Incontinence

If you’re frustrated by urine leakage when you cough, laugh, or exercise, you’re not alone. Urinary incontinence becomes more common as you age. The good news – it’s treatable.

Urinary incontinence is the loss of bladder control which results in accidental urine leakage. Twice as common in women (but can happen in men too), urine leakage can be due to pelvic floor muscles that have weakened, bladder problems, prostate problems (in men), or misfiring of nerves. Leakage can happen suddenly, in small or large amounts.

There are two types of urinary incontinence:

Stress incontinence
As the name suggests, stress incontinence occurs when there is stress or pressure put on your bladder. Because your pelvic floor muscles are weakened and your urinary sphincter doesn’t close appropriately, any stress or pressure easily triggers the release of urine.

When you have stress incontinence, everyday actions that use the pelvic floor muscles, such as sneezing, laughing, jumping, lifting heavy objects, or coughing, tend to cause urine leakage. This also includes sudden physical activity and movements.

Urge incontinence
Also called overactive bladder, urge incontinence occurs when your nervous system does not coordinate properly with the bladder to allow you to hold urine and release it at the right time. The bladder may suddenly empty itself without warning, or you may feel like you need to pass urine more frequently.
Learn more about urge incontinence/overactive bladder on this page. 

Frequent Urination
Needing to urinate more than eight times a day or waking up more than twice at night to urinate.

Bedwetting
Unintentional urination during sleep.

Sudden Urges to Urinate
Strong, uncontrollable urges to urinate, often accompanied by pelvic pressure or spasms.

Leakage with Movement
Involuntary urine leakage triggered by physical activities such as coughing, sneezing, exercising, or lifting heavy objects.

Urinary incontinence can be caused by problems with the nerves and muscles that help the bladder to pass or hold urine.

The pelvic floor muscles that support your urethra, bladder, uterus, and bowels may become damaged or weak. For women this can occur following pregnancy, childbirth, or menopause. With weakened muscles, your bladder and urethra are forced to work harder to hold urine. For men, it can be due to an enlarged prostate, after prostate surgery, or neurologic problems.

Unfortunately, the extra pressure or stress on the bladder and urethra can cause urinary leakage or incontinence.

Urinary incontinence may also be caused by:

• Aging of the bladder muscles
• Being overweight
• Nerve damage
• Surgery in the reproductive organs such as a hysterectomy.
• Certain medications
• Caffeine
• Smoking
• Childbirth
• Urinary tract infection
• Multiple sclerosis
• Stroke
• Brain tumor
• Parkinson’s disease
• Spinal injury
• Urinary stones

During your visit, your doctor will ask you questions regarding your medical history and will perform an exam. It is helpful to keep a bladder diary for at least two to three days before seeing your physician. This will help inform your doctor of things like the severity of your bladder leaks and when you’re experiencing urine leaks, all of which may help to uncover any patterns happening with leakage. It is also helpful to bring a list of any medications, vitamins, or other supplements you are taking to discuss with your doctor.

Other tests that may be performed during or after your visit:

• Urinalysis: this evaluates for any blood in the urine or infection
• Post-void residual: The physician will often ask you to void and then check to make sure you are emptying your bladder.
• Cystoscopy: This is a procedure performed in the office where the physician inserts a small scope into the bladder
• Urodynamics: This is a test where a small catheter is inserted into the urethra/bladder and another into the rectum to help measure the pressures in the bladder while filling the bladder and urination.

For Women and Men

There are many treatment options as well as simple management techniques that can help you get your life back the way you want it.

• Loss of excess weight: Obesity is a risk factor in developing stress urinary incontinence due to the extra pressure placed on the pelvic floor and the bladder. Following a healthy diet and losing weight can help ease symptoms.
• Smoking cessation: All that coughing can put stress on your pelvic floor and that can lead to muscle weakness and leakage.
• Pelvic floor muscle exercises: Kegel exercises are for men and women. They help strengthen the pelvic floor muscles so you’re able to better hold in urine. It’s a good idea to see a physical therapist to get a proper evaluation and to learn how to do these exercises correctly.
• Biofeedback: Biofeedback is often done in conjunction with Kegels. A physical therapist may use a biofeedback instrument to measure your pelvic floor strength and monitor your improvement.
• Bladder retraining: This involves timing your trips to the toilet and slowly increasing the length of time between each visit.
• Pelvic floor stimulation or e-stim: This therapy delivers a small amount of electrical stimulation to the nerves and muscles of the pelvic floor and bladder to help them tighten or contract, thereby strengthening them.
• Percutaneous tibial nerve stimulation (PTNS): Your provider stimulates the nerve by your ankle (which also serves the bladder) weekly for a duration of time to help reprogram the bladder and help relieve symptoms.

For Women

Non-Surgical Treatment

• Pessary: This is a ring-like device that your doctor will fit for you inside the vagina. The device helps to support the base of the bladder to prevent at most 50% of urine leaks. This is especially helpful for those who may have experienced a pelvic organ prolapse
• Topical estrogen: Rarely prescribed to treat stress urinary incontinence due to low success rates, low dosage estrogen is administered vaginally to gently lubricate the tissues of the vagina. Many clinicians observe some improvement in symptoms of SUI in women. This should not be confused with Hormone Replacement Therapy (HRT), which has not proven to relieve incontinence in postmenopausal women.

Surgical Treatment

• Mid-urethral synthetic sling (“sling procedure”): The most common procedure for stress urinary incontinence is a surgical mesh in the form of a “sling” permanently implanted beneath the urethra.
• Autologous fascial sling: The autologous fascial sling uses the patient’s own tissue, taken either from the abdominal region or the thigh, to create the sling that supports the urethra.
• Urethral bulking agents: A medication is injected inside the urethra to make the space around it thicker, thus helping to control urine leakage. The effects may not be permanent.

For Men

Non-Surgical Treatment

• Behavioral changes: Stopping smoking, controlling asthma or COPD, weight loss and exercise all may contribute to improving your symptoms.
• Pelvic floor muscle therapy: Similar to other muscles in the body, these are specific exercises targeting the pelvic muscles that may strengthen the support around the bladder.
• Penile clamp: This is a device placed on the penis to prevent the leakage of urine and decrease the number of pads and diapers utilized. It is a non-surgical method that is offered to patients that do not want to undergo surgical repair.
• Condom catheter: This is a device placed on the penis that will not prevent leakage but will collect the urine that leaks to prevent soiling of clothes or undergarments.

Surgical Treatments (usually for men who have incontinence after prostate surgery)

• Male sling: A minimally invasive procedure involving the placement of a mesh sling to support the urethra, used for mild to moderate leakage.
• Artificial urinary sphincter: A procedure involving placement of a prosthetic cuff around the urethra to help compress the urethra.