Conditions & Treatments

Urinary Incontinence

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OVERVIEW

Urinary incontinence, a common condition, refers to the unintentional loss of urine, often due to weakened pelvic muscles or nerve damage. It can significantly impact one’s quality of life.

The University of Kansas Department of Urology is dedicated to delivering exceptional urological care. Our expert team tailors treatment plans, employing advanced methods and diagnostics to address various urological conditions, including urinary incontinence. Our unwavering focus is on your well-being, and we provide empathetic care to enhance your overall quality of life.

Types of Urinary Incontinence

There are several types of urinary incontinence, each with its own specific characteristics:

  • Stress Incontinence: This occurs when there is pressure on the bladder, such as during coughing, sneezing, laughing, or lifting heavy objects causing urine leakage. It is often associated with weakened or damaged pelvic floor muscles and is more common in women, especially after childbirth and menopause.
  • Urge Incontinence: Occurs in patients with overactive bladder, this type of incontinence involves a sudden and intense urge to urinate, followed by an involuntary loss of urine. People with urge incontinence may experience frequent urination and may not be able to reach the toilet in time.
  • Overflow Incontinence: This occurs when the bladder does not empty properly, leading to frequent dribbling of urine. It can be caused by an obstruction in the urinary tract, nerve damage, neurological conditions, or weak bladder muscles.
  • Mixed Incontinence: Some individuals may experience a combination of stress and urge incontinence, known as mixed incontinence. In this scenario, the most bothersome incontinence is treated first.
  • Functional Incontinence: This type of incontinence is not due to bladder or urinary tract problems but rather due to physical or cognitive limitations that make it difficult for a person to reach the toilet in time. This can be seen in conditions like severe arthritis or dementia.

SYMPTOMS & CAUSES

Symptoms

Common symptoms of urinary incontinence include:

  • Leakage of urine during activities that put pressure on the bladder (stress incontinence)
  • Sudden, strong urges to urinate, sometimes leading to involuntary leakage (urge incontinence)
  • Frequent urination, both during the day and night
  • Difficulty emptying the bladder completely
  • Dribbling of urine between trips to the restroom

Causes

The causes of urinary incontinence can vary depending on the type, but some common factors and causes include:

  • Pelvic Floor Weakness: Weakened pelvic floor muscles can result from factors like childbirth, pregnancy, aging, obesity and hormonal changes (especially in women).
  • Nerve Damage: Conditions such as diabetes, multiple sclerosis, or spinal cord injuries can disrupt nerve signals between the bladder and the brain, leading to incontinence.
  • Bladder Problems: Overactive bladder muscles or an inability of the bladder to stretch properly can contribute to incontinence.
  • Medications: Certain medications, like diuretics, sedatives, or muscle relaxants, can increase the risk of incontinence.
  • Infections: Urinary tract infections (UTIs) can cause temporary incontinence.
  • Obstruction: Conditions such as an enlarged prostate or urinary stones can obstruct the normal flow of urine.
  • Hormonal Changes: Decreased estrogen levels in menopause can lead to changes in the urinary tract and contribute to incontinence.

DIAGNOSIS & SCREENING

Diagnosing urinary incontinence typically involves a thorough evaluation by a healthcare provider. The following steps are often part of the diagnostic process:

  • Medical History: The healthcare provider will ask about your symptoms, medical history, and any medications you are taking. Be prepared to discuss the type and frequency of incontinence episodes.
  • Physical Examination: A physical exam may be conducted to check for signs of underlying health conditions, such as pelvic organ prolapse, enlarged prostate, or neurological problems.
  • Bladder Diary: Keeping a bladder diary can provide valuable information. This involves recording when and how much you drink, when you urinate, and any episodes of leakage.
  • Urinalysis: A urine sample may be tested for signs of infection, blood, or other abnormalities.
  • Post-Void Residual Measurement: This test measures how much urine remains in the bladder after urination to assess if the bladder empties properly.
  • Urodynamic Testing: In some cases, specialized tests like urodynamic studies may be conducted to evaluate bladder function and pressure during filling and emptying.

Screening for underlying causes, such as urinary tract infections, diabetes, or neurological conditions, may also be necessary.

TREATMENTS

Treatment for urinary incontinence varies based on the type and underlying causes. Common treatment options include:

  • Lifestyle Changes:
    • Dietary adjustments to reduce bladder irritants like caffeine and alcohol.
    • Weight management, as excess weight can put pressure on the bladder.
    • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic muscles.
    • Scheduled toilet trips to prevent accidents.
  • Medications:
    • Medications may be prescribed to manage overactive bladder symptoms or relax bladder muscles.
  • Behavioral Therapy:
    • Bladder training involves gradually increasing the time between bathroom trips to improve bladder control.
    • Biofeedback techniques can help you learn how to control pelvic muscles.
  • Medical Devices:
    • Pessaries are devices inserted into the vagina to support the bladder and urethra and reduce stress incontinence.
  • Nerve Stimulation:
  • Surgery:
    • Surgical options may be considered for severe cases or when other treatments are ineffective. Procedures can include sling placement for stress incontinence or bladder augmentation for certain types of urge incontinence.
  • Botox Injections:
    • Injections of botulinum toxin into the bladder muscle can be used to treat overactive bladder and urge urinary incontinence.

OUTLOOK & PROGNOSIS

The outlook and prognosis for urinary incontinence depend on various factors, including the type of incontinence, its underlying causes, and the effectiveness of treatment. In many cases, with the right interventions, urinary incontinence can be managed effectively, and quality of life can be significantly improved.

Some individuals may require ongoing management and lifestyle adjustments to maintain control over their symptoms. For others, complete resolution of incontinence may be possible. Regular follow-up with your healthcare provider is essential to monitor progress and make necessary adjustments to your treatment plan.

Prevention & Management

Preventing and effectively managing urinary incontinence involves a combination of lifestyle changes, self-care strategies, and medical interventions. Here are some key tips for prevention and management:

Prevention:

  • Pelvic Floor Exercises: Engage in regular pelvic floor muscle exercises (Kegel exercises) to strengthen the muscles that support bladder control.
  • Healthy Diet: Maintain a balanced diet and limit the consumption of bladder irritants like caffeine, alcohol, and spicy foods.
  • Weight Management: Maintain a healthy weight to reduce pressure on the bladder and pelvic area.
  • Stay Hydrated: Drink an adequate amount of water each day but avoid excessive fluid intake close to bedtime to reduce nighttime urination.
  • Smoking Cessation: If you smoke, consider quitting, as smoking can irritate the bladder.

Management:

  • Behavioral Techniques: Practice bladder training and timed voiding to improve control and reduce the frequency of accidents.
  • Medications: Follow your healthcare provider’s recommendations for any prescribed medications and be aware of potential side effects.
  • Lifestyle Adjustments: Modify your daily routine to accommodate your condition, such as planning bathroom trips and wearing appropriate absorbent products if needed.
  • Medical Devices: If recommended, use pessaries or other devices as directed.
  • Surgery: If surgery is necessary, discuss the risks and benefits with your healthcare provider, and follow post-operative instructions carefully.
  • Regular Follow-Up: Attend scheduled check-ups with your healthcare provider to monitor your progress and adjust your treatment plan as needed.

CONCLUSION

Urinary incontinence is a common and treatable condition that can significantly impact one’s quality of life. With proper diagnosis and tailored treatment, many individuals can effectively manage their symptoms and regain control over their bladder function. It’s crucial to seek medical attention if you experience urinary incontinence, as early intervention can lead to better outcomes.

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