What Is Urinary Incontinence?
Urinary incontinence refers to a loss or leaking of urine due to faulty bladder control. An estimated 25% to 33% of people in the United States suffer from urinary incontinence. That means millions of people live with the condition. There are many different types of urinary incontinence. Although both men and women suffer from the condition, several factors unique to women increase the risk of urinary incontinence in females. It’s a common misconception that this is a normal part of aging. It is not. Thankfully, there are lots of ways to manage urinary incontinence and minimize the effect it has on your life.
Urinary incontinence is more than a health concern. It affects people on a social, psychological, and emotional level. People who have urinary incontinence may avoid certain places or situations for fear of having an accident. Urinary incontinence can limit life, but it doesn’t have to. The concern is treatable once the underlying cause is identified and addressed.
Symptoms of Stress Incontinence
Common in Women
Stress incontinence occurs when pelvic floor muscles weaken. The condition is the most common type of urinary incontinence in young women. Stress incontinence is the second most common type in older women. Activities like exercise, walking, stretching, bending, laughing, coughing, sneezing, or lifting place strain on weakened pelvic floor muscles, and that leads to leaks. Any activity that increases physical strain on pelvic floor muscles may lead to stress incontinence--even sex. The amount that leaks varies. It may be a few drops or up to a tablespoon or more, depending on severity.
Some studies suggest 24% to 45% of women over the age of 30 suffer from stress incontinence. If you suffer from urinary incontinence, you are definitely not alone. Weakness in not just the pelvic floor muscles, but also in the urethral sphincter often plays a role in this type of urinary incontinence.
Causes of Stress Incontinence
Weak Tissues Lead to Leaks
Weakness of the pelvic floor muscles and tissues that support the bladder and urethra causes stress incontinence. These muscles and tissues may be weakened by a variety of things. Some of the factors that contribute to the disorder are modifiable, and some are not. Knowledge is power. Knowing the modifiable factors is the first step toward managing the condition.
Causes of Pelvic Floor Muscle Weakness
Anything that damages, stretches, or weakens pelvic floor muscles may lead to stress incontinence. Some causes cannot be changed. Increasing age and female gender increase the risk. Pelvic floor surgery, injury to the nerves in the lower back, chronic coughing, smoking, obesity, and pregnancy and childbirth are also causes. Women who have multiple pregnancies are at an even greater risk, as are those who have undergone a C-section.
Symptoms of Urge Incontinence
Urge incontinence occurs due to overactivity of the detrusor muscle. The hallmark symptom of this kind of urinary incontinence is a sudden, overwhelming urge to void, accompanied by loss of urine. Frequent urination and nighttime urination often occur with this type of urinary incontinence. The amount lost is variable. Hearing running water or changing position may trigger bladder contractions and lead to urine loss. This type of incontinence can occur in anyone of any age, but it is more typical with advancing age. Just 9% of women between the ages of 40 and 44 suffer from urge incontinence while 31% of women over the age of 75 suffer from the condition.
Sometimes stress incontinence and urge incontinence occur at the same time. This is called mixed incontinence. People who suffer from urge incontinence lose greater amounts of urine than those who suffer from stress incontinence. Those who suffer from stress incontinence notice leaks with activities that increase abdominal pressure. Keeping a voiding diary, noting the time, place, and activities associated with symptoms of urine loss can help the physician determine whether you suffer from stress incontinence, urge incontinence, mixed incontinence, or another issue.
Causes of Urge Incontinence
The Root of the Problem
The causes of urge incontinence fall into two main categories. Irritation within the bladder is one potential underlying cause. The other is a loss of the nervous system’s inhibitory control of bladder contractions. Neurological conditions like stroke, Parkinson’s disease, multiple sclerosis, and damage to the spinal cord may injure nerves that control the bladder and lead to urge incontinence. Diabetes and cardiovascular conditions can also affect associated nerves. Alcohol consumption and diuretic medicine may underlie urge incontinence. Infections or inflammation that either irritated the bladder or damage its nerves may trigger symptoms.
Something More Serious?
