Urinary Incontinence
What is urinary incontinence?
Urinary incontinence is the inability to control your urine. It affects many people and can happen at any age.
Incontinence can affect your daily life, and is often upsetting. The good news is that incontinence is treatable!
You do not need to live in fear of having an embarrassing accident, because you can get help.
Types of incontinence
 Stress incontinence – When pressure is put on the bladder (sneezing, coughing, lifting, or even
just standing) urine leaks can occur.
 Urge incontinence – Also referred to as “overactive bladder” or OAB, you may feel a strong urge
to urinate or experience frequent urination accompanied with leakage.
 Overflow incontinence – When the bladder does not empty completely, you may retain large
amounts of urine, which may cause leaking of urine.
 Mixed incontinence – This is a combination of both stress and urge incontinence.
To better understand why and how urine leaks, you should first understand the
anatomy of the urinary tract system. The two kidneys collect and filter your
body fluids to produce urine. Urine passes from the kidneys through thin tubes
called ureters into the bladder, where it is stored until you have the urge to
urinate. Pelvic floor muscles help hold the bladder and other pelvic organs in
place, as well as keeping the urethra squeezed closed. When you urinate, fluid
flows from the bladder and through the urethra, another small, thin tube, to the
outside. When you are ready to urinate, the pelvic floor muscles and urinary
sphincter relax, opening the urethra. The bladder muscle contracts and this
force pushes urine out of the body.
Stress incontinence occurs when pressure on the bladder (from coughing,
lifting, etc.) makes the bladder neck open. If the muscles of the pelvic floor and
urinary sphincter aren’t strong enough to close the urethra, urine leaks out.
Several factors, including but not limited to pregnancy, childbirth, hormonal changes, obesity and aging, can
contribute to your stress incontinence.
Urge incontinence occurs when the bladder muscle contracts involuntarily. Even if the bladder isn’t full, the
force of these contractions can cause leakage of urine. Causes of urge incontinence can include urinary tract
infection (UTI), bladder irritation, nerve damage in the bladder, stroke or nerve damage of the brain, and
certain medications.
Overflow incontinence occurs when damage to the bladder nerves interrupts the signal to urinate before it
reaches the brain, or when the bladder muscle is severely weakened. Both of these put pressure on the urinary
sphincter, and the constant pressure from your full bladder causes leaking. A few causes of overflow
incontinence can include stroke, radiation therapy to the pelvic area, spinal cord injury, and diseases such as
Parkinson’s.
How is my type of incontinence diagnosed?
Your doctor will have you fill out a questionnaire that you should receive in the mail prior to your
appointment. If you use pads for your incontinence, you will also be asked to bring in 24 hours’ worth of
used pads, along with 1 dry pad, to obtain an accurate measure of the extent of your leakage. Using the
answers to this questionnaire along with the results of your pad test, the doctor will talk with you regarding
your symptoms. He may do a pelvic exam that includes some simple tests, such as coughing or having you
bear down. You may also have a test that involves filling your bladder with an amount of sterile water. You
will answer a few questions while this is happening. Once your bladder is full, the doctor may perform a
pelvic exam to see the extent of your leakage. He may also look inside your bladder using a small, lighted
scope called a cystoscope. There may be other testing involved, but usually this will be at a later date.
What treatments are available for incontinence?
Depending on your type of incontinence, there are several treatments available. For all types of incontinence,
quitting smoking, losing excess weight, and making certain dietary changes may be helpful.
Stress incontinence may be treated by performing Kegel exercises, biofeedback, timed voiding, bulking
agent injections, or surgery. Urge incontinence can also be treated with Kegel exercises, biofeedback,
stimulator implants, medication, timed voiding, bladder retraining, or Botox injections. Overflow
incontinence is usually treated by stimulator implants or self-catheterization. Below are explanations of these
terms:
 Kegel exercises help strengthen the pelvic floor muscles. These muscles help support the bladder
and urethra. Kegel exercises are performed by squeezing the same muscles you use to stop your
urine stream. They are easy and can be done almost anywhere. You will need to perform these
exercises several times per day; your doctor will tell you how often. You need to be patient while
you perform these exercises. Like any muscle in your body, the pelvic floor muscles take time to
strengthen to achieve a satisfactory result. It can take up to six weeks to notice a difference.
