Urinary Incontinence

WHAT IS IT?

The loss of bladder control (urinary incontinence) is a common problem. Its symptoms range from mild to severe.

Urinary incontinence may result from everyday habits, underlying medical conditions, or physical problems. The most common types of urinary incontinence include:

• Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.
• Urge incontinence. You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You also may need to urinate often. Urge incontinence may be caused by an infection, but frequently it’s associated with overactive bladder contractions related to aging, menopause in women, or prostate problems in men.
• Overflow incontinence. In this condition, you experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

TREATMENT

Treatment for urinary incontinence depends on the type of incontinence you have and its severity. A combination of treatments may be necessary. They may include:

Behavioral techniques. Your doctor may recommend one of the following therapies:

• Bladder training. You delay urination after you get the urge to go. Start by trying to hold off for 10 minutes every time you feel an urge to urinate. The goal is to increase the time between trips to the toilet until you’re urinating every two to four hours.
• Double voiding. This means urinating, then waiting a few minutes and trying again to empty your bladder more completely.
• Scheduled toilet trips. Rather than waiting for the urge to go, you urinate every two to four hours.
• Fluid and diet management. You may need to cut back on or avoid alcohol, caffeine, or acidic foods. Reducing how much liquid you consume also may ease symptoms.

Pelvic floor muscle exercises.

These exercises are used to strengthen the muscles that help control urination. Also known as Kegel exercises, pelvic floor muscle exercises are especially effective for stress incontinence, but they may help with urge incontinence. To do them, imagine that you’re trying to stop your urine flow. Tighten (contract) the muscles you would use to stop urinating and hold the contraction for five seconds, and then relax for five seconds. (If this is too difficult, start by holding for two seconds and relaxing for three seconds.) Work up to holding the contractions for 10 seconds at a time and aim for at least three sets of 10 repetitions daily.

Electrical stimulation. 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. You may need multiple treatments over several months.

Medical devices. Devices to treat incontinence in women include:

• Urethral insert. It’s a small, tampon-like disposable device inserted into the urethra before an activity that can trigger incontinence, such as a game of tennis. The insert acts as a plug to prevent leakage and is removed before urination.
• Pessary. It’s a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder to prevent urine leakage. A pessary may help for incontinence due to a prolapsed bladder or uterus.

Interventional therapies. These treatments include:

• Bulking material injections. Synthetic material is injected into tissue surrounding the urethra. The bulking material helps keep the urethra closed and reduces urine leakage.
• Nerve stimulators. A device resembling a pacemaker is implanted under your skin to deliver painless electrical pulses to the nerves involved in bladder control (sacral nerves). Stimulating the sacral nerves may help reduce urge incontinence.

Surgery.
If other treatments aren’t helpful, surgery may help treat the problems causing the incontinence:

• Sling procedures. A surgeon creates a pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress incontinence.
• Bladder neck suspension. This procedure is used to help support the urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra.
• Prolapse surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may include a combination of a sling procedure and surgery to fix the prolapse.
• Artificial urinary sphincter. In men, a fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter tightly shut. When you’re ready to urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine to flow from your bladder. Artificial urinary sphincters are particularly helpful for men whose incontinence is associated with prostate cancer treatment or an enlarged prostate gland.

         Excerpt From: The Mayo Clinic. “Mayo Clinic A to Z Health Guide”.