Urinary Incontinence

Urinary incontinence—also known as urge incontinence—is a condition involving a sudden and frequent uncontrollable need to urinate. Urine leakage may accompany these urges. This condition may cause problems with everyday life. People may feel embarrassment or have difficulties with work schedules due to frequent bathroom visits. Having to wake up during the night to urinate may also cause chronic fatigue.

In addition to frequent urges to urinate and urinary leakage, signs to watch out for include:

Pain or burning with urination
Pain in the pelvic area
Bladder spasms

Urge incontinence is not a normal condition of aging and may signal a more serious underlying medical problem that should be further investigated. Causes of this condition include:

Bladder infection or inflammation
Bladder cancer
Bladder stones, usually in men
Obstruction of the bladder opening
Enlarged prostate in men
Nervous system disease, like stroke or multiple sclerosis
Trauma to the spinal cord or nervous system
Obesity
Acidic or spicy diet
Frequency of bathroom visits

According to the National Institutes of Health, 45,000 men and 17,000 women are diagnosed with bladder cancer each year.

Doctors and Specialists

Patients usually consult with the physicians that they have an ongoing medical relationship with, including:

Internists: Physicians who focus on prevention, diagnosis, and treatment of adult illnesses.
General practitioners: Doctors who deal with prevention, diagnosis, and treatment of medical problems in all age groups.
Gerontologists: Doctors who specialize in senior and elder medicine.
Gynecologists: Doctors who specialize in maintaining and treating women’s health.

You may be referred to a specialist for further diagnosis and treatment of your urinary incontinence. Specialists include:

Urologists: Doctors who specialize in the health, diagnosis, and treatment of the urinary tract.
Urogynecologists: Doctors with a surgical sub-specialty of urology and gynecology

Preparing for Your Appointment

After you make an appointment for urinary incontinence diagnosis and treatment, there are some steps you can take to make your visit a smooth one.

The first step to prepare for your consultation about urinary incontinence is to maintain a bladder diary for a week. This is a record of:

Volume and types of fluids consumed over a 24-hour period
Any urges to urinate
When you urinate
Any urine leakage that happens with urgency, coughing, sneezing or laughing
What activities make your symptoms better or worse

When going to the doctor’s office, bring:

A list of all medications that are currently being taken including vitamins and herbal supplements
A list of all symptoms experienced, with a time line and any activities that make the symptoms worse
A list of your allergies
Your medical history including surgery, significant medical problems and the dates of each

If you have questions about overactive bladder, write them down and bring them with you so you remember to discuss them with your doctor. This list of common concerns can help you get started.

Questions About My Diagnosis

Could my symptoms be caused by another problem?
Could certain food or beverages cause my symptoms?
What kinds of tests confirm the diagnosis?
Are there brochures or websites that I can use to get more information about the condition?
Is this problem short-term or lifelong?
Will my symptoms get worse? Does stress worsen my symptoms?
Should I see a specialist and if so, what type?

Questions About My Treatment

What treatments are available to me?
Will I need surgery
How frequently will I need follow-up exams?
Will I need to take medication forever?
What are the side effects of the treatment?
What if I choose not to be on the medication?
Is there a natural supplement or holistic approach for this?

Questions About My Lifestyle and Family

Are there exercises that you would recommend to alleviate my overactive bladder problem?
How much fluid can I drink in a day? Is there a time of day that I should refrain from drinking?
Does caffeine make the problem worse? Does alcoholic beverages?
Is there a special diet that you recommend?
Does this run in families?

Tests and Diagnosis

First, the physician will review your medical history and current symptoms. Next, an internal examination is performed with insertion of gloved fingers into the vagina or rectum to assess the bladder, prostate or pelvic organs and feel for any lumps or enlargements.

To confirm a diagnosis of urinary incontinence or rule out conditions that may cause similar symptoms, your doctor will then perform one or more of these tests:

Cystoscopy

To look inside of the bladder and urethra for any growths or obstructions
While lying on your back with your legs in a frog-leg position, a thin tube with lens and light is inserted into the urethral opening, allowing the doctor to see the urethra and the bladder lining.
Normal results include a pink lining with no growths and normal urine flow. Abnormal results include bladder stones, tumors and narrowing of the urethre.

Ultrasound/Sonogram

To look at the kidney, bladder and the pathways between them
After lying down on the table, the technician places clear water-based gel on your abdomen and pelvic area. A handheld probe is then moved back and forth over the area transmitting sound waves. The echoes of these waves create an image on a computer monitor.
Normal results include an intact bladder, ureters, kidneys and urethra. Abnormal results include tumors, growths, narrowing of ureters or urethra, abnormal shape of the bladder, or stones.

