What is Urinary Incontinence?
Urinary incontinence is the involuntary loss of bladder control that causes urine leakage. It can range from occasional leaks when coughing or exercising to sudden urges that make it difficult to reach the bathroom in time.
Bladder leakage can affect both men and women at different stages of life. Understanding the type of urinary incontinence you have is an important first step toward finding an effective treatment.
- Missing out on life events because you’re in the bathroom?
- Constantly planning your life around restroom breaks?
- Losing sleep because you’re getting up frequently in the night to go?
- Feeling embarrassed because you can’t seem to stop the leaks?
As you age, incontinence (losing control over your bladder) can cause you to put a hold on the things you love to do most. From small, minor leaks to being unable to make it to the bathroom in time, incontinence can be stressful, embarrassing, and inconvenient.
Types of Urinary Incontinence
There are different types of incontinence, and each causes various symptoms.
Stress incontinence
Stress urinary incontinence occurs when physical pressure on the bladder causes urine leakage. This may happen while coughing, sneezing, laughing, lifting, or exercising.
Stress incontinence is associated with weakened pelvic floor muscles or changes in the structures that support the urethra. It can affect women after childbirth and men following certain prostate procedures.
The term “stress” refers to physical pressure on the bladder, not emotional stress.
Urge incontinence
Urge incontinence occurs when a sudden, strong need to urinate is followed by involuntary urine leakage. Some people experience urgency so quickly that they cannot reach the bathroom in time.
Urge incontinence is often associated with overactive bladder (OAB). Certain neurological conditions, bladder irritation, and other health factors may contribute to these symptoms.
Overflow incontinence
Overflow incontinence can occur if the bladder is not empty after urinating. Because their bladders are never completely empty, people with overflow incontinence are prone to urine leaks.
Overflow incontinence typically results in small amounts of urine leaking out over time rather than a single large quantity. Overflow incontinence is more common in those who have chronic conditions such as diabetes, multiple sclerosis, or an enlarged prostate.
Post-void dribbling
Post-void dribbling (PVD) is the leaking of urine remaining in the urethra after emptying the bladder. It causes wetness shortly after the person finishes urinating but not at other times.
Mixed incontinence
Stress incontinence and an overactive bladder can be present at the same time, which is known as mixed incontinence. It is essential to pay close attention to what activities or circumstances cause leakage problems. Identifying its causes is often the most effective treatment for mixed incontinence.
Causes & Risk Factors for Urinary Incontinence
Urinary incontinence can develop for several reasons, including changes in pelvic floor strength, bladder function, nerve signaling, or urinary tract health. Certain medical conditions and lifestyle factors may also increase the risk of bladder leakage.
Common causes and risk factors include:
- Pregnancy and childbirth
- Nerve damage from pelvic or back surgery, or herniated discs
- Parkinson's disease, multiple sclerosis, or a stroke
- Medications, alcohol, and caffeine
- Urinary tract infection (UTI)
- Overweight and obesity
- Estrogen deficiency after menopause
- Diabetes
- Prostate surgery
- An enlarged prostate (benign prostatic hyperplasia)
- Uterine prolapse
How is Urinary Incontinence Diagnosed?
Diagnosing urinary incontinence begins with understanding when and how bladder leakage occurs. Your urologist will review your symptoms, medical history, medications, and daily urinary habits. Your doctor will want to know certain things, such as:
- How long you have experienced urine leakage
- If leaking occurs after a sudden urge, with sneezing or coughing, or without warning
- What medications you are taking
- If symptoms are worsening, or if you are experiencing bladder or back pain or blood in the urine
A physical examination and urine testing may help identify possible causes. Your doctor may also recommend a bladder diary to track bathroom visits, fluid intake, and episodes of leakage.
Additional testing, such as cystoscopy or urodynamic testing, may be recommended in certain situations when more information is needed to guide treatment.
Tests can be performed to assess urinary incontinence and may include:
- Bladder stress test: You will cough or bear down while the doctor monitors for urine loss.
- Urinalysis: Evaluation of urine and a urine culture to screen for bacteria, blood, or other problems.
- Cystoscopy: The doctor uses a small camera to examine your urinary tract.
- Urodynamic testing: Tiny catheters assess how much urine your bladder can hold, what causes you to leak urine, and whether you have problems emptying the bladder. It also measures how much urine is left over after you urinate.
You may also be asked to keep a bladder diary for two to three days to track fluid consumption, bathroom visits, and urine loss.
Urinary Incontinence Treatment Options
Urinary incontinence treatment depends on the type of bladder leakage, symptom severity, and underlying cause. Some patients benefit from bladder training or pelvic floor physical therapy. Others may need medications, Botox injections, nerve stimulation, or surgery.
Your urologist will help determine which bladder control treatments may be appropriate based on your symptoms and medical history.
Bladder Retraining
With this method, a prescribed urination schedule is followed to help the bladder coordinate itself. The time between bathroom breaks is gradually extended until a more normal schedule is achieved.
Pelvic Floor Physical Therapy
Strengthening weak pelvic floor muscles can help improve incontinence symptoms. Also called Kegel exercises, when performed regularly, they can be enough to treat some types of incontinence on their own.
Medications for Urinary Incontinence
Medications for urinary incontinence may help reduce bladder leakage, urinary urgency, and frequent urination. The best treatment depends on the type of incontinence, your symptoms, and your medical history.
For urge incontinence associated with overactive bladder, medications may include antimuscarinic drugs or beta-3 agonists. These medications help reduce urgency and improve bladder control.
For men experiencing urinary symptoms related to an enlarged prostate, certain medications may help improve urine flow and bladder emptying.
Not all types of urinary incontinence respond to medication. Stress incontinence, for example, is often treated with pelvic floor physical therapy or other approaches.
Your urologist can help determine whether bladder control medication is appropriate for your symptoms.
Botox injections
Botox bladder injections are a minimally invasive treatment for certain types of urge incontinence and overactive bladder. Botox works by relaxing the bladder muscle, which can. help reduce unwanted bladder contractions, urinary urgency, and urine leakage. Your urologist can help determine whether bladder Botox may be appropriate for your symptoms.
Surgery
Surgery can be performed to support the bladder, improve urine flow, and repair muscles that control urine flow. For example, a sling made from synthetic material or your own tissue can be placed to lift up and support the bladder to treat stress incontinence.
Percutaneous Tibial Nerve Stimulation (PTNS)
PTNS is a non-surgical, in-office procedure that uses electrical stimulation of the tibial nerve in the lower leg. The nerve is connected to the nerves that help control bladder function. Stimulating these nerves can help regulate bladder activity and improve symptoms of overactive bladder and urge incontinence.
InterStim
InterStim is a type of PTNS where a small device is permanently implanted to stimulate the nerves that control bladder function. This is a good treatment option for women who have not had successful outcomes with other types of treatments.
Incontinence isn’t just a normal part of aging – and it CAN be treated.
Find the Right Urinary Incontinence Treatment
There are many treatment options for urinary incontinence available, including pelvic floor physical therapy, bladder retraining, medication, minimally invasive procedures, and surgery. You do not have to accept bladder leakage or loss of bladder control as a normal part of aging.
Talk with the urology specialists at Urology Center of Iowa to identify the causes of your symptoms and explore treatment options that may help you regain bladder control.