Affecting 200 million people worldwide, urinary incontinence can greatly influence an individual’s quality of life, including the social, interpersonal and professional aspects. In the United States, it is estimated that 25 million adult Americans experience chronic or temporary urinary incontinence and that two-thirds of individuals who experience symptoms do not use any treatment to manage them.

Incontinence is an involuntary loss of either urine or stool, with the most common being urinary incontinence.  Urinary incontinence (U.I.) can arise from a variety of causes:

• Neurological disorder

• Trauma to the spinal cord

• Impaired bladder function

• Weakened pelvic muscles

• Overactive bladder muscle

• Irritable bladder

• Diabetes

• Cystitis (bladder infection)

• Side effect of certain medication

Different Types of U.I.

As well as arising from a variety of causes, urinary incontinence comes in many different forms:

Stress Incontinence: Urinary leakage occurs from increased bladder pressure most often caused by activities like:

• Coughing

• Sneezing

• Laughing

• Exercise

• Lifting

Urge Incontinence: Commonly known as overactive bladder, an individual’s sensation of a full bladder varies, and in some, the urge to urinate is stronger than the ability to control it.

Enuresis (Bedwetting): Commonly experienced by children, bedwetting often resolves on its own once the bladder muscles mature.  In an adult, the causes can range from weakened bladder muscles and a poor urge stimulus, to side effects from medications.

Neurological damage or Urinary Obstruction: Neurological damage is often related to spinal cord injuries, which might sever the sensation or urge stimulus. Obstruction can cause incontinence when a partial urinary obstruction causes pressure on the bladder, which results in an involuntary loss of urine.

Menopause: For women, estrogen is a hormone responsible for a number of important functions, one of which is to keep the sphincter muscle at the base of the bladder contracted.  During menopause, estrogen declines, resulting in urine leakage. Hormone replacement therapy (HRT) often solves this and other hormone-related issues.

Diagnosis of U.I.

The first step in treating and possibly curing U.I. is to determine the cause and type of U.I. The most common diagnostic test is the urinalysis, which checks the urine for signs of infection or disease, such as diabetes. The next two diagnostic tests are invasive procedures, the cystoscopic examination of the urethra and the urodynamic study to test bladder function, respectively.  

Treatment Options for U.I.

Simply instructing a patient to do kegel exercises and visit the bathroom after every meal, although helpful, will not cure the problem.  For example, if the cause of the problem is a dietary irritant the cure will be found in an elimination diet to uncover the food irritant or allergy. Instead, an individualized treatment plan has the greatest potential for success. 

If the problem is related to pelvic muscles that have weakened, treatment will result from regular kegel and other exercises tailored to strengthen the pelvic floor. Moreover, surgical repair will cure the problem if the bladder has shifted from its normal position or if there is a partial urinary obstruction. If the cause of incontinence is a bladder infection, a short course of antibiotics will cure the problem.

Unfortunately in many cases, U.I. treatments will not cure but minimize the symptoms; such as   U.I. caused by neurological damage. This type of problem is treated by bladder training, or visiting the bathroom after every meal and beverage to empty the bladder. Sometimes U.I. sufferers have such a slight or non-existent urge-response that the only option left is to self-catheterize or wear incontinent pads. When all other treatments have failed, medication may be the best option. 

Whatever the cause of urinary incontinence, today’s treatments offer hope to those who silently suffer from this common ailment.

Dr. Linda Mundorff