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Urinary Incontinence

Gynecology, Bladder, Urinary Incontinence, Menopause Los AngelesUrinary incontinence refers to an inability to control the leakage of urine. Urinary incontinence can be small and sporadic, or heavy and frequent.

Types of Urinary Incontinence:

Overflow incontinence

Slow, minor leakage after urinating. This can occur when the urethra is blocked or when the bladder muscles fail to completely empty the bladder.

Urge incontinence

Also known as overactive or spastic bladder, urge incontinence is leakage that results from a strong, immediate urge to urinate. This happens when a muscle spasm contracting the bladder overpowers the sphincter muscles that regulate the flow of urine through the urethra.

Stress incontinence

This is leakage that is caused by the physical stress of coughing, sneezing, laughing, or exercising. Stress incontinence is usually due to the deterioration of the tissues and muscles that support the urinary organs.

Mixed incontinence

Exhibiting symptoms of both urge and stress incontinence.

Symptoms of Urinary Incontinence

Women with urinary incontinence can experience symptoms beyond leakage. It’s important to note which symptoms are affecting you so that you can relay the information to your gynecologist. Some symptoms include:

  • Frequency – Urinating more often than normal
  • Urgency – The urge to urinate, even if the bladder is empty
  • Feelings of pressure or discomfort in the lower abdomen
  • Dysuria – Pain or burning while urinating
  • Nocturia – The need to get out of bed to urinate several times a night
  • Enuresis – Urinating the bed while asleep

Causes of Urinary Incontinence

IncontinenceMany different medical conditions may cause urinary incontinence. Some of these conditions are easy to treat while others may require intensive intervention or have long-lasting effects.

Certain medications

Some medications have urinary incontinence as a side effect. These drugs are also known as diuretics. Most patients regain control of their bladder once they are off the medication.

Urinary tract infections (UTIs)

Urinary tract infections are fairly common in women. There are some preventative measures you can take to reduce your risk of a bladder infection or a UTI, and they can usually be treated with antibiotics.

Abnormal growths

Polyps, tumors, and bladder stones may cause urinary leakage, especially urge incontinence. These growths can usually be treated with the help of your doctor.

Abnormalities in the urinary tract

A urinary fistula is an abnormal opening between a urinary organ and another proximal organ. Urine may leak out of this abnormal opening (i.e. through a fistula in the vagina).

Pelvic organ prolapse.

A healthy pelvis contains strong tissue that supports the organs and keeps them in place. In some patients, these tissues and muscles can weaken and cause the bladder, urethra, uterus, or rectum to prolapse, causing urinary leakage and other problems. This condition is sometimes treated with surgery, or with a supportive device known as a pessary.

Neuromuscular issues

Urinary incontinence is sometimes caused by a lapse in the brain’s ability to communicate with the bladder and urethral muscles.

Diagnosing Urinary Incontinence

Because urinary incontinence could be an indication of several very different medical conditions, diagnosing the cause can be tricky. If you’re having difficulty controlling your bladder during the day or night, make an appointment with your OB-GYN.

It is a good idea to keep a diary of your symptoms, noting the time of day and amount of urine you leaked or voided. If you experienced a leak, write down what you were doing at that time. You’ll also want to take note of your liquid intake and any medications you’re using.

At your appointment, your doctor may conduct a combination of tests, including:

Pelvic exam

Your doctor will check for physical abnormalities or any other possible causes of your incontinence.

Stress test

Your doctor will have you cough with a full bladder to observe any leakage.

Postvoid residual volume test

After urinating, your doctor will use ultrasound or a catheter to measure the amount of liquid left in your bladder.

Dye test

Your doctor injects a special dye into your bladder and has you wear a sanitary pad. The amount of dye leaked onto the pad can help your doctor diagnose the severity of your incontinence.

Cystoscopy

Your doctor inserts a narrow, flexible tube into your urethra. The lens at the end allows your doctor to see inside your urinary tract and bladder.

Urinary Incontinence Treatment Options

Depending on the cause of your condition, you may have several options to treat your urinary incontinence.

Some cases of urinary incontinence can clear up with a few lifestyle changes. These include:

  • Drinking less fluid, especially caffeinated drinks
  • Quitting smoking
  • Losing excessive weight (for overweight women)
  • Avoiding constipation, though diet changes and supplements
  • Treating stressors such as chronic coughing

You can also talk to your OB-GYN about therapeutic and medical interventions, such as:

Physical therapy

Physical therapy for urinary incontinence can include a few different strategies. You may be asked to change your fluid intake and practice Kegel exercises to strengthen your pelvic floor muscles. Your physical therapist will also show you techniques for bladder training. This is to reduce the frequency of the urge to urinate to normal levels (about every 4 hours during the day and between 4-8 hours at night). Your therapist may employ a technique called biofeedback to teach you how to monitor your body’s natural signals.

Medication

If urinary incontinence is caused by overactive bladder muscles, then there are some medications can help keep the muscular contractions under control.

Bulking agents

Bulking agents are substances that are injected into the tissues surrounding the urethra. They can add support and bulk to the tissue, and shrink the urethral opening. This helps stop the flow of urine.

Pessary devices

A pessary is a small, doughnut-shaped device that is inserted into your vagina to help provide support for prolapsed pelvic tissue and organs. Some devices can put pressure on the urethra, aiding in the prevention of leaks. A pessary is a good choice for women who may not be good candidates for surgery.

Surgery

There are a number of procedures that can improve urinary incontinence. Your OB-GYN can discuss the options that are right for you based on the cause of your condition, your age, and your overall health.

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