 Biofeedback is a technique that can help you learn how to isolate your pelvic floor muscles for
Kegel exercises. A small probe or adhesive patches are used to sense signals from your muscles.
In the female patient, a small probe is placed in the vagina. For male patients, external patches
may be placed on the skin below the scrotum, or a rectal probe may be inserted. This way you can
learn to use the right muscles and achieve the maximum benefit from your exercises. Biofeedback
can also be used to suppress urges, or those involuntary contractions from your bladder,
lengthening the amount of time you can wait to urinate.
 Medications can be used to improve your incontinence symptoms but may not “cure” your
incontinence. Due to the variety of medications available to help treat incontinence, you may need
to be patient as you and your doctor try different medications. While the medications are similar
to each other, you may need to try several different medications until you find the one that gives
you the best control of your symptoms with the least amount of side effects.
 Timed voiding means urinating on a set schedule instead of waiting for an urge. This helps empty
the bladder and avoid incontinence incidents.
 Bladder retraining is useful for patients suffering from urge incontinence. If you suffer from this
condition, you probably go to the bathroom frequently. By
doing Kegel exercises during these frequent urges, you can
learn to suppress the urge and “retrain” your bladder. Your
doctor will give you additional information regarding how to do
this effectively.
 Urethral bulking agents can be injected in the urethra near the
bladder neck. This makes the tissues bulk and close up,
creating a seal that prevents urine from leaking out. When you
want to urinate, the tissues are still able to separate and allow
urine to flow through.
 Surgery for stress incontinence is usually reserved for more
severe cases. Surgery is used to rebuild support of the bladder and urethra so they remain in place.
There are several surgical procedures available. You and your surgeon will decide which is the
best option for you. Small incisions may be made in the vagina, abdomen, or both. The surgeon
uses these incisions to insert material to support your bladder and urethra. It may also be used to
put pressure on the urethra to keep it closed.
 Stimulator implants function similar to a pacemaker for your heart. When the bladder sends a
false signal to your brain to tell you to urinate, it is intercepted by the stimulator implant, which is
implanted under the skin in your buttocks. The stimulator also gives off mild electrical signals to
the nerves that control your bladder, which can be used in overflow incontinence.
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Botox, or Botulinum toxin, is a procedure during which your doctor will inject Botox into your
bladder, causing paralysis of the muscles and reducing urge incontinence episodes.
Self-catheterization is the use of a small, hollow tube placed into the bladder through the urethra
by you to empty your bladder. By doing this a few times a day, you can control your overflow
incontinence. This procedure is simple and can be taught to you by your doctor’s nursing staff.
What else should I know about my diagnosis of incontinence?
While treatment may greatly improve your incontinence symptoms, it may not cure you entirely. There are
several things you can do to increase your comfort. By using absorbent pads specially designed for
incontinence, you can keep the majority of the wetness away from your skin. Not doing this can lead to skin
irritation and eventually skin breakdown. Keeping yourself very clean and dry will help reduce irritation and
odor.
Many people try to avoid drinking fluids in an attempt to curb their incontinence. Don’t do this! Your body
needs fluids. Instead of avoiding fluids, you can try to drink fluids when you know you can get to a
bathroom. Drinking fluids during the day and limiting them in the evening can help prevent nighttime
problems. Water is always the best choice. Be sure to avoid bladder irritants. These are substances that make
your urine more acidic, which can irritate the bladder lining and give the false sensation of needing to urinate.
There are many lifestyle changes that can help improve your incontinence symptoms. Taking a proactive
approach toward your incontinence is the best thing you can do. Together with your doctor, you should be
able to significantly improve your symptoms.
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