Cystometry

Measures filling pressure of bladder and pressure at which urgency is felt or leakage occurs
While lying on your back with your legs in a frog-leg position, a thin, flexible rubber tube is inserted into the bladder, gradually filling it with water. A second tube is placed in the vagina or rectum to detect involuntary muscle contractions that affect urination.
Normal urgency is felt at 175-250 mL and the point where urination is felt to be imminent is 350-450 mL. No urine should leak from your bladder during the stress test.

CT Scan

To look for any growths, stones, obstructions or blood vessel abnormalities
You will lie on a table that passes slowly through a large x-ray machine. The table then remains motionless while the machine moves around you. Whirring sounds can be heard during the process. You may be asked to hold your breath at certain times.
Normal findings show no enlargements, tumors or vascular changes.

Post Void Residual Urine

Measures the amount of urine left in the bladder after you have urinated
After urination is complete, a thin, flexible tube is inserted into the bladder through the urethral opening. This tube then drains any remaining urine and the volume is measured.
The amount of urine remaining after urination should be less than 30 mL.

Urinalysis

To look for infection, crystallization, sugar, protein and blood in the urine and measure the pH
Urine is placed in a cup for analysis. The technician dips a special paper into the urine for analysis with color changes.
Glucose, protein and blood should be absent in a normal specimen. If any are present, the urine is sent to the laboratory in a sterile cup for further analysis.

Electromyography

Measures the nerve impulses between the urinary sphincter and bladder muscles.
Special sensors are placed on skin next to the urethra and rectum, or a catheter is inserted into the urethra or rectum. A machine records nerve and muscle activity.
Normal results show minimal electrical activity of a muscle at rest.

Medications and Treatment

Treatment is based on the cause of your urinary incontinence. Once infections, stones and other causes have been ruled out, there are steps that you can take at home to lessen urine leakage, including:

Pelvic floor exercises (Kegels): These are exercises to strengthen the muscles of the pelvic floor involved with bladder control. To do them, first tighten, hold, and release the muscles used to start and stop urination. Gradually achieve 3 sets of 10. Contract the pelvic floor (as though you were stopping the urine flow midstream) and hold for 5-10 seconds. Rest and repeat as tolerated. Try this several times each day.
Bladder training: Urinate at scheduled times rather than when you have the urge. Initially this may be hourly and then increase by 30-minute intervals with a goal of 3-4 hours without leakage. Try urinating a second time right after urinating to empty the bladder completely.
Diet: Reducing foods that are irritating to the bladder—acidic or spicy foods or those high in sugar—helps. Avoid alcoholic beverages and caffeine. Eat more fiber to prevent constipation. If you’re overweight, try a diet plan to help you lose the excess weight.
Pessary: This is a vaginal insert, which comes in various, shapes and sizes. Your physician fits you with the appropriate size. You insert the pessary into the vagina to help support the bladder and decrease leakage. It can be worn all day. After removal, wash with mild soap and water.
Urethral insert: Similar to small tampons, these are self-inserted into the urethra before certain activities where leakage may be a problem. This device is not meant for daily use.
Catheter: Especially useful for those having overflow incontinence, the catheter is self- inserted after urination to help empty your bladder completely.

Beta-3 adrenergic agonist: Relaxes the smooth muscle surrounding the bladder; enables the bladder to fill to a greater extent. They may cause increased blood pressure, headache, nasal congestion, urinary tract infections or allergic reactions.

Anticholinergic: Blocks the nerve impulse to bladder muscles to inhibit contraction frequency; decreases urgency; increases bladder capacity. They may cause blurred vision, constipation, dry mouth and a faster heartbeat. They shouldn’t be taken by people with gastrointestinal sensitivity, glaucoma or urinary retention.

Tricyclic antidepressant: Relaxes bladder muscles; decreases urgency. They may cause confusion, dizziness or dry mouth.

Botulinum toxin: Relaxes bladder muscles; offers relief from overactive bladder symptoms

Estrogen: Restores hormone in menopausal women; decreases dryness of bladder lining to increase capacity; decreases dryness around urethra to decrease over-sensitivity.

Capsaicin (from chili peppers): Affects bladder nerves; decreases nerve stimulation which may decrease symptoms

Surgical correction for urinary incontinence may be recommended if other treatments fail or symptoms are so severe that the patient has problems with daily life. Procedures include:

Vaginal sling: Surgical procedure creating a support sling from the bladder to where the urethra and lower stomach muscles connect. This helps to close the urethra more. While urine leakage is lessened, it may only be a temporary fix.
Bladder augmentation: A bowel segment is added to the bladder wall to help with urine capacity.
Implant application: A device is inserted under the skin that emits electrical pulses to the nerves that control the bladder and surrounding muscles.