Urinary incontinence is the loss of bladder control, or unexpected leaking of urine.

Urinary Incontinence affects twice as many women as men, due to reproductive health events unique to women; including pregnancy, childbirth, and menopause. These events affect the bladder, urethra, and other muscles that support these organs. The most common risk factors for urinary incontinence include female gender, and age.

Urinary incontinence can happen to women at any age; but it is more common in older women, likely as a result of hormonal changes during menopause. More than 4 in 10 women 65 and older have urinary incontinence.

For men, mechanisms of urinary incontinence are often resultant of secondary causes such as bladder outlet obstruction due to benign prostatic hyperplasia (BPH), urethral stricture disease, or insult from radiation or surgical interventions. Bladder outlet obstruction may be associated with either overactivity or underactivity of the bladder muscle (detrusor), which can contribute to urinary urge incontinence and perhaps overflow incontinence.

The two most common types of urinary incontinence are:

Stress incontinence

This is the most common type of incontinence. Stress urinary incontinence (SUI) happens when there is added stress or pressure on the bladder, in conjunction with weak pelvic floor muscles. With SUI, everyday actions such as coughing, sneezing, or laughing, can cause you to leak urine. Sudden movements and physical activity can also cause you to leak urine.

Additional risk factors contributing to SUI in women include increased number of
pregnancies, higher body mass index (BMI), vaginal delivery, hormone replacement
therapy, diabetes, and family history.

Urge incontinence

The leakage of urine occurs after a strong, sudden urge to urinate, before you can reach a bathroom. Some individuals with urge incontinence (UI) also feel the urge to urinate more than eight times a day, with very little urine output. This can be referred to as overactive bladder.

Many women with urinary incontinence have both stress and urge incontinence. This is called “mixed” incontinence.


What causes incontinence?

  • Overweight. Extra abdominal weight places added pressure on the bladder, which can weaken the muscles over time. A weak bladder cannot hold as much urine.
  • Constipation. Problems with bladder control can occur with long-term (chronic) constipation. Constipation, or straining to have a bowel movement, can put stress or pressure on the bladder and pelvic floor muscles. This weakens the muscles and can cause urinary incontinence or leaking.
  • Nerve damage. Damaged nerves may send signals to the bladder at the wrong time or not at all. Childbirth and additional health issues; such as, diabetes, Parkinson’s disease, and multiple sclerosis can cause nerve damage in the bladder, urethra, or pelvic floor muscles.
  • Surgery. Any surgery that involves a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed. If the pelvic floor muscles are damaged, a woman’s bladder muscles may not work like they should. This can cause urinary incontinence. Sometimes urinary incontinence lasts only for a short time and happens because of other reasons, including:
  • Certain medicines. Urinary incontinence may be a side effect of medicines such as diuretics (“water pills” used to treat heart failure, liver cirrhosis, hypertension, and certain kidney diseases). The incontinence often goes away when you stop taking the medicine.
  • Caffeine. Drink containing caffeine are likely to irritate the bladder, ultimately causing incontinence. Limiting caffeine may help with incontinence because there is less strain on your bladder.
  • Infection. Infections of the urinary tract and bladder (UTI) may cause incontinence for a short time. Bladder control often returns when the infection goes away.

Treatment approaches

Many safe and effective conservative treatment modalities exist. Procedural and operative interventions are available where conservative management fails. Treatment should be consistent with patient bother, comorbidities, and tolerability for associated risks and financial costs.

Conservative therapies for urge UI include bladder retraining and behavioral therapy, dietary modifications, lifestyle changes, pelvic floor rehabilitation, vaginal pessaries, urethral inserts, and medications.

SUI that is refractory to conservative management may warrant surgical intervention with a sling, urethral bulking agent, or Artificial Urinary Sphincter. Refractory cases of overactive bladder (OAB) and UUI may warrant advanced therapies including bladder Botox, percutaneous tibial nerve stimulation/modulation (PTNS/PTNM), or sacral nerve stimulation/modulation (InterStim).

Conclusion

Urinary incontinence (stress and urge) is a prevalent problem for both men and women, which requires attention from primary care providers and urology specialists. Proper diagnosis with respect to type of UI is the first step to identifying an appropriate plan of care.

If you have been dealing with Urinary Incontinence give us a call today to schedule a consultation. We want to help you get back to the life you love.