Urinary incontinence -- the accidental leakage of urine -- affects millions of Americans, the majority of them women. There are several different types of urinary incontinence.
Stress incontinence may happen when there is an increase in abdominal pressure -- such as when you exercise, laugh, sneeze, or cough. Urine leaks due to weakened pelvic floor muscles and tissues.
Causes of stress incontinence include pregnancy and childbirth, which cause stretching and weakening of the pelvic floor muscles. Other factors may also increase the risk for stress incontinence, such as being overweight or obese, having had prostate surgery, and taking certain medications.
Urge incontinence is often referred to as overactive bladder: You have an urgent need to go to the bathroom and may not get there in time, leaking urine.
- Damage to the bladder's nerves
- Damage to the nervous system
- Damage to muscles
Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Other conditions such as bladder infections, bladder stones, and use of certain medications can also contribute to symptoms.
Some women have both of these types of urinary incontinence -- stress and urge. Doctors call this mixed urinary incontinence.
You may have overflow incontinence if you are not able to empty your bladder appropriately. As a result, you may have leakage once the bladder is already full. This is more common in men with symptoms of frequent dribbling of urine.
Causes of overflow incontinence include:
- Weak bladder muscles
- Blockage of the urethra, such as by prostate enlargement
- Medical conditions, such as tumors, that cause obstruction of urine flow
With functional incontinence, physical problems such as arthritis, or cognitive problems such as dementia, prevent you from getting to the bathroom in time.
Treatment for Different Types of Urinary Incontinence
To improve or eliminate urinary incontinence, you can make lifestyle changes and get treatment depending on which type you have.
For stress incontinence, treatment options include:
- Pelvic floor exercises. If you've had a baby, chances are you've been told to do Kegel exercises. These help to strengthen the pelvic floor after childbirth. It is wise to keep doing the Kegels to keep your pelvic muscles and tissues strong, which can help prevent stress incontinence. Best of all, Kegels can be done anytime, anywhere.To do Kegels:
- Pretend you are trying to stop the flow of urine.
- Hold the squeeze for 10 seconds, then rest for 10 seconds.
- Do 3 or 4 sets daily.
- Biofeedback. Using monitors, the biofeedback instructor feeds you information about bodily processes, including when your bladder and urethral muscles contract. This helps you gain control. It's also often used in combination with Kegel exercises.
- Devices. For stress incontinence in women, doctors may prescribe a device called a pessary that is inserted into the vagina to reposition the urethra and reduce leakage
- Injections and surgery. Injections to bulk up the urethral area may help with symptoms. In more extreme cases, surgery can help. One procedure pulls the bladder back up to a more normal position, relieving the pressure and leakage. Another surgery involves securing the bladder with a "sling," a piece of tissue or other material that holds up the bladder to prevent leakage.
For urge incontinence, treatment options include:
- Timed voiding and bladder training. First, you complete a chart of the times you urinate and the times you leak. You observe patterns and then plan to empty your bladder before an accident would likely occur. You can also "retrain" your bladder, gradually increasing the time between bathroom visits. Kegel exercises are also helpful.
- Medications, electrical stimulation, or surgery. Doctors sometimes prescribe medicines designed to inhibit the contractions of an overactive bladder. Electrical stimulation of the bladder nerves helps in some cases. Surgery is reserved for severe cases. It aims to increase the storage capacity of the bladder.
Talking About Urinary Incontinence
All types of urinary incontinence can be embarrassing to talk about, but overcoming your reluctance is worth it. Treatment can reduce or eliminate the problem.
Here are some tips that may help you overcome your embarrassment and be open about urinary incontinence:
- Be straightforward. Just tell the physician or the nurse you are having problems. Keep it simple: "I'm having bladder problems."
- Expect your doctor to ask numerous questions about your situation: how long the leakage has been happening, how bad it is, how much it upsets your life. If this doesn't happen, it may be time to switch doctors or at least to ask for a referral to another doctor with expertise in this kind of problem.