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Incontinence of Urine

Urinary incontinence is the accidental loss of urine.  More than 15 million American men and women suffer from this disease.  Many of these people suffer in silence unnecessarily, and are prevented from doing activities and living the life they want to lead.  Since incontinence can be managed or treated, the following information should help you discuss this condition and what treatments are available to you with your urologist.  For millions of Americans, incontinence is not just a medical problem. It is a problem that also affects emotional, psychological and social well-being. Many people are afraid to participate in normal daily activities that might take them too far from a toilet, so it is particularly important to note that the great majority of incontinence causes can be treated successfully.

What happens under normal conditions?

Coordinated activity between the urinary tract and the brain controls urinary function. The bladder stores urine because the smooth muscle of the bladder (detrusor muscle) relaxes and the bladder neck and urethral sphincter mechanism are closed. The urethral sphincter is a circular muscle that wraps around the urethra. During urination, the bladder neck opens, the sphincter relaxes and the bladder muscle contracts. Incontinence occurs if closure of the bladder neck is inadequate (stress incontinence) or the bladder muscle is overactive and contracts involuntarily (urge incontinence).

What are the different types of urinary incontinence?

Stress urinary incontinence

Stress incontinence is leakage that occurs when there is an increase in abdominal pressure caused by physical activities like coughing, laughing, sneezing, lifting, straining, getting out of a chair or bending over. The major risk factor for stress incontinence is damage to pelvic muscles that may occur during pregnancy and childbirth.  For more information, see the page for our public awareness campaign It’s Time to Talk About SUI.

Urge urinary incontinence

Also referred to as "overactive bladder," this type of incontinence is usually accompanied by a sudden, strong urge to urinate and an inability to get to the toilet in time. Frequently, some patients with urge incontinence may leak urine with no warning. Risk factors for urge incontinence include aging, obstruction of urine flow, inconsistent emptying of the bladder and a diet high in bladder irritants (such as coffee, tea, colas, chocolate and acidic fruit juices).

Mixed urinary incontinence

Mixed incontinence is a combination of urge and stress incontinence.

Overflow urinary incontinence

Overflow incontinence occurs when the bladder does not empty properly and the amount of urine produced exceeds the capacity of the bladder. It is characterized by frequent urination and dribbling. Poor bladder emptying occurs if there is an obstruction to flow or if the bladder muscle cannot contract effectively.

What is minimally invasive management of urinary incontinence?

Some of the causes of incontinence are temporary and easily reversible. Reversible causes include urinary tract infection, vaginal infection or irritation, medication, constipation and restricted mobility. However, in some cases, further medical intervention is necessary. Minimally invasive treatment options are those treatments that do not involve surgery and should be the first line of treatment for patients. However, they may also be used in conjunction with surgical therapy.

Fluid management

This option consists of instructing a patient to increase or reduce their fluid intake. Incontinent patients may need to reduce the amount of caffeine or other dietary irritants (such as acidic fruit juices, colas, coffee and tea), while at the same time increase water intake to produce an adequate amount of non-irritating, non-concentrated urine. A recommended water intake is six to eight glasses per day.

Bladder training

A diary is the starting point for bladder training. Patients are instructed to record fluid intake, urination times and when their urinary accidents occur. The diary allows the patient to see how often they actually urinate and when incontinence occurs. The diary is also used to set time intervals for urination. Patients who urinate infrequently are instructed to do "timed urination" where they urinate by the clock every one to two hours during waking hours. By achieving regular bladder emptying they should have fewer incontinent episodes. Timed urination may be effective in patients with both urge and stress incontinence.

Bladder retraining

Bladder retraining is used for patients with urinary frequency. The goal of retraining is to increase the amount of urine that the patient can hold within their bladder. Patients are instructed to keep a diary to determine their urination interval. Patients are then instructed to gradually increase their urination interval by 15 to 30 minutes per week. The goal is to have patients urinating every two to four hours while awake with less urgency and less incontinence.

Pelvic floor exercises

Also known as Kegel exercises, this type of minimally invasive treatment focuses on strengthening the external sphincter muscle and the pelvic muscles. Patients who are able to contract and relax their pelvic floor muscles can improve their strength by doing the exercises regularly. Other patients require help from a health-care professional to learn how to contract those muscles. Biofeedback and electrical stimulation can be used to aid patients in doing pelvic floor exercises. During electrical stimulation, a small amount of stimulation from a sensor placed in the vagina or rectum is delivered to the muscles of the pelvic floor. Like any exercise program, the patient must continue to do the exercises to maintain the benefit. Patients with stress incontinence benefit from pelvic floor exercises by increasing resistance at the urethra and by increasing the strength of the voluntary pelvic floor muscles. Patients can also be taught to compensate by contracting the pelvic muscles with certain activities like coughing.

Pelvic floor muscle exercises are effective for urge incontinence, since a contraction of the pelvic floor can interrupt a contraction of the bladder smooth muscle and stop or delay an accident.

 

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Information provided by the American Urological Association.