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Urinary Incontinence

Definition:
Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having sudden, unpredictable episodes of strong urinary urgency. Sometimes, the urgency may be so strong you don't get to a toilet in time.

Although urinary incontinence affects millions of people, it isn't a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition with many possible causes, some relatively simple and self-limited and others more complex.

If you're having enough trouble with bladder control that it affects your day-to-day activities, don't hesitate to see your doctor. In many situations, urinary incontinence can be stopped. Even if the condition can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.

Causes:
Urinary incontinence isn't a disease, it's a symptom. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.

The ins and outs of bladder control
Except when you're urinating, your bladder muscle stays relaxed so that it can expand to store urine. The relaxed bladder gets support from increasing contractions of your pelvic floor muscles. Your bladder and pelvic floor muscles communicate with each other to help hold urine in the
bladder without leaking.

When your bladder is full, it sends nerve signals to your brain. In response, and at an appropriate time and place, you relax your pelvic floor muscles and your bladder contracts, allowing urine to pass through the urethra and out of your body.

Causes of temporary urinary incontinence
Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.
  • Alcohol. Beer, wine and spirits are all diuretics. They cause your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate and act on that need in a timely manner.
  • Over-hydration. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.
  • Dehydration. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the toilet. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become very concentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.
  • Caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly and hold less than usual so that you suddenly and perhaps uncontrollably need to urinate.
  • Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.
  • Medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.
  • Other illnesses or injuries. Any serious illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence.

Easily treatable medical conditions also may be responsible for urinary incontinence.

  • Urinary tract infection. Infectious agents — usually bacteria — can enter your urethra and bladder and start to multiply. The resulting infection irritates 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 trigger urine frequency.
Causes of persistent urinary incontinence
Urinary incontinence can also be a persistent condition caused by some underlying physical problem — weakened pelvic floor or bladder muscles, neurological diseases, or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:
  • Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of a vaginal delivery can weaken the pelvic floor muscles and the ring of muscles that surrounds the urethra (urinary sphincter). The result is often stress incontinence — urine escapes past the weakened muscles whenever pressure is placed on your bladder. The changes that occur during childbirth can also damage bladder nerves and supportive tissue and can lead to a dropped (prolapsed) pelvic floor, producing a vaginal bulge. With prolapse, your bladder, uterus, rectum or small bowel can get pushed down from the usual position and protrude into your vagina. Such protrusions can be associated with incontinence. Incontinence related to childbirth may develop right after delivery or, more likely, may not develop until years later.
  • Changes with aging. Aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.

    Women produce less of the hormone estrogen after menopause, a decrease that can contribute to incontinence. Estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues lose some of their ability to close — meaning that your urethra can't hold back urine as easily as before.

  • Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — runs the risk of damaging the supporting pelvic floor muscles, which can lead to incontinence.
  • Painful bladder syndrome (interstitial cystitis). This rare, chronic condition can be associated with an inflammation of the bladder wall. It occasionally causes urinary incontinence, as well as painful and frequent urination. Interstitial cystitis affects women more often than men, and its cause isn't clear.
  • Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, or inflammation of the prostate gland — a walnut-sized organ located just below the male bladder. Even so, urinary incontinence sometimes occurs with this extremely common condition. The prostate actually surrounds the urethra, so inflammation of the prostate occasionally swells and constricts the urethra, blocking normal urine flow and leading to urinary urgency and frequency. Rarely, this also causes incontinence.
  • Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). The prostate begins to enlarge in many men after about age 40. As the gland enlarges, it can constrict the urethra and block the flow of urine. For some men, this problem results in urge or overflow incontinence.
  • Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments — surgery or radiation — for prostate cancer.
  • Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer and also of bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
  • Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
  • Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Urinary obstruction can also occur after overcorrection during a surgical procedure to correct urinary incontinence, leading to more urine leakage.

