Incontinence

What is Urinary Incontinence?

Simply put, urinary incontinence (UI) means uncontrolled leakage of urine.  In other words, urine leaks out when you don’t want it to and you cannot stop it.  UI is a problem that affects literally millions of people in the U.S.  It is embarrassing and can be severe enough to interfere with work, daily activities, social activities, sleep, etc.  Many people with UI avoid activities that they would normally enjoy out of fear of embarrassment or not being near a bathroom.

What Causes Urinary Incontinence?

UI is not a disease in and of itself.  It is usually a result of another condition that affects the bladder or urinary control muscles.  The list of things that can cause UI is quite long.  It is important to know that UI is NOT part of the normal aging process.  Some of the more common reasons for UI include:
⦁    UI can be a side effect of any number of medications.
⦁    Infections can cause UI.
⦁    Neurologic problems such as stroke, multiple sclerosis, Alzheimer’s, spinal cord injuries, etc. can cause UI.
⦁    Pelvic floor muscle weakness (especially in women)
⦁    Obesity
⦁    Prostate surgery in men
⦁    Childbirth
⦁    Menopause
⦁    Constipation
⦁    Diabetes.

Are There Different Kinds of Urinary Incontinence?

Yes.  In general, there are 4 different types of urinary incontinence:
⦁    Stress incontinence is usually a result of weakness of the pelvic floor muscles that help control urination.  This can occur after childbirth, pelvic surgery, menopause, etc.  Men and women with stress incontinence experience leakage of urine if they cough, sneeze, lift something heavy, etc.
⦁    Urge incontinence can result from almost any of the causes listed above.  It happens when there is a strong urge to urinate but not enough time to get to the bathroom.
⦁    Overflow incontinence is caused by urinary retention or poor bladder emptying.  In this situation, the bladder becomes so full that it can no longer hold the urine and some (perhaps a lot) leaks out.  It can also be due to almost any of the causes listed above.
⦁    Mixed incontinence occurs when there is any combination of the above.

How is Urinary Incontinence Treated?

There is a number of approaches to treating UI.  It is important to know the cause of UI before deciding what treatment approach is best.

Some testing might be recommended to help determine the cause of incontinence.  Some of the common tests that urologists use include:
⦁    Urinalysis to look for signs of infection
⦁    A pelvic exam in women to check the pelvic floor muscles
⦁    Ultrasound to see how much urine is left in your bladder after you urinate
⦁    A test called urodynamics which is designed to see how well your bladder works
⦁    A 3-day bladder diary in which you record how much and what you drink, how much you urinate and how often you have leakage.

Once we have determined the cause of UI, we can usually find a treatment option that works.  There are many different options.  The following list is, by no means, complete.
⦁    Lifestyle changes
⦁    Weight control
⦁    Smoking cessation
⦁    Avoid bladder irritants such as caffeine, alcohol, spicy foods, etc.
⦁    Bladder retraining or physical therapy for your bladder which is usually provided by a physical therapist or continence care nurse.
⦁    There are several medications that are often helpful in treating urge incontinence.
⦁    Some women with pelvic prolapse will benefit from a pessary.
⦁    Nerve stimulation, biofeedback and acupuncture are options for some people.
⦁    Surgery
⦁    So–called sling procedures to “tighten up” the opening of the bladder
⦁    Surgery to fix problems with pelvic floor muscles
⦁    For men, an artificial urethral sphincter is available
⦁    Botox injections into the back wall of the bladder

The important thing to remember is that, if you have UI, you are not alone and there are many ways of dealing with it.  You should not be afraid to discuss this with your family doctor or urologist.

We hope that this answers some of your questions about UI.  Please call Gallatin Urology (406–551–2306) to make an appointment if you would like more information or if you are having problems with UI.