As a urologist, one main things I deal is incontinence for both men and women. The following is a basic question and answer guide about incontinence, the misconceptions and how treatments today can make a big difference in someone’s life.
What is incontinence? Incontinence is simply the unintentional leakage of urine. This can be a small amount with coughing and sneezing or sometimes the entire bladder empties before a person wishes it to. The severity of incontinence can range from insignificant small amounts to large volume leakage, which can severely affect a person’s quality of life.
Are there different kinds of incontinence? Absolutely, and this is an important distinction. There are several different kinds of incontinence, and the causes are very different. This means that the treatments are very different as well, and so it is important to know what kind of incontinence you have so that we can manage it appropriately. The two most common kinds of incontinence we see our stress incontinence and urgency incontinence.
Stress incontinence occurs when the sphincter muscle, which is the muscle that holds urine in the bladder, is no longer strong enough to resist the pressure generated from the abdomen during activity. This typically results in small volumes of leakage with coughing, sneezing, laughing or running. We see this type of incontinence most frequently in women who have had multiple children or in men after prostate removal.
Urgency incontinence on the other hand, is caused by a bladder contraction occurring at an unwanted time. Frequently this can happen when pulling into the driveway, doing dishes, or on the way to the bathroom. It often occurs with increased urgency/frequency of urination or recurrent urinary tract infections. It can be associated with several neurologic conditions such as Parkinson’s disease, strokes, and multiple sclerosis, as well as prostatic enlargement in men.
A third, less common, kind of incontinence is called overflow incontinence. This occurs when a person’s bladder no longer empties well. The urine builds up in the bladder and then leaks. If you think of the bladder as a bucket that holds water, the bucket simply gets overfull and flows over the top. This type of incontinence can be seen in patients with long-standing diabetes, nerve problems, or chronic blockage from a large prostate.
How can I treat my incontinence? As I mentioned before, different types of incontinence have different causes, and therefore the treatments are different.
For urgency incontinence, behavioral and dietary modifications are the initial first line therapy. Beverages that contain alcohol or caffeine, as well as foods that are acidic or spicy can irritate the bladder, making urgency incontinence and over active bladder worse. If dietary modification is not successful, we often can use medications to decrease the contractility of the bladder, which then improves symptoms. Many of these medications can have side effects however, including dry eyes, dry mouth, and constipation. If medications are not successful, the third line therapy includes several potential procedures, including Botox injections and placement of a nerve stimulator.
Stress incontinence on the other hand, is often a surgical problem. We frequently try pelvic floor strengthening exercises first, which in some patient can be successful. However, if therapy isn’t successful, there are several potential procedures which can be very helpful. The goal of surgery is to increase resistance near the sphincter muscle to prevent leakage with the activities that increase abdominal pressure. This can be done in two separate ways. The most common first step is to proceed with urethral injections. This is a procedure performed under sedation. A needle is used to inject a small amount of a synthetic material near the sphincter, which helps increase resistance and prevent leakage. This works best for cases where the patient has mild to moderate leakage. For patients that fail injections or have severe stress incontinence, placing a urethral sling is a better option. This involves placement of a piece of mesh or a patient’s own tissue underneath the urethra through a vaginal incision, which again helps support the urethra, increase resistance, and prevent leakage.
Treatment of overflow incontinence ultimately depends on the underlying cause. In patients where the bladder has lost its ability to squeeze, catheters must be used to drain the bladder. In patients with a blockage, such as from a large prostate, the blockage must be addressed. Often (but not always) the bladder function and bladder emptying will improve.
If you have any questions or concerns about urinary leakage, we would love to work with you in any way we can. Controlling incontinence can make a big difference in your quality of life and we are here to help. Feel free to call us at our Fort Dodge clinic, UnityPoint Health Centers for Urology.
Dr. Mark Newton is affiliated wirh UnityPoint Health Centers for Urology.