Risk Factor:

With so many possible causes, it's not surprising that urinary incontinence is common. These factors increase your risk of developing this common condition:
  • Sex. Women are more likely than men are to have stress incontinence. Pregnancy and 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.
  • Obesity. Being overweight increases the pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze.
  • Smoking. A chronic cough can cause episodes of incontinence or aggravate incontinence that has other causes. Constant coughing puts stress on your urinary sphincter. Longtime smokers often experience stress incontinence for this reason. Smokers are also at risk of developing overactive bladder.
  • Vascular disease. People with extensive vascular disease that can occur with aging are at increased risk of overactive bladder.
  • Participating in high-impact sports. High-impact sports — such as running, basketball and gymnastics — can cause episodes of incontinence in otherwise healthy women. These vigorous activities put sudden, strong pressure on your bladder, allowing urine to leak past your urinary sphincter. However, no data links high-impact sports to an increased risk of chronic stress incontinence.
  • Other diseases. Having kidney disease or diabetes may increase your risk of urinary incontinence.
When to seek medical advice:
You may feel uncomfortable discussing incontinence with your doctor. But seeking medical advice for incontinence 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.
A few isolated incidents of incontinence don't necessarily require medical attention. But if incontinence is frequent or affecting your quality of life, talk to your doctor.

Symptoms:

Urinary incontinence is the inability to control the release of urine from your bladder. The problem has varying degrees of severity. Some people experience only occasional, minor leaks — or dribbles — of urine. Others wet their clothes frequently. For a few, incontinence means both urinary and fecal incontinence — the uncontrollable loss of stools.

Types of urinary incontinence include:
  • Stress incontinence. This is loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It has nothing to do with psychological stress. Stress incontinence occurs when the sphincter muscle at the bladder is weakened. The problem is especially noticeable when you let your bladder get too full. Stress incontinence is one of the most common types of incontinence, often affecting women. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to this type of incontinence.
  • Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may also need to urinate often. The need to urinate may even wake you up several times a night. Some people with urge incontinence have a strong desire to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" — it's contracting even when your bladder isn't full. In fact, urge incontinence is often called an overactive bladder.
  • Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, leading to overflow. With overflow incontinence, sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a damaged bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase the risk of developing overflow incontinence.
  • 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. Usually one type is more bothersome than the other is.
  • Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. Someone with Alzheimer's disease may not plan well enough to make a timely trip to the toilet. This type of incontinence is called functional incontinence.
  • Gross total incontinence. This term is sometimes used to describe continuous leaking of urine, day and night, or periodic large volumes of urine and uncontrollable leaking. The bladder has no storage capacity. Some people have this type of incontinence because they were born with an anatomical defect. It can be caused by a spinal cord injury or by injury to the urinary system from surgery. An abnormal opening (fistula) between the bladder and an adjacent structure, such as the vagina, also may cause this type of high-grade urinary incontinence.
Dignosis:
The first step in diagnosing urinary incontinence is to see your doctor for a complete medical exam.

Your doctor will ask about your symptoms and medical history. How often do you need to urinate? When do you leak urine? Do you have trouble emptying your bladder? Are you experiencing any signs or symptoms in addition to incontinence? Your answers to these questions will help your doctor determine what type of incontinence you have.

A complete physical examination, focusing on your abdomen and genitals, also may give clues to your incontinence. Your doctor will look for reasons for your incontinence, such as a urinary tract infection, mass or compacted stool. If the cause of your incontinence is harder to find, your doctor may want to do some tests.

Common tests
Common tests for urinary incontinence include:
  • Bladder diary. Your doctor may go over a bladder diary that he or she has asked you to complete at home over several days. You record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes. To measure your urine, your doctor may give you a pan that fits over your toilet rim. The pan has markings like a measuring cup. Keeping a bladder diary can be tedious, but it gives your doctor important information.
  • Urinalysis. A sample of your urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities. For the sample to be collected, you're asked to urinate into a container. A urine culture is a lab test that specifically checks for signs of infection in your urine. A urine cytology involves a check of your urine for cancer cells.
  • Blood test. Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.
Specialized testing
If further testing is needed, you'll likely be referred to a doctor who specializes in urinary disorders (urologist). Women might be referred to a doctor who focuses on urological problems in women (urogynecologist). At the specialist's office, you may undergo additional testing such as:
  • Postvoid residual (PVR) measurement. This test helps your doctor determine whether you have difficulty emptying your bladder. For the procedure, you're asked to urinate (void) into a funnel-like container that allows your doctor to measure your urine output. Then your doctor checks the amount of residual urine in your bladder using a catheter — a thin, soft tube that's inserted into your urethra and bladder to drain any remaining urine — or an ultrasound device. For the ultrasound test, a wand-like device is placed over your abdomen. The device sends sound waves through your pelvic area. A computer transforms these sound waves into an image of your bladder, so your doctor can see how full or empty it is. A large amount of leftover (residual) 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 both at rest and when filling. A doctor or nurse inserts a catheter into your urethra and bladder. The catheter is used to fill your bladder with water while a pressure monitor measures and records the pressure within your bladder. Normally, pressure increases by only very small amounts during filling. This test helps your doctor measure the strength of your bladder muscle and the health of your urinary sphincter.
  • Cystogram. In this X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, your doctor injects a fluid containing a special dye. As you urinate and expel this fluid, images show up on a series of X-rays. These images help reveal problems with your urinary tract.
  • Cystoscopy. In this procedure, a thin tube with a tiny lens (cystoscope) is inserted into your urethra. With the aid of this device, your doctor can check for — and potentially remove — abnormalities in your urinary tract.
Once the tests are complete, your doctor can explain the results and discuss treatment options with you.

