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Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is the loss of control over your bladder. Laughing, coughing or sneezing may cause you to leak urine. Or you may not always make it to the bathroom in time when you need to urinate. For some people, urinary incontinence occurs only occasionally, temporarily or it may be only a little leakage from time to time. Others may have a complete lack of control that persists over the long term. There are several types of urinary incontinence. They include:

  • Stress incontinence: A loss of urine during an activity, such as laughing, coughing, sneezing or physical exercise.
  • Urge incontinence: A strong sudden need to urinate immediately, followed by a bladder contraction that results in loss of urine. It is often called overactive bladder.
  • Voiding dysfunction: Any abnormality of filling the bladder, holding urine or emptying the bladder.

What causes urinary incontinence?

Urinary incontinence is a common, often embarrassing, problem for millions of people. Although loss of bladder control is more common in women than in men, it is not necessarily an inevitable outcome of childbirth or menopausal changes, nor is it a normal consequence of aging. Urinary incontinence by itself is not a disease, but it is often an indication of another condition that should be treated.
Causes of temporary incontinence include:

  • Urinary-tract infections
  • Constipation
  • Some medications, including diuretics (water pills)
  • Food or beverages that irritate the bladder
  • Overindulgence in alcoholic beverages
  • Over- or under-consumption of liquids

Incontinence from any of these causes is usually easily managed with simple treatment or a change in habits.

Persistent urinary incontinence is almost always caused by an underlying physical problem, such as a urinary-tract obstruction, weakened muscles or nerve problems. This type of incontinence may result from:

  • Pregnancy and childbirth (may not develop until many years after childbirth)
  • Tumor in the urinary tract
  • Bladder cancer
  • Nerve damage to the bladder from neurological disorders, such as Parkinson's disease, stroke or spinal-cord injury
  • Damage to muscles or nerves as a result of hysterectomy
  • Interstitial cystitis (inflammation of the bladder wall)
  • Reduction in estrogen after menopause

How is urinary incontinence diagnosed?

The first step is a physical examination focused on your pelvic area. Your doctor may ask you how often you experience leakage, whether you have trouble in emptying your bladder, and similar questions. Your doctor may also ask you to keep a bladder diary for a few days. You may be asked to give a urine sample for urinalysis, which is a test for signs of infection, blood in the urine or other abnormalities. Depending on the results of these tests, you may undergo further testing with specialized tests. These tests may include:

  • Stress test: A test in which you cough hard or bear down while the doctor watches for urine loss.
  • Cystoscopy: A test that allows the doctor to see inside your bladder and urethra through a tiny lens attached to a thin tube inserted into the bladder.
  • Urodynamic tests: Tests that measure pressure in the bladder when empty and when filling.
  • Postvoid residual urine (PVR) measurement: A test to determine whether you have problems emptying your bladder.

What treatments are available for urinary incontinence?

Treatment depends on the diagnosis and the severity of the problem. Your doctor will recommend the type of treatment best suited for your condition. In many cases, the doctor will suggest a combination of treatments.
Broadly speaking, treatments fall into four categories:

  • Behavioral changes
  • Medications
  • Medical devices
  • Surgery

Within these categories, there are many options. Your doctor will discuss all appropriate options in detail with you and answer all your questions before beginning treatment.

In most cases, the doctor will suggest starting with the least drastic form of treatment. These options include:

  • Kegel exercises: To help strengthen the muscles that control urination
  • Pelvic-floor physical therapy: To improve your core strength (back, abdomen and pelvic muscles)
  • Fluid and diet management
  • Electrical stimulation: To strengthen the pelvic-floor muscles
  • Medications
  • Pessary: Removable diaphragmlike device that can aid in urinary incontinence
  • Minimally invasive surgical treatments

For most types of urinary incontinence, improvement can be dramatic following treatment. In addition to the reduction or elimination of physical symptoms, many women experience an overall improvement in the quality of their lives.