Urge incontinence may be a sign of something more serious, depending on how your body reacts. If you have blood when you urinate, recurrent urinary tract infections (UTIs), or an inability to empty your bladder completely, see your doctor right away. These are red flags that indicate something more serious than just urinary incontinence may be going on. Further testing is warranted to get to the root cause in these cases.
What Is Overactive Bladder?
The condition known as overactive bladder may or may not be associated with urge incontinence. OAB refers to sudden, uncontrollable bladder contractions. When these contractions are associated with leaks, urge incontinence is also present. OAB is disruptive because strong, frequent bladder contractions prompt numerous trips to the bathroom throughout the day and sometimes also at night. OAB can interfere with work, fitness, and social life. If you get up multiple times at night to urinate, OAB can also keep you from getting a good night’s sleep.
A Common Problem
OAB is an extremely common disorder. Approximately 33% of people in the United States have OAB. An estimated 40% of women in the U.S. have the condition. Despite the fact that millions of people and a large percentage of women have OAB, it is not normal and you don’t have to live with uncomfortable, limiting symptoms. There are treatments that can help.
Medication Triggers of Urinary Incontinence
Check the Medicine Cabinet
Certain medications may trigger urinary incontinence or make it worse. Drugs that affect the brain, nervous system, muscle tone, and fluid balance may trigger the problem. Never stop taking a prescription or change the dose without speaking with your health professional. If you have concerns that a medicine you’re taking may be contributing to your symptoms, discuss the issue with your physician. It may be possible to substitute a problematic drug with another drug that does not cause side effects.
Some Medications Worsen The Problem
Certain classes of medicine increase the risk of incontinence symptoms. Blood pressure medications may relax the bladder, increase coughing, or decrease the tone of the urethral sphincter, all of which may contribute to this health concern. Pain relievers may increase fluid retention or relax or inhibit contraction of the bladder. Drugs to treat depression, Parkinson’s disease, or psychosis may increase the retention of urine. When you really need to urinate badly, some of that urine may leak. Antihistamines and anticholinergic drugs may have similar effects.
Incontinence and Emotional Health
Quality of Life Issue
Incontinence can take a serious toll on quality of life. Women who are affected by it report more depression and limitations in sexual and social functioning than those who do not have the condition. Those who suffer from this health concern are more likely to rely on caregivers. Incontinence also has a negative effect on self-esteem. In general, it negatively affects a woman’s quality of life, the more she should seek aggressive treatment.
An Honest Conversation
Many women feel embarrassed about suffering from incontinence, but they need not. This is a common problem and you are not alone. Effective treatments are available. Be honest with your doctor. Do you avoid certain activities because of your symptoms? Does incontinence impair your work, sleep, sex life, or social functioning? Different interventions are available depending on how it impacts you. Speaking candidly with your doctor is the best way to identify treatments that are most appropriate for your situation.
There are numerous bladder problems and different types of incontinence. The doctor can determine what kind you have by taking a detailed medical history, reviewing the nature of your problem and ordering lab tests. A urine test can screen for blood, protein, and other abnormalities. The doctor will perform a physical exam noting any aberrations. He or she may ask you to perform a cough stress test where you stand and cough to see if it provokes an accident. A post-void residual urine test assesses how much you urinate and the amount left over after voiding. The test helps determine if there’s an obstruction in the urinary tract.
The physician may ask you to keep a voiding diary where you note how much liquid you drink, how much you urinate, and when and where you experience an accident. You will also note approximately how much urine you lose with each episode of incontinence and whether or not you experience a sense of urgency. This information will help your physician determine what kind of incontinence you have. A voiding diary can also help guide treatment decisions.
Specialized Tests to Diagnose Incontinence
Sometimes routine testing does not reveal the underlying cause, and further evaluation is required. You may be referred to a urologist or a urogynecologist for more specialized testing if your health concern is accompanied by pain, recurrent UTIs, blood or protein in the urine, neurological symptoms or muscle weakness, or pelvic organ prolapse. Women with this issue who have a history of radiation or surgery to the pelvic region may also be referred to a urologist.
