What causes urinary incontinence?

Normal bladder function requires coordination between the brain, spinal cord, and the bladder. A disruption to this coordination from any angle could result in urinary incontinence.

Therefore, urinary incontinence could appear as a side-effect of a prescribed medication, conditions like a bladder infection or another situation like the bladder’s outlet does not stay closed.

What are the different types of urinary incontinence?

There are several types of urinary incontinence, each classified by the symptoms or circumstances causing the urine leakage.

Stress incontinence – leaking during activities which strain or “stress” the abdomen. Stress incontinence is often caused by poor bladder support or a weak or damaged sphincter muscle.

Urge incontinence – An “overactive” bladder that contracts unexpectedly. For example, an infection that irritates the lining of the bladder.

Overflow incontinence – Occurs from a weakened or blocked urethra that prevents normal emptying. This often develops in men who have diabetes, are heavy drinkers, or have certain neurological conditions.

Retention Problems – Urine is retained in the bladder and cannot be released.

• Difficulty starting to urinate or partially emptying the bladder
• Only produce a weak dribble or require a catheter to empty
• Lose small amounts of urine during the day (overflow incontinence)
• You can’t feel when your bladder is full

Problems with Urgency/Frequency – Occurs from uncontrollable urges to urinate.

• You almost always have the urge to urinate (urgency)
• You use the bathroom more than 4-7 times per day (frequency)
• You have wake up during the night to urinate
• You may leak urine
• You only urinate small amounts each time

Diagnosis and Tests:

How is urinary incontinence evaluated?

To determine the most effective urinary incontinence treatment your physician will likely begin with an evaluation consisting of a medical history and physical exam.

To confirm the diagnosis, the following tests may be ordered:

Urinalysis – A sample of urine is examined for signs of infection, blood, or other abnormalities

Post-void residual urine measurement – Determines whether any urine remains in the bladder after you urinate. For this, a small, soft tube is inserted into the bladder to drain and measure remaining urine or a bladder ultrasound can be performed.

Cystoscopy – An examination of the inside of the bladder with a small viewing telescope called a cystoscope to let the physician check for problems.

Stress test – To find out what stresses the bladder, you may be asked to cough, stand, or do other activities with a full bladder.

Urodynamic testing – These tests examine the bladder and urethral sphincter muscle by inserting a small tube or by X-rays to determine whether there are normal sensation and capacity to fill and empty normally.

Management and Treatment:

How can urinary incontinence be treated?

Incontinence can almost always be treated and it doesn’t always involve surgery. Options include:

Behavioral therapy – A customized regimen of exercise and instruction may help you improve your bladder control. Some physical therapists can provide exercises that strengthen the pelvic muscles to help regain and maintain bladder control and improve pelvic support. Education regarding fluid intake and bladder retraining has proved successful for those with urinary incontinence.

Medication – Drug therapy can be prescribed to relax the bladder and calm the urge to urinate. Your bladder control can be adversely affected by other medications you may be taking, and your physician can help you determine the best way to manage all of your conditions, including your urinary incontinence.

Surgery – Surgery for urinary incontinence treatment corrects poor bladder support and helps the urethra close properly.

• Sling procedures: The male sling procedure helps with urinary incontinence due to sphincter weakness caused by prior pelvic surgery including TURP (transurethral resection of the prostate) and radical prostatectomy. The procedure includes synthetic mesh-like tape that is positioned around part of the urethra, slightly compressing and moving it into a better position. One of the advantages of this procedure is its fairly short recovery time and small incision site.
• Sacral Nerve Stimulation: This outpatient procedure uses an external device to stimulate the muscles of the bladder and pelvic floor. After an initial testing period, the device is implanted beneath the skin.