Incontinence

Incontinence Evaluation at Southland Urology

Urinary incontinence is the loss of bladder control, which can range from a minor leak to a complete inability to hold urine. While it can be an embarrassing topic, it is a very common condition that affects millions of people. It’s important to know that incontinence is a treatable medical condition, and you should not feel ashamed to talk to a healthcare professional about your symptoms to find the right treatment plan for you.

Understanding Incontinence

Urinary incontinence is a common medical condition characterized by the involuntary leakage of urine. It is not an inevitable part of aging, but its prevalence does increase with age, affecting millions of people. Understanding the different types, causes, and available treatments is key to managing the condition and improving quality of life.

Types of Incontinence

There are several types of urinary incontinence, each with distinct symptoms and causes. Stress incontinence is the leakage of urine when pressure is exerted on the bladder, such as during coughing, sneezing, laughing, or exercising. It is often caused by weakened pelvic floor muscles or a damaged urethral sphincter. Urge incontinence is an involuntary leakage of urine accompanied by a sudden, intense need to urinate. This is typically linked to an overactive bladder, where the bladder muscles contract at inappropriate times. Overflow incontinence occurs when the bladder does not empty completely, leading to frequent dribbling of urine. It is often caused by a blockage or an underactive bladder muscle. Functional incontinence happens when a person is unable to reach the toilet in time due to physical or mental impairments, such as severe arthritis or dementia. Finally, mixed incontinence is a combination of more than one type, most commonly stress and urge incontinence.

Causes

The causes of incontinence can be temporary or chronic. Temporary causes include urinary tract infections, constipation, and certain medications that increase urine production. Persistent causes are more varied. In women, childbirth and menopause can weaken pelvic floor muscles and affect bladder health due to hormonal changes. In men, an enlarged prostate gland (benign prostatic hyperplasia) or prostate cancer treatments can be a common cause. Other factors include neurological disorders like multiple sclerosis or Parkinson’s disease, which interfere with nerve signals to the bladder, and conditions like obesity that place extra pressure on the bladder and pelvic muscles.

Diagnosis

Diagnosing the type of incontinence is crucial for determining the correct treatment. A healthcare professional will typically begin with a thorough medical history, physical exam, and questions about your symptoms. They may ask you to keep a bladder diary for a few days, where you record fluid intake, urination times, and leakage episodes. Other diagnostic tests may include a urinalysis to check for infection or blood, a bladder stress test (where you are asked to cough with a full bladder), and a post-void residual measurement to see how much urine remains in the bladder after urination. In more complex cases, specialized tests like urodynamic studies or a cystoscopy may be performed to evaluate bladder function and structure.

Non-Surgical Treatments

• Behavioral Therapies: These are often the first-line treatment. They include bladder training, which helps you gradually increase the time between bathroom visits to improve bladder capacity. Another key behavioral therapy is pelvic floor muscle exercises, also known as Kegel exercises, to strengthen the muscles that support your bladder and urethra.
• Lifestyle Changes: Simple modifications to your daily routine can help. This includes managing fluid intake, especially before bedtime, and reducing or eliminating bladder irritants like caffeine, alcohol, and acidic foods. Maintaining a healthy weight can also significantly reduce pressure on the bladder.
• Medications: For urge incontinence, medications like anticholinergics or beta-3 agonists can help calm an overactive bladder. For stress incontinence, some antidepressants can be used to increase muscle tone in the urethra.
• Medical Devices: Women may use a pessary, a small device inserted into the vagina that provides support to the bladder and urethra. Urethral inserts, which are small disposable devices, can be used temporarily to block urine leakage during specific activities.
• Nerve Stimulation: This treatment uses mild electrical pulses to stimulate the nerves that control the bladder and pelvic floor muscles. It can be done through a small device implanted in the lower back (sacral neuromodulation) or less invasively through a needle placed near the ankle (posterior tibial nerve stimulation).

Surgical Treatments

Botox Injections: Botulinum toxin A (Botox) can be injected directly into the bladder muscle to treat severe urge incontinence by relaxing the bladder and increasing its capacity. The effects typically last several months before needing to be repeated.

Sling Procedures: This is a common surgery for stress incontinence. A synthetic mesh or a strip of your own tissue is used to create a “sling” to support the urethra and bladder neck, preventing leakage when you cough or sneeze.

Artificial Urinary Sphincter: This procedure involves surgically implanting a mechanical device that closes the urethra to prevent leakage, opening only when the patient wishes to urinate.

Bulking Agents: This is a minimally invasive procedure where materials like collagen are injected into the tissue around the urethra. This “bulks up” the area, helping the urethra stay closed and reducing leakage. The effects are temporary and may require repeat injections.