Urinary incontinence is a hot-button item these days, as it should be. Fifty percent of females experience stress urinary incontinence. A total of $26 billion dollars is spent annually in the United States to treat urinary incontinence. That is more money than is spent on all of the cancer care for women combined. Diabetes and obesity, both increasingly prevalent in the U.S. population, are strongly associated with urinary incontinence. Fifty to sixty percent of diabetics experience incontinence. Fifty to seventy percent of people who are classified as obese battle incontinence. And before you think this is a problem that occurs only in women, think again. Close to 20% of men older than 60 years of age struggle with incontinence as well.
Urinary incontinence can be classified into different categories based on the etiology, or cause. Stress incontinence is leakage that typically occurs when a person strains, such as by laughing, sneezing, coughing, or picking something up . The sphincter muscle’s ability to squeeze and obstruct, or block, the urethra has been compromised. Urge Incontinence is classically associated with the bladder muscle squeezing when it should not. It is often accompanied by a sense of urgency to urinate, but not always. It can occur with changes in hormones, bowel irregularity, nerve damage and with irritation of the bladder. Bladder irritation can be from something as simple as a person’s diet, like particular foods or drinks, to something as severe as bladder cancer. Overflow incontinence typically occurs when the bladder is not emptying well and the name describes exactly what occurs. The bladder is like a full cup that is too full and the urine just continuously dribbles out.
Treatment of all urinary incontinence should start with paying more attention to when the incontinence occurs. This can often be accomplished by use of a bladder diary. Stress incontinence can sometimes be improved with Kegel exercises and timed voiding. There are surgical options to treat stress incontinence when the above conservative measures are not effective. Surgery can be in the form of injecting material into the urethra to help the sphincter close off the urethra, or by placement of a sling or lifting the urethra, in order to assist in kinking off the urethra when you strain. Both of these treatment options are possible in men and women. Urge incontinence can be treated in a variety of ways, all looking to address what may be causing it. As alluded to above, there are a lot of reasons as to why urge incontinence occurs. Treatment can vary from diet modification, to medicine that can be taken daily, to stimulating the nerves that go to and from the bladder.
To make matters even more complicated, a large portion of the time, the above incontinence types occur together, which is given the generic name of mixed incontinence. This is why a full evaluation of the individual is necessary, including a look in the bladder with a scope(cystoscopy), a genitourinary examination, and oftentimes a procedure called urodynamics. These examinations and procedures, along with a collection of information from the patient, helps the health care provider to determine how best to address the incontinence. It also is necessary in order to rule out other causes of incontinence, such as cancers, neurologic disease, etc.
Finally, there is overflow incontinence which is really just a manifestation of the bladder not emptying well. This is typically because of either an obstruction, such as a large prostate, or an inability of the bladder to squeeze appropriately. Treatment can vary from resection of the obstructing item, for example the prostate, or further evaluation as to the cause behind why the bladder won’t squeeze. This latter scenario has been given the name of an “underactive bladder” and urologists across the country have been working to bring attention to this very prevalent problem which has historically been ignored.
When it comes to incontinence, a lot of the time, particularly in women, it comes down to the genes inherited from Mom, Grandma, etc. Certainly pregnancy and delivery have their role in causing stress incontinence, as well as aging with resulting changes in hormones, support of the bladder in the pelvis. Simple things that can be done to help reduce incontinence risk include taking the time to drink plenty of fluids, going to the bathroom regularly, rather than putting it off and damaging the bladder over time. In addition, learn to be aware of your pelvic floor muscles and practice squeezing them and relaxing them. You can help yourself to identify them by stopping and starting your urinary stream when you are going to the bathroom.
Urinary incontinence is a common problem and it does increase with age, but that does not mean it should be ignored and just “put up with.” There are simple and easy things that can be done to address the leakage and, perhaps most importantly, it could be a sign or symptom of something more ominous, such as cancer or a neurologic disease.