Urinary incontinence (UI) is a common condition in men and women that involves the involuntary loss of urine. It can occur while laughing, coughing, sneezing or jogging, which is known as stress incontinence. It can also come on as a strong urge to urinate without enough time to reach a bathroom, known as urge incontinence. While neither condition is serious, it can be embarrassing and have a negative effect on daily life.
People of all ages can experience urinary incontinence. Pregnancy, menopause, prostate problems, obesity and poor overall health are conditions that may increase the risk of urinary incontinence. It’s important to note that UI is not hereditary and is not a normal part of aging.
Urinary incontinence can usually be diagnosed through a medical examination and simple tests. Treatment may include lifestyle changes, medication, or a minimally invasive procedure.
At Summit Health, we’re here to help. We understand that urinary incontinence is an uncomfortable condition. Our highly trained specialists and staff are here to provide a warm, private environment for patients who are looking for effective treatment and personalized care.
Stress incontinence
Stress urinary incontinence is loss of urine that occurs at the same time as physical activities that increase abdominal pressure such as sneezing, coughing, laughing, and exercising. These activities can increase the pressure within the bladder, which behaves like a balloon filled with liquid. The rise in pressure can push urine out through the urethra, especially when the support to the urethra has been weakened.
Pregnancy and delivery can have significant effects on the mechanisms of continence. Obstetricians are becoming more aware of the risks of injury to the pelvic floor caused by vaginal delivery. Excessive stretching of the supportive tissues, muscles and nerves, can cause permanent defects even after post-pregnancy healing. This may lead to various pelvic floor support problems for the surrounding organs.
Although the urinary incontinence often resolves in the first few months after delivery, its initial presentation may signal the development of more troublesome incontinence in the future.
Some women with stress incontinence may notice leaks only: occasionally, with aggressive exercise, during colds or allergies, or at times when the bladder is especially full. Other women have a great deal of leakage with simple activities such as getting up out of a chair or simply walking. Although the severity may vary, many women find that these symptoms begin to limit their physical or social activities and can have a serious impact on quality of life.
Overactive bladder (OAB) and urge incontinence
Overactive bladder (OAB), or urge incontinence, occurs when a person experiences urine leakage after feeling a sudden urge to urinate. This happens because the bladder muscles contract at inappropriate times, regardless of how much urine has collected in the bladder. It can happen to anyone at any age, although it is most common in women and the elderly.
The term “overactive bladder” is sometimes used to refer to any of the following conditions:
- Frequency — more than 8 voids in each 24 hours
- Urgency — a powerful urge to urinate, that is difficult to put off)
- Nocturia — waking up twice or more at night to urinate
- Urge incontinence — leakage of urine associated with an urge to urinate, or not making it to the bathroom in time
OAB can be caused by neurological injuries or diseases as well as bladder problems such as infection, cancer, stones, inflammation (swelling), or obstruction (blockage). In many cases, however, a cause for OAB cannot be found.
Tests for OAB may include a physical exam, urinalysis, urine culture, urinary stress test, ultrasound, cystoscopy, and a post-void residual (PVR) test to measure how much urine is left in the bladder after urination. Your doctor will want to test for other types of incontinence as well. Treatment depends on the type and severity of symptoms, the underlying cause (if one is detected), and the patient’s and doctor’s preferences. In general, the three types of treatment are medication, retraining and surgery
Symptoms and causes
Affecting an estimated 33 million Americans, overactive bladder (OAB) is a term used to describe a collection of symptoms that include:
- Frequency of urination: urinating at least eight times per day
- Nocturia: getting up and urinating at least two times per night
- Urge incontinence: a seepage of urine when the urge to urinate occurs
- Urinary urgency: failure to postpone the need to urinate
OAB occurs when the muscles of the bladder start to contract involuntarily, regardless of the volume of urine, due to a disruption in the signals between the brain and bladder. The involuntary contraction is what causes the sensation of needing to urinate. This condition occurs mostly in women but may also occur in men and can be a source of embarrassment for those living with it.
What are the risk factors for developing OAB?