Specialized testing can assess how well the bladder, urethra, and sphincters store and dispose of urine. There are many different types of instruments that can be used for urodynamic testing. Cystometry is a test that is used to help diagnose urge incontinence. It measures bladder pressure. The structures in the pelvis can be visualized with ultrasound. Uroflowometry can measure the volume of urine and flow rate. This test is used to determine the strength of related muscles and helps assess whether urine flow is blocked. There are other tests a urologist may perform depending on your symptoms.
Lifestyle Changes for Mild Incontinence
Lifestyle Changes Can Help
Mild cases of incontinence may be helped with simple lifestyle changes. Drink adequate fluids to avoid dehydration – about six 8-ounce glasses per day – but don’t drink too much. Limit your intake of fluids after dinner in the evening to minimize nighttime accidents. Avoid caffeinated drinks like coffee, tea, and colas as caffeine is a diuretic. Avoid alcohol, smoking, and carbonated beverages which may contribute to leaks. Losing weight if you are overweight may help relieve pressure on the bladder.
The Importance of Fiber
Getting adequate fiber helps move your bowels, which in turn helps minimize the risk of incontinence. Most adults should aim to get between 25 and 30 grams of dietary fiber per day. Lentils, beans, artichokes, avocados, berries, and figs are good sources of fiber. Fiber and water work together to optimize bowel health and minimize constipation. Being constipated increases pressure in the abdomen.
Kegel Exercises for Women
Strengthening pelvic floor muscles can reduce or even cure symptoms of stress incontinence. Kegel exercises target the muscles that control the flow of a stream of urine. You need to do the routine regularly to attain and maintain maximum benefit. Kegel exercises are easy to do; it just takes a little practice to make sure you’re concentrating your efforts on the right area.
How to Do Kegel Exercises
To perform Kegel exercises, contract the muscles you use to stop a stream of urine. Hold for 3 seconds and then release. Relax for 3 seconds. Work up to 3 sets of 10 Kegels. You can start performing these workouts while lying down. As you get stronger, you can do them while sitting or standing. If you’re having trouble isolating the correct muscles, a doctor, nurse, or physical therapist can help you with your technique.
Help from Technology
Biofeedback is a type of therapy in which electrical patches are placed over areas of the body to record muscle contractions. The signals are then visualized on a computer screen. A technician can help you isolate the necessary muscles using biofeedback. This real-time information allows you to know whether or not you’re performing the routine correctly. Once you have the technique down, you’ll be able to perform Kegel exercises on your own without the help from biofeedback.
Effectiveness of Biofeedback
Biofeedback is effective for both common forms of this disorder. A review of more than 24 different studies involving more than 1,500 affected women concluded that those who received biofeedback in addition to pelvic floor muscle training were much more likely to report improvements or cures of their condition compared to those who received pelvic floor muscle training alone. However, it is unknown whether the increase in successful outcomes was due to the addition of biofeedback or the extra time that women spent with healthcare professionals during the sessions.
A pessary is a device used to treat this problem. The device is inserted into the vagina by a doctor or nurse. The pessary pushes into the vaginal wall, affecting the position of the urethra so that leaks are less likely. A pessary may be used as a nonsurgical option to treat certain kinds of pelvic organ prolapse. Some pessaries are meant to be worn continuously. Others may be used as needed, for example only during grueling exercise.
Pessary Fitting and Type
A pessary ring is one of the most common types of devices used to treat incontinence in women. Pessaries can be difficult to insert and remove, so frequent medical visits, usually once every 2 to 3 months, are required so that the doctor or nurse can remove, clean, and reinsert the device. Patients who are allergic to silicone or latex may not be candidates for pessaries. The patient is asked to urinate before being fitted for a pessary. It is recommended to use the largest pessary that fits comfortably.
Bladder Training for Urinary Incontinence
Stick to a Schedule
Bladder training is a useful way to treat both common forms of urinary incontinence. To implement this training, go to the bathroom at set times to urinate. The goal is to urinate frequently enough that it minimizes urges to void and accidents. As the bladder strengthens and accidents are less frequent, you can increase the length of time between bathroom trips. Stick to the schedule whether or not you feel the need to urinate. If your goal is visit the restroom every hour and 15 minutes, do so to help decrease your symptoms.
