Urology Center of Englewood

Urinary Incontinence

Overview

The urinary tract includes the kidneys, the ureters, the bladder, and the urethra. The kidneys create urine by filtering the blood and removing waste and excess water. From the kidneys, urine travels to the bladder through small tubes called ureters. Urine is then stored in the bladder until it is passed to the outside of the body through the urethra. The opening of the urethra is at the end of the penis in men, and just in front of the vagina in women.

Urinary incontinence refers to the involuntary loss or leakage of urine. Factors that can contribute to incontinence include nerve problems, childbirth, menopause, and prostate problems.1,2 Incontinence can occur when the bladder muscle contracts suddenly, or when the sphincter muscle (the muscle that surrounds that urethra) is not able to block the flow of urine.

For people with incontinence, the amount of urine lost can range from only a few drops to a much larger amount. Incontinence can have a profound effect on quality of life, and may limit a person’s ability to engage in certain activities. Treatments are available, however, and if you are experiencing incontinence you should discuss the condition with your physician.

What are the Different Types of Urinary Incontinence?

Stress Incontinence: Stress incontinence refers to the loss of urine when pressure is put on the bladder. Pressure on the bladder can be caused by activities such as laughing, coughing, sneezing, or lifting.

Urge Incontinence: Urge incontinence is characterized by loss of urine after a sudden, strong urge to urinate. It is often the result of abnormal bladder contractions. These contractions can result from damage to nerves or damage to the bladder muscle.

Mixed Incontinence: Mixed incontinence involves a combination of stress incontinence and urge incontinence.

Overflow Incontinence: When the bladder isn’t able to empty normally and becomes too full, it can cause a constant dribbling of urine and a very weak urine stream. This is referred to as overflow incontinence.

Who Develops Urinary Incontinence?

Incontinence can be a problem for anyone, but certain groups of people are at higher risk than others. Factors that increase the likelihood of incontinence include being female, growing older, going through pregnancy and childbirth, having an enlarged prostate, undergoing treatment for prostate cancer, being overweight, and having health conditions that involve nerve problems. Examples of these health conditions are long-term diabetes, stroke, Parkinson’s disease, multiple sclerosis, spinal cord injury, and overactive bladder.

Conditions that may contribute to temporary incontinence include urinary tract infections and constipation.

How is Urinary Incontinence Evaluated?

In addition to performing a physical examination, your doctor will collect information about your medical history, medication use, usual fluid intake, and incontinence symptoms. You will probably be asked to provide a sample of urine for testing. Other tests may also be performed, such as tests to more closely evaluate your bladder and urethra, but the need for these other tests will depend on your particular situation.

Management of Urinary Incontinence

The treatment of urinary incontinence depends on the type of incontinence, the severity of the problem, and your gender. Because no single treatment works for everyone, you may have to work with your doctor to try more than one type of treatment before you find one that’s right for you.

Treatment of stress incontinence: Surgical and nonsurgical treatments are available for stress incontinence. Nonsurgical options include exercises to strengthen pelvic floor muscles (Kegel exercises), bladder training (making timed trips to the bathroom), modification of fluid intake, and use of a pessary (a device inserted into the vagina that helps to reposition the urethra in women).

Surgical options for stress incontinence in women include injection of agents that bulk up the tissues around the urethra, sling procedures (using a narrow strip of material to support the urethra), and retropubic suspension (use of sutures to lift and support the opening of the bladder and the urethra). Surgical options in men include injection of bulking agents around the urethra, implantation of an artificial urinary sphincter (a patient-controlled device that can open and close the urethra), and use of a sling to compress the urethra.

Treatment of urge incontinence: Treatments for urge incontinence include behavioral changes such as urinating on a regular schedule, modifying your fluid intake, and strengthening pelvic floor muscles (Kegel exercises); use of medications that relax the bladder muscle; and use of a device that stimulates the bladder nerves.

Treatment of overflow incontinence: If overflow incontinence is due to a blockage in the urinary tract, treatment of the blockage can relieve the incontinence. If no blockage is present, use of a catheter to completely empty the bladder on a regular basis can reduce or prevent accidental urine loss.

References


1 National Kidney and Urologic Diseases Information Clearinghouse. Urinary Incontinence in Women. NIH publication No. 08-4132. October 2007.

2 National Kidney and Urologic Diseases Information Clearinghouse. Urinary Incontinence in Men. NIH publication No. 07-5280. June 2007.