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Urinary Incontinence
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Introduction
Urinary incontinence is involuntary loss of urine that ranges from losing a few drops of urine while sneezing or coughing or strong, sudden urge to urinate just before losing a large amount of urine. Urine loss can also occur during sexual activity and cause tremendous emotional distress.
For some women, the risk of public embarrassment due to urinary incontinence keeps them from enjoying many activities with their family and friends.
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Types of Urinary Incontinence
Stress Incontinence
If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. This type of incontinence is common in women and, in many cases, can be treated.
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Urge Incontinence
If you lose urine for no apparent reason after suddenly feeling the need or urge to urinate, you may have urge incontinence. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.
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Overactive Bladder
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.
Specifically, the symptoms of overactive bladder include:
  • Urinary frequency—bothersome urination eight or more times a day or two or more times at night
  • Urinary urgency—the sudden, strong need to urinate immediately
  • Urge incontinence—leakage or gushing of urine that follows a sudden, strong urge
  • Nocturia—awaking at night to urinate
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Mixed Incontinence
Stress and urge incontinence often occur together in women. Combinations of incontinence—and this combination in particular—are sometimes referred to as mixed incontinence. Most women don’t have pure stress or urge incontinence, and many studies show that mixed incontinence is the most common type of urine loss in women. Urinary incontinence can be cured or significantly improved once the underlying cause has been detected. However, it's important to recognize that incontinence is a symptom and not a disease. Its cause may be quite complex and involve many factors. Your physician should complete an in-depth evaluation before beginning treatment.
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Evaluation of Incontinence
The evaluation begins with a comprehensive history and physical examination, including a pelvic examination. To confirm the diagnosis, some of the diagnostic tests mentioned below also may be ordered:
  • Bladder stress test—You cough vigorously as the doctor watches for loss of urine from the urinary opening.
  • Urinalysis and urine culture—Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
  • Post-void residual urine measurement—This test determines whether any urine remains after you have tried to empty your bladder completely. A small, soft tube, called a catheter, may be inserted into the bladder to drain and measure remaining urine.
  • Ultrasound—This test is useful in determining the volume of urine.
  • Cystoscopy—The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.
  • Urodynamics—Various techniques measure pressure in the bladder and the flow of urine to determine whether you have normal bladder sensation and capacity and whether your bladder fills and empties normally.
Use of a Catheter
The most common method for measuring PVR is with a catheter, a soft tube, which is inserted into the urethra within a few minutes of urination. The advantage of the catheter is that it can also collect urine for analysis.
Once these tests have confirmed the cause of your incontinence, your physician can make specific recommendations for treatment, many of which do not require surgery. No matter how serious the problem seems, incontinence is a condition that can be significantly helped and, in most cases, cured.
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Treatment of Incontinence
"behavioral techniques." Kegel exercises (exercises you do to strengthen your pelvic muscles) By following an individually designed regimen of exercises and instruction, you may be able to improve your bladder control.
  • Bladder training (going to the bathroom at regular times, like every two hours)
  • Keeping track of how much liquid you drink and cutting back your liquids when it's hard to get to a bathroom
But these techniques alone might not be enough. You might be doing some of these things already, and yet you still worry about leaking. That's why your doctor may suggest prescription medicine. In fact, a study has shown that when these behavioral techniques are used along with prescription medicine, treatment success is higher.
"Anticholinergic" prescription medication is often used to help treat the bladder symptoms described above.
Surgery is another option if symptoms do not improve with noninvasive methods. Many are available, and most are designed to correct poor bladder support restore the bladder neck and urethra to their anatomically correct positions and help the urethra close properly.
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Brooklyn, NY 11209
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1529 Richmond Road
Staten Island, NY 10304
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