Urinary Incontinence – Causes, Symptoms, Diagnosis, And Treatment
What is urinary incontinence?
Urinary incontinence refers to the unintentional passing of urine. This condition occurs when you are not able to keep urine from leaking out. This condition can range from mild leakage to uncontrollable wetting. Urinary incontinence is a common problem that affects many people.
What causes urinary incontinence?
Bladder control problems cause urinary continence due to various conditions and reasons. Bladder control problems occur when muscles are too weak or too active.
The following are the common causes of urinary incontinence:
- Blockage in the urinary system
- Other problems with the urinary system
- A weakness of the pelvic or urethral muscles
- Brain or nerve problems
- Dementia or other mental health problems (These problems make it hard to feel and respond to the urge to urinate)
- Nerve and muscle problems
Urinary incontinence can be sudden and go away after a short period of time or it may continue long-term.
The following are the causes of sudden or temporary incontinence:
- Prostate infection or inflammation
- Stool impaction from severe constipation (this causes pressure on the bladder)
- Urinary tract infection or inflammation
- Bed rest (such as when you are recovering from an illness or surgery)
- Weight gain
- Certain medicines (such as diuretics, antidepressants, tranquilizers, some cough and cold remedies, and antihistamines)
- Mental confusion
The following are the causes of long-term urinary incontinence:
- Bladder cancer.
- Bladder spasms.
- Large prostate in men.
- Nervous system conditions, such as multiple sclerosis or stroke.
- Nerve or muscle damage after radiation treatment to the pelvis.
- Pelvic prolapse in women. (falling or sliding of the bladder, urethra, or rectum into the vagina)
- Problems with the urinary tract.
- Weakness of the sphincter. (circle-shaped muscles that open and close the bladder).
- Spinal cord injuries.
- Alzheimer disease.
What are the symptoms of urinary incontinence?
Unintentional leakage of the urine is the main symptom of urinary incontinence. Many people experience occasional, minor leakage of urine. Some people may lose small to moderate amounts of urine frequently. Different types of urinary incontinence can occur due to various health conditions.
The following are the types of urinary incontinence that can occur:
- Stress Incontinence: This type occurs during activities like coughing, sneezing, laughing, or exercise.
- Urge Incontinence: This type occurs as a result of a strong, sudden urge to urinate. Then the bladder squeezes and you lose urine. You don’t have enough time after you feel the need to urinate to get to the bathroom before you do urinate.
- Overflow Incontinence: This type occurs when the bladder cannot empty. This leads to dribbling.
- Functional Incontinence: This type occurs when you are unable to make it to the toilet in time due to a physical or mental impairment. If you have a condition like severe arthritis, you may not be able to unbutton your pants quick enough to urinate.
- Mixed Incontinence: Mixed incontinence occurs when you have more than one type of urinary incontinence.
How is the cause of urinary incontinence diagnosed?
The doctor will perform a physical exam and review your symptoms and medical history. The physical exam includes a pelvic exam and rectal exam. The doctor may check the strength of the pelvic floor muscles. He/she will also check if the prostate is enlarged in male patients.
The doctor may order the following tests to diagnose the cause of urinary incontinence:
- Bladder Diary: You have to keep a bladder diary for 2-3 days about how much you drank when urination occurs, how much urine is produced, and the number of episodes of incontinence.
- Urinalysis: To look for signs of infection and abnormalities.
- Blood Test: To assess kidney function.
- Postvoid Residual Measurement (PVR): To assess how much urine is left in the bladder after urinating.
- Pelvic Ultrasound: To help detect any abnormalities.
- Stress Test: You will be asked to apply sudden pressure while the doctor checks if there is any loss of urine with pressure.
- Urodynamic Testing: To determine how much pressure the bladder and urinary sphincter muscle can withstand.
- Cystogram: This provides an image of the bladder and problems in it.
- Cystoscopy: To view any abnormalities in the urinary tract.
How is urinary incontinence treated?
Treatment depends on the type of urinary continence and what caused it. Treatment consists of self-care measures, medicines, catheter, never stimulation, and surgery. Usually, the doctor may recommend trying self-care measures either before any treatment or along with treatment.
The following self-care measures may help improve urinary incontinence:
- Avoid constipation by increasing the fiber in your diet.
- Quit smoking (to reduce coughing and bladder irritation).
- Avoid alcohol and caffeinated drinks such as coffee (these substances stimulate your bladder).
- Control your weight if obese.
- Avoid foods and drinks, such as spicy foods, sodas, citrus fruits and juices that may irritate your bladder.
- Keep your sugar in control if you have diabetes.
- For urine leaks, wear absorbent pads or undergarments.
Bladder Retraining And Kegel Exercises
Bladder retraining helps you gain better control over your bladder. Your doctor will explain to you about bladder strengthening and retraining.
Doing Kegel exercises will help strengthen the muscles of your pelvic floor. Your doctor will show you how to do them or refer you to a pelvic floor specialist.
Your doctor will prescribe medicines to help prevent muscle spasms, relax the bladder, and improve bladder function. What medications your doctor will prescribe depends on the type of incontinence you have.
Your doctor may recommend a catheter if you have overflow incontinence or you cannot fully empty your bladder. A catheter can either be in-dwelling (a catheter that stays in long-term) or one that you can put in and take out. The doctor will teach you how to insert and take it out.
Bladder Nerve Stimulation
Your doctor may recommend electrical nerve stimulation to treat urge incontinence and urinary frequency. In this procedure, pulses of electricity are used to reprogram bladder reflexes. In one technique, the provider inserts a stimulator through the skin near a nerve in the leg. This is done weekly in the doctor’s office. Another method uses a battery-operated implanted device similar to a pacemaker that is placed under the skin in the lower back.
Your doctor may recommend Botox (Onabotulinum A toxin) injection for urge incontinence. Botox injection relaxes the bladder muscle and storage capacity of the bladder. This injection is delivered through a cystoscope (a thin tube with a camera at the end). In most cases, the procedure can be done in the doctor’s office.
If the above measures or treatments don’t work or you have severe incontinence, your doctor may recommend surgery. The type of surgery your doctor recommends will depend on the severity of your symptoms, the type of incontinence, and what causes the problem.
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.