or may not – have wanted answered about urinary incontinence…

How common is incontinence?

Incontinence is defined as the inability to control the evacuative functions of urination. At the most basic level, it is the leakage of urine from the bladder without control. Incontinence is a very common condition, with reports indicating that 15-45 percent of women will experience some form of urinary leakage during their lives. Most studies report that nearly one in every four women experience incontinence starting in middle age. This number increases over time, with nearly half of all nursing home residents dealing with some type of incontinence.

What are the different types of incontinence?

There are several different types of incontinence, which vary in incidence. These include stress incontinence, urge incontinence, mixed incontinence, overflow and total incontinence. Stress incontinence and urge incontinence are the most common types of incontinence.

Stress incontinence is leakage associated with activities such as exercise, sneezing, laughing or coughing. Urge incontinence is leakage from a strong urge to go to the bathroom (e.g. bladder spasm) that is not associated with any activity. Overflow incontinence is leakage associated with a bladder that is filled to capacity and cannot hold any more urine. Total incontinence is leakage without association with activities or urgency. This type of incontinence can be a sign of a fistula (communication between the urinary system and the vagina).

What is urodynamics?

Urodynamics is a test that urologists will commonly order for a patient with incontinence. It is a test that involves placing a small catheter into the bladder and rectum. The pressure in your bladder is measured as it fills with fluid.

The severity of stress incontinence can be measured when you are asked to cough and bear down, which can help determine what treatment might be needed.

Urodynamics can also help detect urge incontinence from bladder spasms. This test measures the capacity of the bladder before you are able to void, allowing your medical team to see how strongly your bladder contracts and how well you empty your bladder.

How do we treat stress incontinence?

Physical therapy with Kegel and core exercises is the first and easiest treatment for stress incontinence. Exercises can help strengthen the urethral and pelvic floor muscles. This works well for people who have mild incontinence (leaking less than one-two pads per day). Patients should continue to do exercises to keep the incontinence from recurring.

Unfortunately, although at one point there was some promise with certain medications (e.g. estrogen creams, alpha agonists, and selective serotonin reuptake inhibitors), they generally do not work well for the treatment of stress incontinence. For this reason, surgery is often recommended. Sling surgeries are the mainstay of treatment for stress incontinence, which conceptually tighten the urethral opening from the bladder. Originally, harvested (from a patient during surgery or decellularized and decontaminated porcine or cadaveric tissue) tissue was used as sling material. Although this is sometimes recommended, urologists typically use synthetic mesh materials because of their durability and ease of use. Sling surgery is usually an outpatient procedure that involves a short recovery time.

How do we treat urge incontinence?

Like stress incontinence, conservative exercises such as bladder drills or timed voiding/urge suppression exercises can be used to retrain a bladder that is overactive or has urge incontinence.

Medications are the most common strategy used to treat urge incontinence. More than half a dozen medications, including pills, patches and gels, are currently on the market with more coming out every year. Their common bothersome side effects include dry mouth, constipation and blurry vision.

Neuromodulation is an alternative to medications for urge incontinence. By stimulating the nerves until they turn off, bladder spasms and urge incontinence can be controlled. There are two types of neuromodulation – posterior tibial nerve stimulation (PTNS) and interstim sacral nerve stimulation. Posterior tibial nerve stimulation involves placing a small acupuncture sized needle by a nerve in the ankle that communicates with the bladder. This stimulation is performed in the office once a week for 12 weeks, before being tapered off to do maintenance protocol. Interstim sacral nerve stimulation is performed in two stages. A testing is performed with a temporary lead that is placed in the back to stimulate the sacral nerve that innervates the bladder. If this testing is effective, then a permanent generator is placed into the buttock, which is like a “pacemaker for your bladder”. Botox is also an effective, but off label use, for overactive bladder and urge incontinence. This type of treatment provides minimal risk, but unfortunately will only last six months to one year before it needs to be repeated.

What if I have both symptoms?

Many women have elements of both stress and urge incontinence. Typically, one type is more bothersome. Treatment will focus on the predominant component, but many patients will often receive multiple strategies to improve their symptoms.

What about total and overflow incontinence?

Overflow incontinence is associated with urinary retention. When someone cannot hold any more fluid in their bladder, it “overflows” and leaks out. This can often be associated with an obstruction or blockage of the urethra that needs to be corrected to improve the leakage.

Total incontinence secondary to a fistula or communication between the bladder and vagina usually needs to be fixed with surgery to close the hole.

What do I do now?

The great news is that treatments for incontinence have been consistently improving over the past few years. You can attempt conservative therapies at home, but if you have questions and would like to come in for a consultation, please visit www.tucc.com or call 303.825. TUCC (8822).