Urinary incontinence -- when you accidentally leak urine -- is a problem that affects millions of Americans, most of them women. There are several different types, causes, and treatments.
Pregnancy and childbirth can stretch and weaken a woman’s pelvic floor muscles. Other things that can lead to stress incontinence are being overweight or obese, neurological conditions, trauma to the urethral sphincter muscle, taking certain medications or, in men, having prostate surgery.
This is also called overactive bladder (OAB). With this type, you have an urgent need to go to the bathroom and may not get there in time.
Causes of overactive bladder include:
- Damage to the bladder's nerves
- Damage to other parts of the nervous system
- Damage to muscles
Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Bladder problems, such as infections and bladder stones, and certain medications can also cause it.
If you can't empty your bladder, you may have overflow incontinence. This means you may dribble urine.
- Weak bladder muscles
- Nerve damage
- Conditions that block the flow of urine, such as tumors or an enlarged prostate
- Certain medications
You need to get the condition treated. If your bladder can't empty, that can lead to infections and other problems.
Mental or physical problems such as dementia or arthritis prevent you from getting to the bathroom in time.
Mixed Urinary Incontinence
This means you have any two types of the condition. Many women have both stress and urge incontinence.
Treatment for Different Types of Urinary Incontinence
Lifestyle changes and treatments can help with symptoms. Your doctor can help you come up with a plan that’s right for you.
Behavioral therapies, vaginal inserts, electrical stimulation and surgery are the four treatment options for women with stress incontinence. The objective is to rehabilitate the pelvic floor by building the strength and function of the muscles that support the bladder, urethra and other organs contained within the pelvic region.
For stress incontinence, treatments include:
Pads and Vaginal Inserts.
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. They also help prevent stress incontinence. Best of all, you can do Kegels anytime, anywhere.
- Squeeze the muscles that you use stop the flow of urine.
- Hold the squeeze for 10 seconds, then rest for 10 seconds.
- Do 3 or 4 sets daily.
Note: You can learn how to do Kegels by stopping your urine, but don’t do this routinely. Stopping the flow of urine can lead to an infection.
Biofeedback. A probe is inserted to monitor when your bladder muscles squeeze. When you’re able to recognize it as it's happening, you can start to gain control of it. It's often used in combination with Kegel exercises.
Electrical Stimulation: electrical stimulation is FDA approved for the treatment of SUI. It uses low-grade electrical current to stimulate weak or inactive pelvic muscles to contract. Regular electrical stimulation sessions can supplement or augment your pelvic muscle exercise regime. Units are available for home use and may be covered by Medicare or insurers. They include a coin-sized device called a tibial neurostimulator that can be implanted in the lower leg and reduce UUI symptoms.
Pessary. For women, doctors may prescribe a device called a pessary that is inserted into the vagina. It repositions the urethra to help reduce leakage.
Injections and surgery. Shots to bulk up your urethral area may help. In more extreme cases, you may need surgery. One procedure pulls the urethra back up to a more normal position, relieving the pressure and leakage. Another surgery involves securing the urethra with a "sling," a piece of material that holds up the urethra to prevent leakage.
For urge incontinence, treatment options include:
Timed voiding and bladder training. First, you complete a chart of the times you pee and the times you leak. You observe patterns and then plan to empty your bladder before an accident would happen. 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 (or inject Botox in the bladder) that block 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 amount of urine your bladder can store.
For overflow incontinence, treatments include:
Medication or surgery. Meds called alpha-blockers often can help if the problem is caused by an enlarged prostate. If there's a blockage, you may need surgery.
Catheter. Some people use a catheter to make sure their bladder is emptied. It's a thin plastic tube that you insert in your urethra. A doctor or nurse can teach you how to insert it for yourself.
It's important to identify any underlying disease or blockage causing overflow incontinence and treat that.
Talk to Your Doctor
You might feel embarrassed to talk about your urinary incontinence, but it’s worth it. Your doctor can help you figure out what’s causing your problem. That’s the first step to getting help.
Be straightforward. Just tell your doctor you're having problems. Keep it simple: "I'm having bladder problems."
Your doctor should ask questions, like how long the leakage has been happening, how bad it is, and how much it upsets your life. They may suggest tests or refer you to an expert in this kind of problem.