Urinary Incontinence
Urinary Incontinence
embarrassing problem. The severity ranges from occasionally leaking urine when
you cough or sneeze to having an urge to urinate that's so sudden and strong you
don't get to a toilet in time.
Though it occurs more often as people get older, urinary incontinence isn't an
inevitable consequence of aging. If urinary incontinence affects your daily
activities, don't hesitate to see your doctor. For most people, simple lifestyle
changes or medical treatment can ease discomfort or stop urinary incontinence.
Risk factors
Factors that increase your risk of developing urinary incontinence include:
Gender. Women are more likely to have stress incontinence. Pregnancy,
childbirth, menopause and normal female anatomy account for this
difference. However, men with prostate gland problems are at increased risk
of urge and overflow incontinence.
Age. As you get older, the muscles in your bladder and urethra lose some of
their strength. Changes with age reduce how much your bladder can hold
and increase the chances of involuntary urine release.
Being overweight. Extra weight increases pressure on your bladder and
surrounding muscles, which weakens them and allows urine to leak out when
you cough or sneeze.
Smoking. Tobacco use may increase your risk of urinary incontinence.
Family history. If a close family member has urinary incontinence, especially
urge incontinence, your risk of developing the condition is higher.
Other diseases. Neurological disease or diabetes may increase your risk of
incontinence.
Complications
Complications of chronic urinary incontinence include:
Skin problems. Rashes, skin infections and sores can develop from
constantly wet skin.
Urinary tract infections. Incontinence increases your risk of repeated
urinary tract infections.
Impacts on your personal life. Urinary incontinence can affect your social,
work and personal relationships.
Diagnosis
It's important to determine the type of urinary incontinence that you have, and
your symptoms often tell your doctor which type you have. That information will
guide treatment decisions.
Your doctor is likely to start with a thorough history and physical exam. You may
then be asked to do a simple maneuver that can demonstrate incontinence, such
as coughing.
After that, your doctor will likely recommend:
Urinalysis. A sample of your urine is checked for signs of infection, traces of
blood or other abnormalities.
Bladder diary. For several days you record how much you drink, when you
urinate, the amount of urine you produce, whether you had an urge to
urinate and the number of incontinence episodes.
Post-void residual measurement. You're asked to urinate (void) into a
container that measures urine output. Then your doctor checks the amount
of leftover urine in your bladder using a catheter or ultrasound test. A large
amount of leftover urine in your bladder may mean that you have an
obstruction in your urinary tract or a problem with your bladder nerves or
muscles.
If further information is needed, your doctor may recommend more-involved
tests, such as urodynamic testing and pelvic ultrasound. These tests are usually
done if you're considering surgery.
Treatment
Treatment for urinary incontinence depends on the type of incontinence, its
severity and the underlying cause. A combination of treatments may be needed. If
an underlying condition is causing your symptoms, your doctor will first treat that
condition.
Your doctor is likely to suggest the least invasive treatments first and move on to
other options only if these techniques fail.
Behavioral techniques
Your doctor may recommend:
Bladder training, to delay urination after you get the urge to go. You may
start by trying to hold off for 10 minutes every time you feel an urge to
urinate. The goal is to lengthen the time between trips to the toilet until
you're urinating only every 2.5 to 3.5 hours.
Double voiding, to help you learn to empty your bladder more completely
to avoid overflow incontinence. Double voiding means urinating, then waiting
a few minutes and trying again.
Scheduled toilet trips, to urinate every two to four hours rather than
waiting for the need to go.
Fluid and diet management, to regain control of your bladder. You may
need to cut back on or avoid alcohol, caffeine or acidic foods. Reducing liquid
consumption, losing weight or increasing physical activity also can ease the
problem.
Pelvic floor muscle exercises
Your doctor may recommend that you do these exercises frequently to strengthen
the muscles that help control urination. Also known as Kegel exercises, these
exercises are especially effective for stress incontinence but may also help urge
incontinence.
To do pelvic floor muscle exercises, imagine that you're trying to stop your urine
flow. Then:
Tighten (contract) the muscles you would use to stop urinating and hold for
five seconds, and then relax for five seconds. (If this is too difficult, start by
holding for two seconds and relaxing for three seconds.)
Work up to holding the contractions for 10 seconds at a time.
Aim for at least three sets of 10 repetitions each day.
To help you identify and contract the right muscles, your doctor may suggest you
work with a physical therapist or try biofeedback techniques.
Electrical strimulation
Electrodes are temporarily inserted into your rectum or vagina to stimulate and
strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for
stress incontinence and urge incontinence, but you may need multiple treatments
over several months.
Medications
Medications commonly used to treat incontinence include:
Anticholinergics. These medications can calm an overactive bladder and
may be helpful for urge incontinence. Examples include oxybutynin (Ditropan
XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz),
solifenacin (Vesicare) and trospium (Sanctura).
Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication
relaxes the bladder muscle and can increase the amount of urine your
bladder can hold. It may also increase the amount you are able to urinate at
one time, helping to empty your bladder more completely.
Alpha blockers. In men with urge or overflow incontinence, these
medications relax bladder neck muscles and muscle fibers in the prostate and
make it easier to empty the bladder. Examples include tamsulosin (Flomax),
alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin.
Topical estrogen. For women, applying low-dose, topical estrogen in the
form of a vaginal cream, ring or patch may help tone and rejuvenate tissues
in the urethra and vaginal areas. Systemic estrogen taking the hormone as
a pill isn't recommended for urinary incontinence and may even make it
worse.
Medical devices
Pessary types