You can help prevent urinary incontinence by…
You can help prevent urinary incontinence by…
You can help prevent urinary incontinence by…
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Our Urinary Incontinence Specialists
Dr. Korman, Howard
Dr. Kearney, David
If you have incontinence, this means that you leak urine – in either small or large amounts. Muscles and nerves in and around your bladder work with your brain to store urine and help you empty your bladder when it’s full. If the muscles or nerves aren’t working correctly, this can cause you to have trouble holding your urine or emptying your bladder.
There are two main types of incontinence that are classified based on your symptoms and what’s causing them.
- Urge Incontinence: Bladder leakage that happens in conjunction with a sudden, strong or frequent urge to urinate
- Stress Incontinence: Bladder leakage that occurs when you put pressure on the muscles around your bladder, like when you cough, laugh, sneeze, lift something or exercise
What are the types of urinary incontinence?
Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:
Stress Urinary Incontinence (SUI)
With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.
SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.
There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include “Kegel” exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.
Overactive Bladder (OAB)
OAB is another common type of urinary incontinence. It is also called “urgency” incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people’s lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren’t near a bathroom. They may not even be able to get a good night’s sleep. Some people have both SUI and OAB and this is known as mixed incontinence.
With OAB, your brain tells your bladder to empty – even when it isn’t full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.
The main symptom of OAB is the sudden urge to urinate. You can’t control or ignore this “gotta go” feeling. Another symptom is having to urinate many times during the day and night.
OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.
Mixed Incontinence (SUI and OAB)
Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.
With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.
One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called “dribbling.”
This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.
The symptoms tell you what kind of urinary incontinence you have.
Not all incontinence is long term. Some causes are temporary so that the incontinence ends when the cause goes away. Vaginal infections can cause temporary incontinence. Irritation, medications, constipation and restricted mobility can cause it. Urinary tract infections (UTIs) are a common cause of temporary incontinence and should be addressed.
It remains important that if the cause isn’t temporary or easily treated, the leakage is probably one of the four types described above. With SUI, the pelvis or sphincter muscles (or both) aren’t strong enough to hold the urine by closing the bladder and urethra. With OAB, the bladder muscles contract too much, pushing urine out even when you are not ready to release it. Mixed incontinence is usually both SUI and OAB. With overflow incontinence, the bladder gets too full without releasing.
These are the symptoms for each:
The key symptom of SUI is leaking when you are active. The activity and amount of leaking depends on how severe the SUI is.
The main symptom of OAB is a sudden, strong urge to urinate that you can’t control. The urge may or may not cause your bladder to leak urine.
Mixed incontinence (SUI and OAB)
The symptoms of mixed incontinence include leaking and a sudden, strong urge to urinate. Mixed incontinence is when you have more than one type of incontinence. Most often, people with mixed incontinence have SUI and OAB.
Frequent small urinations and constant dribbling are the main symptoms of overflow incontinence. The bladder is unable to empty. Symptoms happen when the bladder is full. This type is less often in women however, dropped bladders, prior bladder surgeries or diabetes may affect this. It is more common in men with a history of prostate problems or surgery.
Urinary Incontinence Testing and Evaluation
Your doctor might perform tests such as:
- Urinalysis: testing a sample of your urine for infection, blood or other abnormalities
- Urodynamic Testing: a series of tests to measure how well your bladder and urethra function
- Cystoscopy: your urologist looks inside your bladder by inserting a thin tube with a lens in it through your urethra. This helps your doctor check for things like chronic inflammation and bladder stones.
Urinary Incontinence Management
You can help prevent urinary incontinence by keeping your bladder healthy with lifestyle changes.
- Avoid food and drinks that seem to increase your symptoms such as caffeine and acidic foods (alcohol, tomatoes, citrus)
- Keep hydrated to avoid your urine getting too concentrated, which can irritate your bladder
- Schedule regular bathroom visits with the goal of gradually increasing the length of time between trips
- Urinate before and after sex and wipe from front to back after a bowel movement to discourage bad bacteria from growing in the urethra and creating an infection
- Eat more fiber and avoid straining during bowel movements. Constipation and straining can put extra pressure on your bladder and weaken your pelvic floor muscles.
- Quit smoking. Persistent coughing from smoking can stress pelvic floor muscles.
- Maintain a healthy weight. Obesity puts extra pressure on your bladder and can make incontinence worse.
Urinary Incontinence Treatment Options
Treatment for bladder leakage depends on the type of incontinence (urge or stress) and its cause. Treatments may include:
- Pelvic Floor Physical Therapy – These help men and women strengthen and control the muscles involved in urination. Kegels are one example of pelvic floor muscle exercises.
- Medicines: If you have urge incontinence, depending on what’s causing it, medicines may be able to help.
- Topical Estrogen (for women): Especially in post-menopausal women topical estrogen can restore the health of the bladder and vagina tissue, allowing them to resume their role in controlling bladder leakage.
- Pessary: This is a small device a provider puts into a woman’s vagina to help support her pelvic muscles and stop leaks.
- Electrical Stimulation and Neuromodulation sends small pulses of electricity to your pelvic muscles to make them tighter and stronger
- Injections of botulinum toxin (BOTOX®) into the bladder muscle to keep it from contracting too often. This treatment wears off and will need to be repeated in 6-9 months
- Surgery and Outpatient Procedures: When other treatments haven’t worked, depending on the type of incontinence and its cause, surgery and outpatient procedures can treat urinary incontinence.
Frequently Asked Questions
Loss of bladder control is not normal at any age. It is the sign that there is a problem that you need to discuss with your doctor.
If you are drinking an adequate amount of water (enough that your urine is clear or light yellow), you should urinate every 2-3 hours and wake no more than twice at night to urinate. Holding urine longer can cause it to become concentrated or the bladder to become overfull, both of which increase the likelihood of leaks.
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