By VINCENT FIORICA, MD
What is urinary incontinence (UI)?
UI is the loss of urine control, or the inability to hold your urine until you can reach a restroom.
According to the National Association for Continence, approximately 25 million adult Americans experience temporary or chronic urinary incontinence. UI can strike at any age. Women over age 50 are the most likely to develop UI although men can be affected as well.
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.
What causes urinary incontinence?
Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications, and/or the onset of an illness.
Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop incontinence after pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.
What are some of the different types of urinary incontinence?
The following are some of the different types of urinary incontinence:
Urge incontinence. The inability to hold urine long enough to reach a restroom. While the majority of people with urge incontinence are healthy and have no underlying condition it is also found in people who have conditions, such as diabetes, stroke, dementia, Parkinson’s disease, and multiple sclerosis.
Stress incontinence. The most common type of incontinence that involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder.
Functional incontinence. Leakage due to a difficulty reaching a restroom in time because of physical conditions such as arthritis.
Overflow incontinence. Leakage that occurs when the bladder is full to capacity and unable to empty adequately.
What are the symptoms of urinary incontinence?
The following are the most common symptoms or associated symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:
Leakage of urine before being able to get to the restroom. This may prevent certain activities or be embarrassing
Wetting without awareness or leaking urine during sleep
Pain related to filling the bladder and/or pain related to urination
Progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying
Increased frequency of urination
Abnormal urination or changes in urination related to a nervous system
Abnormality, such as stroke, spinal cord injury, or multiple sclerosis that interferes with urination
Leakage of urine that began or continued after surgery
Frequent bladder infections
The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.
How is urinary incontinence diagnosed?
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 urine samples.
In many cases, patients will then be referred to a urologist, a doctor who specializes in diseases of the urinary tract. Additional testing may include cystoscopy, a simple in-office procedure to visualize the inside of the bladder and/or urodynamics, a test of the bladder to assess its capacity and function and the function of the urethra (water passage tube) and sphincter (control valve).
What is the treatment for urinary incontinence?
Specific treatment for urinary incontinence will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include:
Behavioral therapies (to help people regain control of their bladder), including the following:
Bladder training. Teaches people to resist the urge to void and gradually expand the intervals between voiding.
Toileting assistance. Uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.
Diet modifications (i.e., eliminating caffeine in coffee, soda, and tea, and/or eliminating alcohol)
Pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage), including the following:
Kegel exercises. Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women.
Biofeedback. Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles. This may be combined with pelvic floor electrical stimulation to stimulate pelvic floor contractions. This is performed as an in-office procedure
Medication (including specific drugs for incontinence as well as estrogen therapy, which may be helpful in conjunction with other treatments for postmenopausal women with UI)
Surgery. This may include surgery to prevent the urethra from moving out of position causing stress incontinence. It could also include certain treatments for urge incontinence such as bladder injections of Botox to calm the bladder, in-office stimulation of a nerve in the lower leg to retrain the bladder nerves or implantation of a nerve stimulator to re-regulate the bladder nerves.
Bladder management. When other options have not been successful or cannot be used, the leakage can be managed by using specially designed absorbent underclothing or by using a permanent urinary catheter.
If you would like to discuss management and treatment of urinary incontinence with Dr. Fiorica please call 505.661.9150 to schedule a consultation.