Urinary incontinence refers to the loss of urinary control which causes a patient’s physical or social harm. It is a common urological condition that can have a significant impact on the quality of life for those who suffer from the condition, but also potentially for friends and family members of the patient. Incontinence is a treatable condition that begins with an evaluation by a urologist. It can be due to a variety of causes and effects both men and women. Once the evaluation is complete and the underlying problem identified, then treatment may be considered. Therapy for urinary leakage may include, lifestyle changes, specific exercises, medications, surgery or a combination of these depending on the type of incontinence There are three major classifications of incontinence and some patients may have more than one type.

  • Urge Incontinence (Overactive Bladder) — Leakage that is accompanied by a strong need (urge) to urinate that does not allow time to reach the bathroom.
  • Stress Incontinence — This is leakage which occurs with coughing, sneezing, exercising or straining. It is most common among middle aged and older women and some men after prostate removal.
  • Incontinence Without Sensation (Overflow Incontinence) — This leakage occurs when the bladder empties poorly and often without good sensation. Urine may overflow through a relatively weak urinary sphincter.

Urge Incontinence (Overactive Bladder)

Symptoms

  • A sudden, strong urge to urinate
  • Inability to get to the bathroom in time
  • Frequent need to urinate, including at night
  • Feeling the urge to urinate when you hear water running

Causes

  • Most commonly this disorder is due to changes in the bladder muscle and pelvic nerves.
  • A diet high in bladder irritants such as coffee, tea, chocolate or acidic fruit juices can worsen the symptoms
  • Recurrent urinary tract or vaginal infections
  • Bowel problems including chronic constipation or irritable bowel disease
  • Some medications
  • Damage to the nervous system caused by Multiple Sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, diabetes and other causes.

Stress Incontinence

Symptoms

  • Urine leaks when lifting heavy objects, exercising, coughing, sneezing, etc.
  • Symptoms worsen when your bladder is full or you are more active.

Causes

  • Most commonly this disorder is due to weakness in the pelvic floor muscle or external sphincter. This weakness may be is worsened by:
    • childbirth
    • menopause
    • previous pelvic surgery (i.e. hysterectomy).
    • Prostate surgery in men

Incontinence Without Awareness or with Overflow

Symptoms

  • Usually patients are unaware when the leakage occurs. It may happen when they first rise from sitting or at night when the bladder silently fills. Some patients note a constant, slow leaking through the day that worsens with cough, sneeze, and other physical activities. At times however the only indication is a damp pad or underwear.

Causes

  • Aging can cause a gradual loss of sensation in the bladder and sphincter area.
  • Neurological conditions from injury or with diseases such as diabetes.
  • Obesity Side effects from medication that cause the bladder to be over relaxed.

Diagnosis

The first step is a thorough history and physical by your doctor, who will examine your abdomen, urethra, and genital area carefully. Additional tests may include:

  • Bladder diary — your doctor may ask you to keep a record of times and volume of urination, and intake of fluids.
  • Urinalysis
  • Measurement of the angle of the urethra

More specialized tests that your urologist may perform include:

  • Postvoid residual test (PVR) — your doctor can determine how well you empty your bladder by using an ultrasound that detects the amount of leftover (residual) urine. A large amount may indicate a blockage, or a nerve or bladder muscle problem.
  • Urodynamic test — More specific measurement of bladder function using a catheter inserted into your bladder, slow flow of fluid into the bladder and measurements of pressure, flow and sphincter relaxation or overactivity.
  • Cystogram — a special X-ray of your bladder.
  • Cystoscopy — An office procedure where a small scope is inserted gently into the bladder through the urethra.