Urinary Incontinence

Urinary incontinence is a condition that impacts many people’s lives. When you have incontinence, you may experience bladder control issues and leak urine. This leakage is often uncontrollable and can negatively impact your life.

Causes of Urinary Incontinence #

Urinary tract infections (UTIs) #

An infection inside your urinary tract (urethra, ureters, bladder and kidneys) can cause pain and increase your need to pee more often. Once treated, the urge to urinate frequently usually goes away.

Pregnancy #

During pregnancy, your uterus places extra pressure on the bladder as it expands. Most women who experience incontinence during pregnancy notice that it goes away in the weeks after delivery.

Medications #

Incontinence can be a side effect of certain medications, including diuretics and antidepressants.

Beverages #

There are certain drinks — like coffee and alcohol — that can make you need to urinate much more often. If you stop drinking these beverages, your need to urinate frequently typically goes down.

Constipation #

Chronic constipation (stool that’s hard and dry) can cause you to have bladder control issues.

Symptoms of Urinary Incontinence #

You might leak urine when you:

• Exercise.

• Cough.

• Laugh.

• Sneeze.

• Have an urge to urinate, but can’t make it to the toilet on time.

• Have to get up in the middle of night to urinate (nocturia).

Diagnosis of Urinary Incontinence #

Physical exam #

Your healthcare provider will typically do a physical exam early in the diagnosis process. During this exam, your provider will look for any physical reason that could be causing your incontinence. This could include doing a pelvic exam if you’re a woman or checking the size of a man’s prostate.

Urine samples #

• Your provider may take samples of your urine to test for infections or blood.

• Testing your urine is also called urinalysis.

• An ultrasound of your bladder: An ultrasound is a painless test that uses sound waves to create an image of your internal organs.

• This imaging test will allow your provider to look at the contents of your bladder and assess the emptying ability of your bladder in a non-invasive way.

Stress test #

During this test, your provider will ask you to cough to see if any urine leaks from this action. If you’ve noticed leakage during other activities, like running or jumping, your provider may ask you to repeat those actions to see if you have a leakage issue.

Cystoscopy #

A cystoscope is a thin flexible tube with a camera on the end that can be inserted into your urethra and bladder to get a close look at the inside of your urinary tract. This tool allows your provider to see a lot of detail inside your body.

Urodynamic testing #

This testing involves several tests that check how much your bladder can hold and how well your urethral sphincter muscle (the muscle that holds your urethra shut) is working. One part of this testing may involve inserting a tube into your bladder that will fill the bladder up with fluid. This checks how much your bladder can actually hold.

Pad test #

Your provider may give you a pad to wear, which will catch any leaked urine. At the end of the test, this pad will be checked to see how much urine you lost.

Treatment of Urinary Incontinence #

Medications #

Common medications that can be used to treat incontinence include:

• Oxybutynin (Ditropan), oxybutynin XL (Ditropan XL), oxybutynin TDDS (Oxytrol).

• Tolterodine (Detrol).

• Solifenacin (Vesicare).

• Fesoterodine (Toviaz).

• Darifenacin (Enablex).

• Trospium (Sanctura XR).

• Antidepressant medication — Imipramine (Norfranil, Tipramine, Trofranil).

• Mirabegron (Myrbetriq).

Lifestyle changes to manage incontinence #

• Sometimes, there are changes to your everyday life that can actually help your incontinence.

• These changes often include exercises you can do to strengthen your pelvic floor muscles, changes to your normal habits and an improved diet.

• Some people notice improvements by making these changes at home and don’t need additional treatment.

• Talk to your healthcare provider about these home treatment options for incontinence before starting any of them.

• You might not be able to treat all types of incontinence with these lifestyle changes.

• Your provider might also make detailed suggestions to you about the best lifestyle changes to try given your incontinence diagnosis.

Vaginal insert #

There are over-the-counter devices that can be placed in the vagina that can compress the urethra and help reduce stress incontinence in women.

Procedures and surgeries to treat incontinence #

If other non-invasive treatment options have failed to treat your incontinence, there are several procedures that your provider might suggest. These procedures range from simple injections to more complicated surgeries. Your provider will discuss the best procedural option for you based on the type of incontinence you have and your symptoms.

Bulking agents #

• This treatment option is an injection that’s typically used in women with stress incontinence.

• A permanent substance is injected into the lining of your urethra to help increase the size of the urethra’s lining.

• Botulinum toxin injections (Botox): You might think of Botox as a cosmetic treatment, but it can also be used to relax muscles in your body.

• Your provider might inject Botox into your bladder to help relax the muscles helping with urge incontinence. This treatment isn’t permanent and will need to be repeated over time.

Neuromodulation devices #

Pacemakers that stimulate the nerves to the bladder to improve control can be implanted. Furthermore, a nerve near your ankle can be stimulated to achieve better bladder control.

Sling procedures #

There are sling procedures to treat incontinence for both men and women. In women, either a synthetic material or strip of your own tissue is typically used to support the urethral channel.

Artificial urethral sphincter #

This is a device that’s used in men with stress incontinence that is placed to close the urethra when not urinating. It’s typically used for leakage after prostate cancer surgery.