Incontinence: What It Is, Causes, Types, Diagnosis, Treatment

What Is Incontinence?

Urinary incontinence is defined as the involuntary loss of urine. It can be stress, urge or mixed incontinence. When any part of the urinary system malfunctions, incontinence can result.

Who is affected by incontinence?

Urinary incontinence is reported to affect 13-25 million people in the United States. Many patients do not seek treatment due to embarrassment, or a misperception that nothing can be done about it. Many women believe that incontinence is a normal part of the aging process. It is important to know urinary incontinence can usually be successfully treated.

What causes incontinence?

Urinary incontinence can be caused by many factors. A few of the most common causes are:

• Pregnancy and childbirth
• Diabetes
• Bladder or kidney infection
• Menopausal drying/thinning of the urethra
• Interstitial cystitis
• Excess alcohol consumption
• Excess caffeine consumption
• Excess fluid consumption
• Certain medications
• Nervous system disorders that may effect the lower urinary tract
• Spinal cord lesions
• Multiple sclerosis
• Parkinson’s
• Stroke

How is incontinence diagnosed?

Urinary incontinence is diagnosed by a thorough clinical evaluation. This may include:

1. Medical history
2. List of medications
3. Pelvic exam
4. Voiding diary (recorded over 3-7 days)
5. Urinalysis and culture
6. Urodynamics (cystometrogram)

How is urinary incontinence treated?

Treatment of urinary incontinence depends on the type of incontinence you have. The three major categories of treatment are behavioral modification, pharmacological therapy, and surgical treatment. Treatment can involve:

• Behavioral Modification
• Pharmacologic Treatment
• Surgical Treatment

A cystometrogram or CMG is a test used to evaluate your bladder’s ability to store and release urine.

Incontinence; Behavioral Modification

Lifestyle Changes

• Quit Smoking – Smoking can lead to:
• Chronic Cough
• Damage to Bladder
• Damage to Urethra
• Lose weight – Excess weight puts extra pressure on the pelvic floor muscles.
• Avoid caffeine and alcohol as this may make you urinate more.

Timed Voiding

Your physician may instruct you to urinate every 2-4 hours, while awake. The goal of this therapy is simply to keep the patient dry. This will help to empty the bladder and avoid accidents.

Bladder Re-training

This involves timed voiding, but the length of time between the bathroom trips is gradually increased. This therapy trains the bladder to delay voiding for larger time intervals.

Incontinence: Kegel Exercises

Kegel exercises help to strengthen the pelvic floor muscles. The success depends on commitment to performing them daily.

Kegel exercises are easy to learn and simple to do. If you do them right, no one can tell you are doing them, so they can be done anywhere.

Isolating The Pelvic Floor Muscles

• While urinating, try to stop the flow of urine. Start and stop as often as you can.
• Tighten your muscles as if you were stopping your stream of urine, but do it when you are not urinating.
• Tighten your rectum as if trying to not pass gas. Contract your anus, but don’t move your buttocks.
  If you have isolated the right muscles, your leg, buttock or stomach muscles should not move.

 How long should I hold them?

Try holding each contraction for 5 seconds. This will be difficult at first but it will get easier as the pelvic floor gets stronger.

How often should I do them?

This Exercise can be done several times a day. The more you do them, the stronger the muscles become. However, just like any exercise, the muscles can become fatigued if overworked.

When and Where can I do my Kegels?

Kegels can be done anywhere and anytime.

Incontinence: Surgery

There are many types of different surgical procedures that may be used to treat incontinence. The type of surgery recommended will depend on the type and cause of your incontinence.

Slings: Urethral slings are used to treat stress incontinence (SI). SI is usually caused by sagging of the urethra and/or bladder neck, or by problems with the sphincter (muscular outlet of the bladder). This involves placing a sling around the urethra to lift it into place and to exert pressure on the urethra to aid in holding the urine.

The advantages of sling surgery are:

• Usually done in an outpatient setting (go home the same day)
• Quick recovery time
• Very little to no pain
• Extremely effective in eliminating incontinence

What are the risks and possible complications?

1. Infection
2. Bleeding
3. Injury to surrounding area
4. Mesh erosion or rejection of the sling material (the sling material may wear away the tissue of the urethra or vagina)
5. A small percentage of patients will have trouble urinating immediately following the procedure and may need a catheter until normal bladder emptying is established. This catheter is usually removed 3-7 days post-op.

What can I expect during recovery?

Most women return home within 24 hours of the procedure. You will be sent home once you are feeling well and are able to urinate. If you need pain relief, mild analgesics are usually enough. It is important to rest after the operation and allow yourself to heal.

General recommendations are:

• Restrict activity for first 2 weeks following procedure
• Weeks 2-6, light activity only
• Avoid heavy lifting for 6 weeks. This includes shopping bags, laundry baskets, and children.
• No sexual activity for 6 weeks
• No sports or strenuous exercise for 6 weeks