Length of Training
Training may take between 3 and 12 weeks or longer. During the program, the physician may ask you to keep a diary of your bathroom habits including when and how much you urinate. You may be asked to record your fluid intake and if and when you have any accidents and how much you lose at a time. This information will help you and your health professional identify triggers for your symptoms and help optimize treatment.
Medications to treat urinary incontinence fall into several major classes. Antispasmotics decrease bladder contractions in an attempt to minimize leaks. These medications are available in pill form. Some are available as extended release forms or transdermal patches. Tricyclic antidepressants dampen nerve signals and decrease spasms in the bladder, both of which may decrease urine loss. Antidiuretic hormone is prescribed to help the body retain water. Taking antidiuretic hormone makes the urine more concentrated.
Medication Side Effects
The drugs prescribed to treat urinary incontinence may be associated with side effects. Antispasmodics may cause an increased sensitivity to light, decreased sweating, and dry mouth. Wearing sunglasses will help shield the eyes from bright light. Sucking on hard candy or chewing gum can provide relief from dry mouth. If you don’t sweat very much, take extra care to drink plenty of fluids and avoid overheating, especially in warm weather. If side effects of medications are dangerous or bothersome, talk to your doctor who can adjust the dose or prescribe another drug that may have fewer side effects.
Additional Treatments for Urinary Incontinence
If behavioral and lifestyle interventions do not bring relief of urinary incontinence, electrical nerve stimulation may be an option to consider. Small devices implanted near the tibial nerve in the ankle or the sacral nerve in the lower back deliver impulses that help relieve urinary incontinence symptoms. Stimulation of the tibial nerve interrupts the impulses from the bladder that go to the brain. Stimulation of the sacral nerve may improve blood flow to the bladder and make pelvic muscles that control the bladder stronger. Nerve stimulation may also trigger the relief of chemicals that block pain.
In some cases of urinary incontinence unresponsive to other treatments, a physician may inject bulking agents near the urinary sphincter to help close the bladder opening. A mixture of collagen and carbon beads are injected under local anesthesia. About 40% of those who undergo the procedure have a successful outcome. If a neurological condition is contributing to the issue, Botox injections to the bladder may provide relief by decreasing bladder contractions. In cases where weak or prolapsed pelvic organs play a role, surgery may be required.
Be Ready and Prepared
Despite your best efforts, accidents may still happen from time to time. There are many products that can help you feel confident being out and participating in the world. Adult diapers are one option to stay dry in the event of an accident if you tend to leak large amounts. Disposable pads worn in underwear may be enough protection if you are prone to smaller accidents. Waterproof underwear is another safeguard to help keep clothing from getting wet. If nighttime accidents are a concern, disposable pads can be placed on the bed to protect the mattress.
Loss of urine can be irritating to the skin. Keep skin clean and dry. Ask your doctor for recommendations about cleansers that are gentle enough to be non-irritating to the area around the urethra. Creams are also available to help block the urine from the skin. If strong urine smell is distressing, deodorizing tablets are available to help cut down on odor.
Healthy Habits Are Key
The best treatment for incontinence is prevention. Exercise regularly to boost your overall health and keep weight within a healthy range. Excess weight puts extra strain on the bladder. If you’re worried about having an accident while exercising, be active somewhere that has restrooms readily accessible, like a gym. Regular exercise reduces your risk of obesity and diabetes, two conditions that may trigger urinary incontinence or make it worse. Don’t forget to do Kegel exercises regularly to strengthen and tone muscles that control urination. Avoid smoking as it can lead to chronic cough, which stresses the bladder and may trigger leaks.
Eat for Health
Certain foods may irritate the bladder and increase inflammation, both of which may trigger or exacerbate urinary incontinence. Potentially problematic foods and beverages include tomatoes, citrus drinks, and highly acidic foods. Spices, alcohol, and chocolate may provoke bladder irritation and leaks. If you’re unsure whether diet plays a role in your symptoms, keep a food diary and note what you eat and drink prior to experiencing symptoms. It may take some time to identify triggers, but it’s well worth the effort.