While the most common risk factor for OAB is increasing age, other common factors may include:
- Consuming alcohol or caffeine
- Dementia
- Diabetic nerve damage
- Having multiple pregnancies
- Infection, such as a urinary tract infection (UTI)
- Nerve damage due to multiple sclerosis (MS)
- Obesity
- Parkinson’s disease
- Previous pelvic surgery
- Previous stroke resulting in nerve damage
- Prostate surgery
- Spinal cord injury
- Taking certain medications
How is OAB diagnosed?
After ruling out an infection or a neurological issue, a urologist may order a urodynamic test to assess the function of the bladder. Types of urodynamic tests include:
This test, known as cystometry, measures pressure in the bladder and surrounding region. During the procedure, a catheter is fed into the bladder and fills it with warm water. An additional catheter with a sensor is placed in the rectum or vagina that identifies if the bladder is experiencing involuntary muscle contractions or is unable to store urine under low pressure.
Patients may also be asked to participate in a pressure flow study, which measures the amount of pressure used to empty the bladder. It is usually used to confirm or rule out an obstruction.
It should be noted that this test is generally used for patients with established neurological diseases that affect the spinal cord.
This test is used to determine if the bladder doesn’t empty completely after urination or is experiencing urinary incontinence. Any leftover urine may cause symptoms that mimic the symptoms of OAB. To check for leftover urine, an ultrasound may be ordered. The bladder may also be drained by the urologist via catheter and measured.
Known as uroflowmetry, this test uses a device patients urinate into that measures changes in the rate at which urine flows.
Treatment
There are a number of treatments available today for overactive bladder (OAB). A combination of treatment strategies may be used to effectively relieve symptoms:
Changing behavior is generally the first course of action when treating OAB because of its high efficacy and lack of side effects. These include:
- Double voiding, where patients attempt to empty the bladder again after initially urinating to ensure it is completely empty
- Intermittent catheterization, where patients can fully self-empty the bladder using a catheter
- Limiting the times when fluids are consumed, as well as the amount consumed
- Losing weight
- Muscle exercises, known as Kegels, strengthen the pelvic floor muscles and urinary sphincter
- Scheduling trips to the bathroom to get the body back on track, rather than waiting for the urge to urinate
- Training the bladder to delay voiding urine by gradually waiting to use the bathroom
- Wearing absorbent pads
There are medications that help relax the bladder and relieve symptoms of OAB, including:
- Darifenacin (Enablex®)
- Fesoterodine (Toviaz®)
- Mirabegron (Myrbetriq®)
- Oxybutynin as a skin patch (Oxytrol®), gel (GELNIQUE), or oral medication (Ditropan XL®)
- Solifenacin (Vesicare®)
- Tolterodine (Detrol)
- Trospium (Sanctura)
Botox® can be an effective treatment for the symptoms of OAB — including urgency, frequency, and urgency incontinence — when symptoms fail to improve with medications, or the medications are poorly tolerated.
Botox® is injected directly into the bladder muscle via cystoscopy — a procedure in which long tube with a lens that is inserted into the urethra to view the bladder. It causes a relaxation of the overactive muscle and generally provides symptomatic relief for six to nine months. It can be effective both for general OAB as well as OAB associated with neurological conditions.
Electrical stimulation may be used to treat symptoms of OAB by sending a mild electrical current to the nerves in the low back or the pelvic muscles used for urination. A surgical procedure is performed in which a wire is temporarily placed for a trial period close to the sacral nerves, located near the tailbone. In some cases, a permanent electrode may be implanted for a longer trial period before the surgical placement of the battery-powered pulse generator.
The pulse generator sends stimulating electrical impulses to the bladder in the same way a pacemaker does to the heart. If the treatment is successful, the wire is connected to a small battery device placed under the skin.
Surgery as a treatment option is only reserved for patients with severe symptoms who have not responded to any other treatment modalities. With surgical intervention, the goal is to improve how well the bladder stores urine and reduce pressure in the bladder. It should be noted that surgery will not relieve pain associated with the condition.
Surgical procedures include:
- Increasing bladder capacity - to increase the bladder’s ability to manage urine levels effectively, pieces of the bowel are taken to replace a portion of the bladder. Intermittent catheterization to fully empty the bladder may be required for the rest of the patient’s life following the procedure.
- Removing the bladder - When the bladder is removed, a replacement may be constructed, or an opening in the body can be created for urine to empty into a bag connected to the skin.
