Urinary incontinence is the unintentional loss of urine. The severity of urinary incontinence ranges from mild episodes to significant loss of urine.
If urinary incontinence affects your day-to-day activities, don't hesitate to call us. Most cases, simple lifestyle changes or medical treatment can ease your discomfort or stop urinary incontinence.
Types of urinary incontinence include:
- Stress incontinence. This is loss of urine when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
- Urge incontinence. Urge incontinence is the loss of urine, due to uncontrollable muscle spasm of your bladder.
- Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder.
- Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.
When to see a doctor
You may feel uncomfortable discussing incontinence with your doctor. But if incontinence is frequent or is affecting your quality of life, seeking medical advice is important for several reasons:
- Urinary incontinence may indicate a more serious underlying condition, especially if it's associated with blood in your urine.
- Urinary incontinence may be causing you to restrict your activities and limit your social interactions to avoid embarrassment.
- Urinary incontinence may increase the risk of falls in older adults as they rush to make it to the toilet.
Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.
- Alcohol. Alcohol acts as a bladder stimulant and a diuretic.
- Overhydration. Drinking a lot of fluids, especially in a short period of time, increases the amount of urine your bladder has to deal with.
- Caffeine. Caffeine is a diuretic and a bladder stimulant that can cause a sudden need to urinate.
- Bladder irritation. Carbonated drinks, tea and coffee with or without caffeine artificial sweeteners, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate your bladder.
- Medications. Heart medications, blood pressure drugs, sedatives, muscle relaxants and other medications may contribute to bladder control problems.
- Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
- Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency. In addition, compacted stool can sometimes interfere with the emptying of the bladder, which may cause overflow incontinence. Constipation has a significant effect on bladder control and is very important to have normal bowel movements.
- Sex. Women are more likely than men 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. However, getting older doesn't necessarily mean that you'll have incontinence. Incontinence isn't normal at any age — except during infancy.
- Being overweight. Being obese or overweight increases the pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
- Smoking. A chronic cough associated with smoking can cause episodes of incontinence or aggravate incontinence that has other causes. Constant coughing puts stress on your urinary sphincter, leading to stress incontinence. Smoking may also increase the risk of overactive bladder by causing bladder contractions.
- Other diseases. Kidney disease or diabetes may increase your risk for incontinence.
- Skin problems. Urinary incontinence can lead to rashes, skin infections and sores (skin ulcers) from constantly wet skin.
- Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.
- Changes in your activities. Urinary incontinence may keep you from participating in normal activities. You may stop exercising, quit attending social gatherings or even stop venturing away from familiar areas where you know the locations of toilets.
- Changes in your work life. Urinary incontinence may negatively affect your work life. Your urge to urinate may cause you to have to get up often during meetings. The problem may disrupt your concentration at work or keep you awake at night, causing fatigue.
- Changes in your personal life. Perhaps most distressing is the impact incontinence can have on your personal life. Your family may not understand your behavior or may grow frustrated at your many trips to the toilet. You may avoid sexual intimacy because of embarrassment caused by urine leakage. It's not uncommon to experience anxiety and depression along with incontinence.
Preparing for your appointment
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared. Here's some information to help you get ready, and what to expect from your doctor.
What you can do
Print off and complete our voiding diary.
- Write down key personal information, including any major stresses or recent life changes.
- Bring a list of all medications, vitamins or supplements that you're taking.
If further information is needed, you may undergo additional testing, including:
- Postvoid residual (PVR) measurement. For this procedure, you're asked to urinate (void) into a container that measures urine output. Then your doctor checks the amount of leftover (residual) urine in your bladder using a catheter. 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.
- Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.
- Stress test. For this test, you're asked to cough vigorously or bear down as your doctor examines you and watches for loss of urine.
- Urodynamic testing. These tests measure pressure in your bladder when it's at rest and when it's filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, the pressure in your bladder is monitored. This test helps determine what type of incontinence you have.
Treatment depends on the type of incontinence, the severity of your problem and the underlying cause. A combination of treatments may be needed.
Initially we will suggest the least invasive treatments first. We usually begin with behavioral techniques and physical therapy first and add other treatments as necessary.
Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.
- Bladder training. We may recommend bladder training. This type of therapy may used alone or in combination with other types of therapy. In bladder training you begin with a frequency of urination that you are able to maintain. Once you able to keep the initial voiding schedule we have you then add 15 minutes between each void until you are able to void on schedule every 2 to 4 hours.
- Fluid and diet management. In some cases, you can simply modify your daily habits 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 are other lifestyle changes that can help.
- Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles to help control your bladder. Pelvic floor exercises or physical therapy has a significant impact on improving both stress urinary incontinence and urge incontinence.
See Pelvic Floor exercises.
- Kegal Cones. These are a good adjunct to pelvic floor exercises. Initially you insert the largest cone vaginally and hold while standing upright for 10 minutes in the am and 10 minutes in the pm. Once you can keep the cone in for these durations, 2x a day for 2 weeks then you move to the next size smaller and heavier until you get to the last cone. Once at the last cone you continue on this regiment. These cones may be ordered from online stores such as Amazon.
Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:
- Anticholinergics. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Possible side effects of these medications include dry mouth, constipation, blurred vision and flushing.
- Estrogen. Estrogen may be taken orally in a systemic form or topical to help with both vaginal and bladder health.
- Imipramine. Imipramine (Tofranil) is a tricyclic antidepressant that may be used to treat mixed (stress and urge) incontinence.
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:
- Pessary (PES-uh-re). Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.
- Bulking material injections. Bulking agents are materials that are injected into tissue surrounding the urethra. This helps keep the urethra closed and decrease urine leakage. The procedure is usually done in a urologist office.
If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence.
- Sling procedures. A sling procedure uses a synthetic material or mesh to create a pelvic sling or hammock around your bladder neck and urethra. The sling helps keep the urethra closed, especially when you cough or sneeze.
- Bladder neck suspension. This procedure is designed to provide support to your urethra at the level of the neck of your bladder. It involves an abdominal incision, so it's done using general or spinal anesthesia.
Absorbent pads and catheters
If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.
- Pads and protective garments. Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear, and you can wear them easily under everyday clothing.
- Catheter. If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder (self-intermittent catheterization). This should give you more control of your leakage, especially if you have overflow incontinence. You'll be instructed on how to clean these catheters for safe reuse.
Problems with urine leakage may require you to take extra care to prevent skin irritation. Some things you can do to protect your skin include:
- Use a washcloth to clean yourself.
- Allow your skin to air dry.
- Avoid frequent washing and douching because these can overwhelm your body's natural defenses against bladder infections.
- Consider using a barrier cream, such as petroleum jelly or cocoa butter, to protect your skin from urine.