What is Urinary Incontinence?
Urinary incontinence, the most common pelvic floor disorder, is a urinary condition relating to the involuntary release of urine due to a loss of bladder control. Its severity varies from person to person. Some may "leak" a few drops of urine when they cough, laugh, sneeze or exercise. Others may feel strong, sudden urges to urinate that can’t be controlled. Others may lose some urine during sexual activity.
As many as 25 million Americans suffer from incontinence, but research estimate that less than half of this population have been evaluated and treated due to embarrassment of lack of information about available treatments. Urinary incontinence is not limited to older adults—young people, including athletic women, new mothers, and people coping with illness, birth defects or physical trauma, such as surgery or spinal cord injuries are also affected.
How Does Urinary Control Work?
Urinary control is driven by both the brain and the bladder. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed which holds the urine in prior to voiding.
In normal urinary function, the neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra (the tube that carries urine out of the body) which prevents urine from leaking. Upon urination, the brain sends a signal to the bladder to contract the bladder muscles, to expel urine out through the urethra.
Who Usually Gets Urinary Conditions?
Urinary conditions affects both men and women. In the U.S., approximately 25 percent to 30 percent of men and women suffer from urinary incontinence.
It’s difficult to determine exactly how many people are affected by urinary conditions due to the embarrassing side effects that people avoid reporting to their doctors. Additionally, some may simply think the condition is a normal part of aging and simply not seek treatment.
Generally, there are several risk factors linked to urinary incontinence: diabetes, smoking, obesity and high blood pressure. Women are more likely to develop urinary incontinence due to childbirth and the additional pressure this puts on the pelvic area. Also, women in menopause are more likely to develop urinary incontinence due to lower estrogen rates in the body.
For men, those who experience problems with their prostate are more likely to have urinary incontinence.
What Are the Different Types of Urinary Conditions?
There are three main types of urinary incontinence:
- Stress Urinary Incontinence
- Urge/Overactive Bladder
- Mixed Urinary Incontinence.
Stress Urinary Incontinence
This occurs when urine accidentally leaks out when a person laughs, coughs, sneezes, exercises or lifts heavy items. This leakage is due to weakened and/or stretched pelvic muscles. Stress urinary incontinence is more common in older women but not as common in men. The most common symptom is the accidental leaking of urine with activity.
Urge Incontinence/Overactive Bladder
When a person has a sudden urge to urinate, this is caused by urge incontinence or overactive bladder. Because urinary control is controlled by both the brain and the bladder, urge incontinence can scramble these signals and cause the brain to send a signal to urinate to the bladder even though it isn’t full. Or, the bladder will begin contracting in anticipation of urination when the bladder isn’t full – this causes the sudden “urge” to go. The most common symptoms associated with urge incontinence are:
- Sudden urge to urinate
- Urine leakage
- Frequent urination (more than 8 times during a 24 hour period)
- Waking up at night to urinate
Mixed incontinence is having more than one form of incontinence at the same time. The most common form of mixed incontinence is stress urinary incontinence with overactive bladder. Symptoms include: urinary leaking and a strong, sudden urge to urinate.
Transient incontinence is less common and can result from urinary tract infections, medications, urtheritis or chronic incomplete emptying of the bladder. Normally, this condition can be resolved by diagnosis and treatment of the underlying cause.
What Are the Treatments for Urinary Conditions?
There are several types of treatment available for urinary incontinence which include: medications, behavioral training, medical devices and surgery.
There are specific medications one can take to help manage their symptoms and successfully treat urinary incontinence or overactive bladder.
The most commonly prescribed are those that prevent bladder spasms such as: Detrol, Ditropan XL, Enablex, Oxytrol, Urispas, and Vesicare. Some of these medications will also be prescribed for overactive bladder.
Certain lifestyle changes can help address symptoms of urinary conditions and can be relatively easy to adopt. For stress related conditions, limiting one’s daily fluid intake can help prevent any accidental leakage of urine.
For urge incontinence, it may be helpful to avoid foods that can irritate the bladder such as spicy foods, caffeine, and carbonated drinks.
Kegel exercises are also helpful with strengthening the pelvic floor muscles and may aid with alleviating urinary incontinence symptoms.
There are medical devices specifically for women with urinary incontinence that may help treat the condition. The first is a urethral insert, which is similar to a tampon, and is inserted into the urethra prior to any physical activity to prevent accidental leakage. Another device is called a pessary which is similar to a diaphragm as it is inserted into the vagina to help support the bladder.
Radiofrequency therapy is a non-surgical approach to treat stress urinary incontinence. A small catheter-like device is inserted into the urethra where low level heat is applied to the bladder. The heat stimulates the collagen in the bladder tissue so that it becomes more firm to stop urine leaks during physical activity.
Botox Injections (Botulinum toxin type A)
Primarily used for overactive bladder, Botox injections are administered into the bladder muscle to help strengthen bladder function.
Bulking agents are injected into the tissue of the urethra to keep it closed, preventing leakage.
Sacral Nerve Stimulation
Nerve stimulation using InterStim® therapy occurs when a device similar to a pacemaker is inserted under the skin. The device delivers electrical pulses to the sacral nerves that control bladder function.
There are several surgical treatment options for urinary incontinence:
- Pelvic Sling Procedure – Primarily used to treat stress incontinence, a pelvic sling is placed around the urethra and the neck of the bladder to provide additional support and keep the urethra closed
- Bladder Neck Suspension – With this procedure, the bladder is restored surgically to its normal anatomical position
- Prolapse Surgery – Mainly for treating mixed incontinence along with pelvic organ prolapse, this surgery may utilize a combination of the pelvic sling procedure and prolapse surgery
- Artificial Urinary Sphincter – This procedure is used primarily for men whose incontinence is associated with prostate cancer treatment or an enlarge prostate gland. A small ring is implanted around the bladder neck to keep the urinary sphincter closed until urination. A valve (also implanted under the skin) is pressed to begin urination
Memorial Hermann-Texas Medical Center is affiliated with highly qualified, experienced specialists and provides technologically advanced equipment for personalized diagnosis and treatment of men's and women's incontinence. Learn more about referrals and appointments.