Urinary incontinence is a common condition, but also a private one that can be embarrassing to discuss. Thankfully, there are usually effective treatment options that can lead to significant improvement in a person’s symptoms and quality of life.
Bill Fletcher, MD, is an OBGYN specialist with Rochester Regional Health who treats cases like these frequently. He explains the causes, symptoms, and treatment options available.
What is urinary incontinence?
Urinary incontinence is an uncontrolled leakage of urine that stems from a loss of bladder control.
The body creates urine by filtering waste from your blood through the kidneys. From the kidneys, small tubes called ureters carry urine into the bladder.
When the bladder is full and it is time for the urine to be released, the muscles surrounding the bladder tighten and push the urine out. At the same time, muscles around the urethra, a tube that carries urine to the outside of the body, relax to allow the release of urine.
Incontinence can happen for several reasons, such as the muscles not working with the body’s urinary system as they should or when those muscles relax without warning.
Causes and risk factors
Some common causes and risk factors for this condition include:
- Overactive or weak bladder muscles
- Nerve damage affecting bladder control
- Diabetes
- Neurological disorders, such as stroke, spinal cord injuries, Parkinson’s disease, or Multiple Sclerosis
- Severe constipation
- Obesity
- Smoking
- Excessive caffeine intake
- Childbirth – particularly prior vaginal birth
- Insufficient pelvic floor support under the urethra
- Urinary tract infections
- Vaginal infection/irritation
- Menopause
- Fistula (an abnormal connection between the bladder and reproductive tract)
Urinary incontinence is a very common occurrence for women. Women who have experienced pregnancy, childbirth, and/or menopause have more significant stress on their pelvic floor and the muscles that support it.
The older you are, the more likely you are to have issues with incontinence. As the body ages, most muscles tend to stretch or weaken – including the ones helping the urinary system function.
Different types of incontinence
There are several different types of incontinence; each one has its own causes. Some people may live with more than one.
Stress incontinence: This form of leakage occurs when physical pressure is placed on the bladder (through laughing, coughing, sneezing, or exercising) and there is insufficient pelvic floor support under the urethra.
Overflow incontinence: When the bladder is full but a person cannot fully empty it (due to weakening of the muscle in the bladder wall, for example), urine can leak out. Associated symptoms can include urinary hesitancy, weak urinary stream, increased urinary frequency, or excessive urination overnight.
Urge incontinence: The urge to empty the bladder is usually gradual and allows a person enough time to plan to find a toilet. With urge incontinence, this comes on very suddenly and can result in a person not being able to make it to a bathroom in time. This is usually due to overactivity of the muscle in the bladder wall.
Functional incontinence: People living with functional incontinence have normal bladder control, but have other conditions, such as cognitive impairment, that make it difficult to make it to a bathroom to use the toilet.
Treatment options
When discussing potential incontinence problems with your doctor, he or she will likely perform a physical exam and ask about your medical history – including current medications and recent surgeries or illnesses. A doctor may also test your urine or blood, or test the ability of your bladder to empty fully.
“A thorough history and exam, in addition to other necessary tests, can help diagnose the type or types of incontinence you may be experiencing,” Dr. Fletcher said. “Understanding the type(s) of incontinence a person is dealing with is important, as the various types of incontinence are addressed with different types of treatment.”
There are often several available treatment options for urinary incontinence, ranging from medication to more invasive surgical treatments. The best treatment for a particular patient is usually determined after a thorough evaluation and discussion with your doctor about all of your options.
Lifestyle changes & exercises
Some of the steps you can take to reduce or eliminate urinary incontinence are changes you can make in your daily life.
Losing weight, quitting smoking, drinking less caffeine and alcohol, and minimizing fluid intake in the hours leading up to bedtime are all proven to help reduce instances of incontinence.
Set a regular schedule to visit the bathroom and use the toilet. Instead of waiting for the urge to go, go to the toilet at a pre-determined time.
Perform Kegel exercises to strengthen the muscles in your pelvic floor. This is done by tightening your pelvic floor muscles (the muscles you utilize to hold urine), holding them for a few seconds, and then releasing them. Building up the frequency and duration of the hold over time helps to strengthen those muscles.
Avoid lifting heavy objects without another person with you. If you are engaging in physical activities, use the toilet beforehand to avoid any leakage.
Physical therapists who specialize in treating disorders of the pelvic floor muscles, like urinary incontinence, can offer formal exercise/treatment regimens to help strengthen these muscles.
Medications and surgery
After a conversation with your doctor, medication can be an option for managing some types of incontinence.
Some prescription medications can help muscles tighten or relax better, reduce leaks, or help the bladder empty more fully.
In some cases, surgery may be discussed. These surgeries may shift the position of the bladder or add support under the urethra to help with better urinary control. This is considered after most other treatment options have been exhausted.
“In the end, the goal is to help you manage urinary incontinence and live a better life,” Dr. Fletcher said. “We will discuss all of the options you have available, review the benefits and disadvantages of these options, and decide together on the treatment that is best for you.”
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