Urinary incontinence

What is urinary incontinence?

Urinary incontinence is a loss of control over urination. Urine leaks before you are able to get to a toilet.

Normally, kidneys make urine that travels through tubes (called ureters) into the bladder. The bladder is a balloon-shaped structure with walls of muscle. The muscular walls are relaxed until the bladder fills up. The underside of the bladder is supported by pelvic floor muscles.

When the bladder is full, the walls of the bladder are stretched. That signals the muscular walls to squeeze down, causing an urge to urinate. When you are ready to urinate, the muscular walls squeeze down harder, and another tube (the urethra) opens up that carries urine out of the bladder and into the outside world.

With the various types of urinary incontinence, this normal process gets disrupted.

One type of incontinence is stress incontinence. Your pelvic muscles are located beneath your bladder. Stress incontinence occurs when your pelvic muscles aren't strong enough. They cannot withstand a "stress" or pressure pushing on the bladder.

When your pelvic muscles give way, they release their squeeze around the bottom of your bladder. As a result, urine can drain out.

Stress incontinence is common during

• pregnancy
• coughing
• sneezing
• lifting
• laughing
• some awkward body movements.

Another common type of urinary incontinence is urge incontinence. This is also called overactive bladder. In overactive bladder, the bladder becomes overly sensitive to stretching and nerve signals. As a result, the muscles of the bladder start to tense up, causing an urge to urinate when your bladder is only partly filled. Also, your bladder can squeeze after only a minimal trigger.

Many women have urinary incontinence after childbirth. Pregnancy and childbirth can affect the conditioning of the pelvic muscles. They can also stretch and injure the pelvic nerves. Incontinence may last for a surprisingly long time after childbirth.

Temporary urinary incontinence is frequently caused by a urinary tract infection (UTI). Infection of the vagina or irritation of the vagina from lack of estrogen (vaginitis) is another cause of temporary incontinence.

Neurologic problems such as multiple sclerosis or spinal cord injury can cause incontinence. They can cause the bladder to overfill and overflow. Or they can cause the bladder to empty unpredictably.

Incontinence can be a complication of radiation treatment or prostate surgery.

Some people have normal bladder function and control. But they are not able to move easily. This can lead to urinary incontinence because the person cannot get to the bathroom in time.

Urinary incontinence is more common in women than in men.

Symptoms of urinary incontinence

The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent or rare. It can be a soaking or a small squirt.

Urge incontinence can cause leakage during sleep.

A urinary tract infection is likely to be causing incontinence if urine leakage is accompanied by

• pain during urination 
• pink, red, or dark discoloration of your urine 
• urine odor 
• abdominal or back pain 
• frequent urinating.

Diagnosing urinary incontinence

Your doctor will review your medical history.

Your doctor may ask you to keep a voiding diary for one to three days. You should record:

• times and amounts of urine leakage
• fluid intake
• possible triggers (e.g., physical activity, coughing, laughing).

A neurological examination and a pelvic examination may be done. These will help to reveal the cause of your urinary incontinence.

You may also have a test to see whether you can empty your bladder completely. You will be asked to urinate to empty your bladder. Then, the amount of urine left in the bladder will be measured.

Your doctor should check for a urinary tract infection.

If your doctor suspects that nerve injury is causing your incontinence, you may need an imaging study. This may be a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of your brain or spinal cord.

Expected duration of urinary incontinence

Urinary incontinence may be a short-term problem. This is likely if it is related to pregnancy or to a UTI.

Urinary incontinence is more often a long-term problem if it results from

• muscle weakness
• pelvic injury
• nerve problems.

Preventing urinary incontinence

There is not much to be done to prevent urinary incontinence from starting. Obese women are more likely to develop urinary incontinence. So are women who don't exercise regularly. Thus, regular exercise and maintaining a healthy weight can help prevent you from developing incontinence.

On the other hand, once incontinence starts, the problem can be treated effectively to reduce or eliminate the number of episodes.

Treating urinary incontinence

Kegel exercises

Many women can improve or eliminate urinary incontinence by doing pelvic muscle exercises. These are called Kegel exercises. They strengthen the muscles that surround the openings of the urethra, vagina, and rectum.

To do Kegel exercises, squeeze your muscles to tighten your rectum and vagina. Hold Kegel squeezes for six to eight seconds. Group eight or 12 squeezes into each session. You can repeat these exercises several times each week.

Kegel exercises are particularly helpful for stress incontinence. They can also help control other types of incontinence. It can take several months or longer to see benefits.

Bladder retraining

Urge incontinence can be improved by retraining. The goal is to help your bladder become less sensitive to the things that trigger its tendency to squeeze down and create a tremendous urge to urinate — or urination itself.

The squeezing of your bladder is a conditioned response. You need to give your bladder a period of time when it is not stimulated by the signal of a full bladder. This helps your bladder to be less "jumpy."

To accomplish this, empty your bladder on a rigid schedule before it becomes full. You may need to urinate every half hour or hour. Gradually lengthen the interval between your bathroom stops. Your bladder may not respond as urgently after several weeks of retraining.

You also can improve urge incontinence by calming your bladder signals. Try not to race to the bathroom when you feel an urge to urinate. Instead, try sitting and breathing deeply for a short time. Or do Kegel exercises to distract your bladder.

Some specialists provide bladder sphincter biofeedback. This shows levels of bladder, rectum, and abdominal pressure during Kegel squeezes or during relaxation techniques.

Medications

Many medications are available to reduce symptoms of urge incontinence. Initial choice often depends upon cost and potential risk of side effects.

Women who have a UTI are given antibiotics. Curing the infection ends the incontinence caused by infection.

Some postmenopausal women have vaginitis caused by too little estrogen. Estrogen creams or tablets in the vagina can be helpful. 

OnabotulinumtoxinA (Botox) injections into the bladder wall can help reduce incontinence. They needed to be repeated every three to six months after their initial injections.

Devices to strengthen the pelvic muscles

Your doctor may recommend using cone-shaped weights. You place one of these cones into your vagina before you begin pelvic muscle exercises. These maximize the muscle-conditioning effect of Kegel exercises.

Pessaries

Urine leakage may be caused when the uterus sags into the vagina (a condition called uterine prolapse), bending the urethra. In these cases, a pessary may help. A pessary is a firm rubber ring that supports the bottom of your uterus, and keeps it from prolapsing. It can be inserted in the vagina by a physician and worn continuously.

Surgery

A common cause of stress incontinence in women is lack of support at the bladder neck. Surgery may be considered when other treatments have been ineffective.

Other strategies

If your urine leaks when you cough, seek treatment for your cough. If your cough results from smoking, talk to your doctor about ways to quit.

Pads or adult diapers can offer security. But they can also irritate the skin. They should not be the first or only strategy used for incontinence.

When to call a professional

If you experience urinary incontinence, tell your doctor. He or she can provide basic treatments for urinary incontinence. For more persistent symptoms, your doctor may refer you to specialist with expertise in evaluating and treating urinary incontinence.

Prognosis

Most women who seek treatment for urinary incontinence find that their symptoms improve. Bladder retraining can lead to good results after only a few weeks. Kegel exercises improve urine control in many women who use them consistently.

Surgery for urinary incontinence can be very successful. But it can result in one or more complications. These include:

• difficulty emptying the bladder
• bladder spasms
• bladder infection
• injury to the bladder during surgery
• return of incontinence.

Additional info

American Urological Association
https://www.urologyhealth.org/