Patient Education

Urinary Incontinence

Accidental urine leaks can be embarrassing and difficult to manage. Though leaking is never normal, many women do occasionally leak small amounts of urine, either with a strong urge to go, or with activities like coughing/sneezing or running/jumping. This uncontrolled urine loss is called urinary incontinence. This page covers the basic information about urinary incontinence and its treatment.

WHAT IS URINARY INCONTINENCE?

When the bladder works well, the urine is held in by the muscles at the bladder base and along the urethra (the tube connecting the bladder with urinary opening. When it is time to urinate, those muscles relax and the bladder muscles contract pushing the urine out through the urethra. There are several reasons why this system breaks down and a woman has uncontrolled urine loss, or urinary incontinence.

  • Functional Incontinence: Functional urinary incontinence arises when a woman has a condition that does not allow her to reach the bathroom in time. For instance, someone with Parkinson’s disease or arthritis may have trouble walking. Side effects of medications can cause confusion or dizziness also making it difficult to reach the toilet. Poor vision or long distances to the bathroom are other examples.
  • Stress Incontinence: Stress incontinence is most common in younger women. This occurs when the pressure inside the bladder overwhelms the muscles holding the urine inside. Several situations increase the pressure in the abdomen that then causes the bladder pressure to go up and leaking to occur, like sneezing, coughing, laughing. Certain activities can also cause leaking like walking, running, and jumping.
  • Overflow Incontinence: This occurs when the bladder does not completely empty during urination. Eventually the bladder overfills and this causes small leaks over a long period of time. This may occur when the urethra is blocked or the bladder muscle is weak.
  • Urge Incontinence: This type of incontinence occurs when a woman has intense urges to urinate and leaks before she can reach the toilet. Another related condition that can cause urge incontinence is OVERACTIVE BLADDER. In this case, the bladder muscle contracts more often and more intensely than normal, leading to sudden strong urges to urinate even though the bladder may not be full. BLADDER INFECTIONS also can be the cause of urgency leading to urine loss.
  • Mixed Incontinence: This is simply a combination of both stress and urge incontinence occurring in the same woman. 

Urinary incontinence can be a very embarrassing thing for a woman. Some women avoid social situations for fear of leaking in public. Many women do not discuss urinary incontinence with their providers because they believe that it is too embarrassing or that it is a normal part of aging. However, urinary incontinence can often be successfully treated, and women need not live in fear of leaking or needing pads and absorbent underwear. If you experience urinary incontinence, it is important to tell your provider so that you can receive treatment.

WHAT ARE THE SYMPTOMS THAT SUGGEST BLADDER CONTROL PROBLEMS?

  • Urgency- needing to "go" even if the bladder is not yet full. 
  • Frequency- urinating more often than necessary or usual.
  • Dysuria- painful urination.
  • Nocturia- needing to urinate more than 1-2 times at night.
  • Enuresis- leaking during sleep or bedwetting.
  • Any uncontrolled urine loss.

WHAT ARE THE CAUSES OF URINARY INCONTINENCE?

There are several different things that may cause urinary incontinence:

  • Pelvic Support Problems: Pelvic support problems can arise when the muscles and tissues that hold up the pelvic organs become weakened often from pregnancy and childbirth. This causes those organs to sag, often causing them to press against the bladder, making it more sensitive to pressure and leaving less room to expand. In addition, the bladder itself can "fall" increasing the chance of incontinence.
  • Urinary Tract Infection (UTI): UTIs are infections of the bladder and urethra that can cause feelings of pressure and pain. Symptoms of UTIs include painful/burning urination, frequency, urgency and blood in urine. UTIs can be treated with antibiotics.
  • Medications: Certain classes of medications, like diuretics or "water pills" increase the amount of urine flowing into the bladder. This can contribute to urgency and incontinence.
  • Neuromuscular Disorders: Neuromuscular disorders are conditions that affect muscles and nerves that control the bladder. The result can be difficulty emptying the bladder, or bladder spasms Examples of neuromuscular disorders include stroke, multiple sclerosis/amyotrophic lateral sclerosis, and diabetes.
  • Urinary Tract Abnormalities: Changes can occur in the bladder or urethra, resulting in incontinence problems. For example, fistulas are abnormal openings between organs and can occur between the bladder or urethra and the vagina. This causes urine to leak directly out of the vagina . Fistulas can develop as a result of childbirth, radiation, surgery, cancer, and pelvic surgery.

HOW CAN URINARY INCONTINENCE BE DIAGNOSED?

There are several ways that your urinary incontinence can be diagnosed. First, your provider will ask you questions about your medical history, especially about any surgeries you may have had and details about your pregnancies. Then, he or she may ask you to keep a bladder diary listing when you urinate, when you leak, and what you drink on a daily basis. This can be a helpful tool for your provider to determine exactly what is causing the problem.

Your provider will likely perform a pelvic exam, to see if there are any physical conditions in your pelvis that could be causing the incontinence. He or she will ask for a urine sample and probably test for a bladder infection. For some, further specialized testing might be needed . This could involve special equipment that monitors pressure in the bladder (urodynamics), or that provides pictures of the inside of the bladder and urethra (cystoscopy).

HOW IS URINARY INCONTINENCE TREATED?

There are several different ways to treat urinary incontinence, depending on the cause and severity of your condition. Treatment often works best when the condition is diagnosed early, and treatments are used in combinations. Options include:

  • Behavioral Treatments: Behavioral therapy involves learning about the bladder and how best to control it without medicine or surgery. These LIFESTYLE CHANGES may include:
    • Avoiding constipation
    • Stopping smoking
    • Avoiding heavy lifting
    • Losing weight
    • Getting treatment for lung problems that cause coughing
    • Avoiding caffeine and diet pills
    • Changing drinking habits (what, when and how much)
  • Medications: Medications can help reduce urinary incontinence by treating other conditions. If you have a UTI, you will be given antibiotics to clear up the infection. If you have uncontrollable bladder spasms, medication to reduce the spasms may be prescribed. Also, medication that strengthens the urethra may be used. Sometimes, these medications cause side effects, such as nausea, blurred vision, constipation, dry mouth, and sleeping changes.
  • Physical Therapy: Physical therapy centers around the idea of strengthening the pelvic muscles in order to help a woman control her urges to urinate and to hold back any leaks. These exercises are called Kegel exercises, and when practiced regularly, they can help a woman hold her urges and control her bladder muscles. Bladder training and biofeedback are also other methods used in physical therapy.
  • Devices: Sometimes, devices are inserted into the vagina to help strengthen the pelvic muscles or support the pelvic organs. These include-
    • Weighted Cones: A tampon-shaped cone is inserted into the vagina for several minutes twice a day. This device contains weights, and as the muscles of the pelvis flex to keep it in place, they are exercised and become stronger.
    • Pessary: A pessary is a device that is placed in the vagina to support "falling" or "sagging" pelvic organs. They come in a variety of shapes and sizes. Some are removed daily, and some stay in place for weeks. Theses need to be selected and sized in a provider’s office.
  • Surgery: Surgery is a treatment for serious, stress related incontinence. Whether or not your provider chooses this method for you will depend on factors such as your age, medical history, health, and lifestyle.

IN CONCLUSION…

Urinary incontinence is a medical condition that can be inconvenient, embarrassing and can limit one’s life-style choices. If you have troublesome bladder symptoms or incontinence, talk to your provider about what can be done to relieve the symptoms.