UW Health gynecologists provide a broad range of medical and surgical services to diagnose and treat urinary incontinence.
Urinary incontinence is when a person leaks urine or losses bladder control due to problems with the supporting tissues and muscles and nerves in the bladder that are used to hold and release urine. Symptoms can range from occasional leakage of urine to uncontrollable complete loss of urine.
Causes of Incontinence
While incontinence can occur to anyone, it generally becomes more common with age. Women are twice as likely as men to be affected by incontinence, especially those women who have given birth or experienced menopause.
Trauma during childbirth can weaken the pelvic floor muscles and supporting structures. Weakening of these muscles and supporting structures allow the bladder to drop downward affecting the ability to store urine and void properly.
Nerve damage also can lead to incontinence – nerve damage may be from chronic conditions such as Multiple Sclerosis, Parkinson's disease, Alzheimer's disease and stroke. Obesity, hyperthyroidism, uncontrolled diabetes and medications for fluid retention and high blood pressure may also worsen urinary leakage.
Types of Incontinence
- Stress Incontinence: Involuntary urinary leakage that occurs with increases in abdominal pressure, such as with lifting heavy objects, coughing, sneezing or laughing.
- Urge Incontinence (Overactive Bladder): Sensation of strong urge to urinate all of a sudden. Often the "urge" is so strong that individuals are not able to make it to the bathroom resulting in small leakage or complete urine loss.
- Overflow Incontinence: The bladder doesn't empty properly, primarily due to weak improper bladder nerve function or a blockage in the urethra. The urine will accumulate until it begins to overflow, resulting in leakage.
- Mixed Urinary Incontinence: Symptoms of both stress and urge incontinence.
Diagnosis of Incontinence
The first step for diagnosis is reviewing symptoms and medical history with a healthcare provider. This information will help the provider determine the type of incontinence and how to treat it.
Many providers will ask patients to fill out a bladder diary for several days or weeks. These diaries track urine leakage, urination measurements, fluid intake and discomfort. These diaries may provide insight into behavior changes that can be suggested to improve symptoms.
Further testing might be necessary for some patients. Tests could include:
- Bladder capacity test: Measuring the amount of urine the patient's bladder can hold.
- Bladder stress test: The doctor or nurse will watch for loss of urine while the patient coughs vigorously.
- Residual urine test: The patient urinates, and then a catheter is placed into the bladder to measure any remaining urine. Excessive residual urine may be a clue to the cause of urinary incontinence.
- Urinalysis/urine culture: Testing urine for evidence of infection, urinary stones or other contributing factors.
- Urodynamics: Use of a machine that measures bladder pressure and urine flow through catheters.
- Cystoscopy: A thin tube with a camera is inserted into the urethra, allowing doctors to see inside the urethra and bladder.
- Ultrasound: To view the kidneys, bladder, ureters and urethra.
Treatment of Incontinence
Possible courses of treatment of incontinence include:
- Exercises: Kegel exercises to strengthen the pelvic floor and bladder muscles completed independently or with direction from a pelvic floor physical therapist.
- Behavioral changes: Bladder retraining and timed voiding (going to the bathroom at scheduled times).
- Medications: Primarily used for urge incontinence. The most common medications are called anticholinergics. The main side effects commonly reported are dry mouth, but blurred vision, increased heartbeat and constipation may also be side effects. These side effects vary depending on dosage. Patients with glaucoma should consult their ophthalmologist before taking anticholinergics.
- Biofeedback: Use of vaginal devices placed in the vagina temporarily to track and improve pelvic floor/bladder muscle strength.
- Pessary: A device that is inserted into the vagina that helps reposition the urethra and bladder leading to less stress leakage. Pessaries come in different shapes and sizes. Individuals with pessaries need to be evaluated by their provider to monitor for infections and other complications.
- Neuromodulation: Used for urge incontinence that doesn't respond to behavioral treatments or medications. This involves stimulation of the nerves to the bladder via an implanted device.
- Injections: The doctor injects bulking agents, such as collagen or carbon spheres, near the urinary sphincter in an attempt to close the bladder opening and reduce stress incontinence. Repeat injections might be needed.
- Surgery: Options include placement of a synthetic mesh material that supports the urethra to reduce stress urinary incontinence symptoms. This is commonly referred to as a sling.