Complication:
Complications of chronic urinary incontinence include:
  • 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 refrain from laughing because you're afraid of an accident. You may even reach the point at which you stop traveling or venturing out of 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 keep you away from your desk or cause you to have to get up often during meetings. The problem may be so distressing that it disrupts your concentration at work. Urinary incontinence may also keep you awake at night, so you're tired most of the time.
  • 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.
The good news, however, is that incontinence isn't something you necessarily have to live with. Most cases of incontinence can be eliminated or controlled, especially when treatment begins early.

Treatment:
Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches best suited to your condition. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.
Treatment options for urinary incontinence fall into four broad categories — behavioral techniques, medications, devices and surgery. In most cases, your doctor will suggest the least invasive treatments first, so you'll try behavioral techniques first and move on to other options only if these techniques fail.

The success of your treatment depends most of all on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.

Behavioral techniques
Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.
  • Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises frequently to treat your incontinence. They are especially effective for stress incontinence, but may also help urge incontinence.

    To do pelvic floor muscle exercises (Kegels), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use and hold for a count of three. Relax, count to three again, then repeat. You can do these exercises almost anywhere — while you're driving, watching television or sitting at your desk at work.

    With Kegels, it can be difficult to know whether you're contracting the right muscles and in the right manner. In general, if you sense a pulling-up feeling when you squeeze, you're using the right muscles. Men may feel their penises pull in slightly toward their bodies. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor. Another way to be sure you're doing Kegels correctly is a simple finger test. Place a finger in your anus or vagina. Then squeeze around your finger. The muscles you contract are your pelvic floor muscles.

    If you're still not sure whether you're contracting the right muscles, ask your doctor for help. Your doctor can refer you to a physical therapist for biofeedback techniques that will help you identify and contract the right muscles.

    After several months of doing pelvic floor muscle exercises correctly, you should notice improvement in your urinary control. Contract your pelvic muscles to control leakage when you have an urge to urinate or when you cough or sneeze.

  • Bladder training. Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try increasing the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

    Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid overflow incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

  • Scheduled toilet trips. This means timed urination — going to the toilet according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis — usually every two to four 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 or caffeine, if either causes you incontinence. If acidic foods irritate your bladder, cutting back on such triggers may rid you of your problem. For some people, reducing liquid consumption before bedtime is all that's needed. Losing weight also may eliminate the problem.
Medications
Many times, urinary incontinence can be corrected with the help of medication. Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:
  • Anticholinergic (antispasmodic) drugs. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Examples include tolterodine (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare) and darifenacin (Enablex). These drugs can be effective at controlling incontinence, but a side effect is dry mouth. To combat dry mouth, you may be tempted to drink more water. But that may not help your incontinence. Your doctor may recommend that you suck on a piece of candy or chew gum instead to produce more saliva. Or you may want to try an extended-release form of oxybutynin (Ditropan XL) or tolterodine (Detrol LA) or an oxybutynin skin patch (Oxytrol). These forms of medication may have fewer side effects than the standard forms do.
  • Imipramine (Tofranil). This antidepressant may occasionally be used in combination with other medications to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.
  • Antibiotics. If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.
  • Others. Your doctor may prescribe drugs that actually relax your urinary sphincter or make your bladder contract more, depending on the underlying cause of your incontinence. If you're a man with incontinence caused by an enlarged prostate gland, your doctor may prescribe medications or other therapies to treat your condition. The goal may be to relax muscles around your urethra so that you can urinate with more control or to shrink the size of your prostate. Rarely, a medication known as bethanechol (Urecholine) may be prescribed to improve a weakened bladder's muscle strength. But because bethanechol is associated with heart and blood vessel side effects, you shouldn't take it in high doses or without careful monitoring to make sure it is working — that is, improving the emptying of your bladder.
Electrical stimulation
In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work. And it can cause side effects, such as abdominal cramps, diarrhea and bleeding. Electrical stimulation is usually reserved for people with severe urge incontinence who don't respond to behavioral techniques or medications.

