Causes and Treatment of Urinary Incontinence

Diagnosing and Treating the Loss of Bladder Control

Desperate woman wetting herself
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Urinary incontinence, or the sudden loss of bladder control, is not something women or men talk about much outside the confines of a close relationship. It is not only embarrassing, it can cause distress for those unable to pinpoint a cause.

Causes of Urinary Incontinence

There can be any number of reasons why a person should experience a sudden loss of bladder control. Some are short-term issues that eventually resolve on themselves; others are more serious and require medical intervention.

Among the most common causes:

  • Infections of the urinary tract and vaginal infections can lead to incontinence as they can affect the very system which regulates our urge or ability to pee.
  • Sphincter problems may be to blame as the muscles that control the opening and closing of the urethra can suddenly weaken. This is common during and after pregnancy. Overactive bladder muscles can also be an issue.
  • Neurologic disorders, including a spinal cord injury, cervical spondylosis, or degenerative, multiple sclerosis, are also associated with incontinence.
  • Diabetic neuropathy can damage the nerves of the urinary tract, resulting in the loss of bladder control.
  • Mobility impairment may make it difficult to get to the bathroom quickly.
  • Psychological issues, such as depression, may interfere with a person's normal urination patterns.

Types of Urinary Incontinence

To identify the cause, doctors will try to identify the circumstances and factors that give rise to an incontinence.

The conditions are broadly defined as follows:

  • Urge incontinence is the sudden and intense urge to pee that you cannot stop. It can happen at night, causing you to wet the bed, or in social situations where you have no option to excuse yourself urgently.
  • Overactive bladder, also referred to as OAB, is the sudden urge to urinate that you cannot suppress. It is often viewed as a subcategory of urge incontinence.
  • Stress incontinence is that which happens when you cough, laugh, sneeze, or have a sudden emotional jolt. 
  • Overflow incontinence is when you feel your bladder is full but can only release small amounts of urine.
  • Mixed incontinence combines several or all of the above-listed conditions.

Diagnosis of Urinary Incontinence

A comprehensive investigation for urinary incontinence will include a physical exam, a full review of your health history, a battery of lab tests, and urodynamic tests to assess how well your bladder and urinary tract are functioning. You may also be asked to keep in voiding diary to document your urination patterns on an hour-by-hour basis over anywhere from 48 to 72 hours.

Treating Urinary Incontinence

Behavioral changes, including diet and exercise, can help some people regain bladder control if performed consistently. In some cases, drugs may be prescribed to supplement these strategies.

One such technique is bladder training which involves a structured urination schedule that you will be asked to follow. Every two to three hours during the day, you would go to the bathroom to pee only then. You document each visit, detailing an urgency or problem you may have experienced.

The goal is to increase the capacity of your bladder and to go only when you need to (as opposed to running to the bathroom every time you think you might). This helps you learn how to sense a full bladder and eliminate extra trips to the toilet when your bladder just isn't full.

There are other techniques, both therapeutic and supportive, that doctors use:

  • Pelvic muscle training teaches you how to squeeze and release your kegel muscles to better control the urinary flow. This is particularly helpful for women who have lost some of their bladder control after pregnancy.
  • Modifying fluid Intake restricts the amount of fluids you drink as well as any beverages which have a diuretic effect. These include caffeinated drinks (coffee, tea, cola) that not only promote urination but can also irritate the bladder. The technique also prepares you for social events by restricting fluid intake two to three hours before leaving.
  • A pessary (a small soluble block that is inserted into the vagina) may be used for post-menopausal women with bladder control issues. This is more a supplemental device rather than a form of treatment.
  • Male incontinence devices can be used in men who have failed other types of therapy. Options include an artificial sphincter (an inflatable cuff that presses the urethra) and a male sling (a wearable device that supports the urethra).
  • Bulking agents are substances, like collagen, that is injected around the urethra to bolster sagging muscles and tissue. Women may require only a local anesthetic for this procedure, while mean may require general or regional anesthesia. 
  • Retropubic suspense is a surgical technique used in women to lift the sagging bladder neck and urethra.
  • A suburethral sling is a minimally invasive surgical procedure that aims to increase compression of the urethra in women. This is most typically used to treat stress incontinence.

Source:

Shamliyan, T.; Wyman, J.; Bliss, D.; et al.  "Prevention of urinary and fecal incontinence in adults." Evidence Report/Technology Assessment. December 2007; 161:1–379.

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