For the estimated 13 million Americans with urinary incontinence, poor bladder control can severely disrupt daily life. Some people don't always make it to the bathroom in time or they can't hold it in when they cough or sneeze. Some even curtail social activities because they don't have reliable bladder control.
Yet the majority of people with this condition never see a doctor—either because they're too embarrassed to discuss it or because they assume that it's a normal part of getting older.
Not true. About 80% of patients can regain nearly normal bladder control with lifestyle changes or, if necessary medication or surgery.
TYPES OF INCONTINENCE
As the bladder fills with urine, it eventually sends signals to the brain that tell the person "it's time to go." Before that happens, the bladder walls relax to permit urine to accumulate. This gradual process is what allows most people to wait hours before going to the bathroom. Urinary control also is achieved by a ring of muscle called the urinary sphincter. It contracts to keep urine in, then relaxes to let it out.
Incontinence occurs when there's a problem with either muscular or nervous system control—or a combination of both. Women are about twice as likely as men to have incontinence, although men who have prostate enlargement or have had prostate surgery have an increased risk of incontinence.
The main types...
- Stress incontinence is most common, affecting at least 50% of the women who have urinary incontinence. It occurs when the urinary sphincter isn't strong enough to hold in urine, particularly during activities that cause an increase in abdominal pressure, including laughing, coughing, sneezing and exercise.
Stress incontinence frequently occurs during pregnancy and can persist in women who have had several vaginal births. Large babies and long labors can stretch and weaken the pelvic floor muscles and/or damage some of the bladder nerves. The drop in estrogen that occurs after menopause can weaken the urethra, inhibiting its ability to hold back the flow of urine.
- Urge incontinence often is caused by inflammation or irritation of the bladder or urethra—due to infection, urinary stones or, in men, irritation of the prostate gland. This causes frequent (and sudden) urges to urinate. This type of incontinence also may be caused by bowel problems and neurological problems, such as stroke or Parkinson's disease.
- Overflow incontinence. Patients with nerve damage (from diabetes, for example) or damage to the bladder may constantly dribble urine because they're unable to empty the bladder completely when they urinate.
Other potential causes of incontinence are an enlarged prostate gland, a tumor in the urinary tract or bladder cancer. The majority of patients have either stress or urge incontinence—or a combination of both, known as mixed incontinence.
DIAGNOSIS
Most cases and types of incontinence can be diagnosed with a medical history alone. Keep a bladder diary for a week or two before you see your doctor. Write down how often you urinate...when you leak...and if you have trouble emptying your bladder. The answers to these questions usually are sufficient to allow a definitive diagnosis.
Tests may be required to provide additional information. Most common...
- Stress test. The doctor examines the urethra while the patient coughs or bears down. A leakage of urine indicates that the patient has stress incontinence.
- Urodynamic testing. There are a variety of tests that measure pressure in the bladder and how much fluid it can hold.
Example: The doctor might insert a catheter into the bladder, inject small amounts of fluid and measure changes in bladder pressure. Sudden increases in bladder pressure and/or spasms could indicate urge incontinence.
Patients may require an ultrasound to check how well the bladder empties. Your doctor also should perform urinalysis to check for blood or signs of infection in the urine.
TREATMENT
Some forms of incontinence are transitory and will go away when the underlying problem (an infection or inflammation, for example) improves. Most incontinence requires one or more of the following treatments, which can bring about significant improvement for most patients.
- Behavioral techniques. These techniques are used to help patients achieve better bladder control and are considered the mainstay of treatment. Examples...
- Bladder training requires patients to avoid going to the bathroom for longer and longer periods. A person might try to wait afl extra 10 minutes when he/she has the urge to urinate. The goal is to lengthen the waiting time over a period of days or weeks. Vith practice, most patients are able to wait several hours. This is for patients with bladder overactivity and frequent urination.
- Timed urination means going to the bathroom at specific intervals—say, once every hour, even if you don't feel as though you have to go. This might be used for frail, elderly people who tend to wet themselves because they can't hold it once the urge hits. The idea is to void before the bladder hits that point of no return.
- Kegel exercises. Patients are advised to tightly squeeze the same muscles that they would use to stop the flow of urine. Contract the muscles for three to five seconds, relax, then repeat again. Do the cycle several times daily, working up to more repetitions each time. Kegels are helpful for men and women and for both stress and urge incontinence cases.
- Medications. Antispasmodic drugs reduce bladder contractions that contribute to urge incontinence. These drugs often cause dry mouth as a side effect. They're usually used in combination with behavioral treatments.
- Surgery. If behavioral changes and medications don't adequately control incontinence, patients may require surgery, Main approaches…
- Tension-free uaginal tape (TVT) procedure. This is standard for women with stress incontinence. A mesh-like tape is slung under the urethra like a hammock. It compresses the urethra to prevent leaks.
- Bulking injections. Collagen or synthetic bulking agents are injected into tissue surrounding the urethra or urinary sphincter. The extra bulk causes surrounding tissue to tighten the seal of the sphincter. The procedure usually needs to be repeated every six to 18 months because collagen is absorbed by the body over time.
- Sphincter replacement. An artificial, doughnut- shaped device is implanted around the urethra. When patients are ready to urinate, they press a valve that causes the device to deflate and let out urine. This procedure is mainly used for men who have had prostate surgery.