Medical devices
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:
  • Urethral inserts. These are small, tampon-like disposable devices or plugs that a woman inserts into her urethra — the tube where urine exits the body — to prevent urine from leaking out. Urethral inserts aren't for everyday use. They work best for women who have predictable incontinence during certain activities, such as playing tennis. The device is inserted before the activity. Whenever the woman needs to urinate, she simply removes the device. Urethral inserts are available by prescription.
  • 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.
Surgery
If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence. In men, surgery may be necessary to remove the obstructive part of an enlarged prostate gland.

If your bladder or uterus has slipped out of position, a surgeon can put it back in place with a variety of techniques. Rarely, surgery to treat urinary incontinence may involve enlarging the bladder or correcting a birth defect. Or surgery may be needed to bolster weakened urinary sphincter muscles.

Some of the more common procedures include:
  • Artificial urinary sphincter. This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland, and it's used rarely in women with stress incontinence. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery is the most effective procedure for male incontinence. Complications include malfunction of the device — which means the surgery will need to be repeated — and infection, but both are uncommon.
  • Bulking material injections. Some women and men with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials — which may be cow-derived collagen, carbon particle beads or synthetic sugars — into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated after several months, because the effect can be lost over time. There is a risk of rejection or infection.
  • Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and provides relief from heavy leaking in many cases. Possible complications include infection, but the device can be removed.
  • Sling procedure. The most popular and common surgery for women with stress incontinence is the sling procedure. During this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra. Or the surgeon may use a strip of synthetic mesh material or a strip of tissue from a donor (xenograft) or cadaver. The strip acts like a hammock, compressing the urethra to prevent leaks that occur with the activities of daily living. Sling procedures improve or cure incontinence in most cases. There are varying techniques for the sling procedure, so talk with your doctor about what procedure is planned and why.
  • Bladder neck suspension. In this procedure, your surgeon makes a 3- to 5-inch incision in your lower abdomen. Through this incision, he or she places stitches (sutures) in the tissue near the bladder neck and secures the stitches to a ligament near your pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz, or MMK, procedure). This has the effect of bolstering your urethra and bladder neck so that they don't sag. The downside of this procedure is that it involves major abdominal surgery. It's done under general anesthesia and usually takes about an hour. Recovery takes about six weeks, and you'll likely need to use a catheter until you can urinate normally.
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. These products should be a last resort, because most people benefit from other treatments.
  • 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. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by closefitting underwear. Men and women can wear panty liners or pads in their underwear to collect urine. Adult diapers are available in both disposable and reusable forms and come in a variety of sizes. Some people find that wearing plastic underwear over their regular underwear helps keep them dry. Others opt for washable underwear and briefs with waterproof panels. Incontinence products can be purchased at drugstores, supermarkets and medical supply stores.
  • 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 re-use. In rare cases of extreme illness, people have to keep a catheter in constantly. The catheter is connected to an external bag to hold urine. As needed, the bag is emptied.

Prevention:
Incontinence is not always preventable. However, you may be able to decrease your risk of urinary incontinence with these steps:
  • Maintain a healthy weight. By taking good care of yourself and keeping or getting your weight under control, you may be able to decrease your risk of urinary incontinence.
  • Don't smoke. Get help in quitting if you do smoke.
  • Practice Kegel exercises. Because pregnancy and childbirth can weaken the urinary sphincter and pelvic floor muscles, doctors may advise pregnant women to do Kegel exercises during pregnancy as a preventive measure.
  • Avoid bladder irritants. Avoiding or limiting certain foods and drinks may help prevent or limit urinary incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.
  • Eat more fiber. Including more fiber in your diet or taking fiber supplements can help prevent constipation, a risk factor for urinary incontinence. Your doctor may recommend that you drink more or less water as a preventive measure, depending on your bladder problem.
  • Be active. Physical activity reduces your risk of developing incontinence. Results from the Nurses' Health Study show that women in that study who participated in moderate amounts of low-impact physical activity were less likely to experience urinary incontinence.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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