Incontinence and Overactive Bladder
Bladder control problems range from urinating too frequently to actual urine leakage (urinary incontinence). These problems affect millions of people of all ages and both sexes. If your incontinence interferes with your daily life, you should seek help promptly.
There are several types of incontinence and some people experience more than one kind.
- Urge incontinence (overactive bladder) – in this type urine leaks when the bladder inappropriately contracts and you may not be able to get to a bathroom quickly enough
- Stress incontinence – this type is most common among middle aged and older women. Exercising, coughing, sneezing or other activities put pressure on a weakened bladder sphincter and cause leaks.
- Overflow incontinence – in this type, which mostly affects men, you don’t feel the urge to urinate, your bladder does not empty well and small amounts of urine may leak continuously.
- A sudden strong urge to urinate
- inability to get to the bathroom on time
- Frequent need to urinate, including at night
- Feeling the urge to urinate when you hear water running
- Leaking urine when you stand up after sitting
- A diet high in bladder irritants such as coffee, tea, chocolate, or acidic juices
- Urinary tract or vaginal infections
- Bowel problems
- Some medications
- Damage to the nervous system caused by Multiple Sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke or other medical problem
- Urine leaks when lifting heavy objects, exercising, coughing, sneezing , etc.
- Problem worsens when your bladder is full
- Bladder surgery or removal of the prostate (men)
- Your bladder is never completely empty
- Frequent need to urinate, day or night
- Inability to urinate when you feel the urge
- Urine leaks, even after voiding
- Benign prostatic hypertrophy (BPH) – an enlarged prostate can interfere with the passage of urine through the urethra, the tube that carries urine from the bladder
- Damage to the nerves near the bladder causing under-activity. This can occur with neurological injury or with diseases such as diabetes
- Urinary stones
- Bladder cancer
- Side effects of medications
The first step is a thorough history and physical by your doctor, who will examine your abdominal and genital area carefully.
Additional tests may include
- Bladder diary – keep a record of what you drink and how much you urinate
- Blood tests
More specialized tests that may be recommended are
- Post void residual (PVR) – your doctor can determine how well you empty your bladder by using and ultrasound (most common) or by inserting a catheter into the bladder to measure the amount of residual urine. A large amount may indicate blockage or a nerve or muscle problem
- Bladder ultrasound – painlessly checks for abnormalities in the bladder
- Stress test – during your exam, your doctor will ask you to cough or bear down and will watch for leakage while you cough or bear down
- Video urodynamic test – a test done in the office that helps determine the best treatment plan by assessing how your bladder functions and why you are having problems
- Cystoscopy – a tiny instrument called a cystoscope is inserted into the urethra to look for abnormalities
Treatment will depend on your type of incontinence and its cause. Most people can be treated successfully, allowing them to return to a normal life.
Improvement may take time with lifestyle changes
- Fluid and diet management – avoid caffeinated or tomato based food and drink and drink adequate amounts of water
- Bladder retraining – follow a schedule for bathroom trips and gradually increase the length of time between them to improve your bladder control
- Pelvic floor (Kegel) exercises – learn techniques to strengthen your pelvic muscles
- Biofeedback – can help to determine if you are using the right muscles
- Special absorbent pads and underwear – these have improved in recent time and can help you feel more confident, especially while undergoing diagnosis and initial treatment
- Anticholinergic drugs help to relax your bladder muscles
- Electrical stimulation devices – electrodes may be placed temporarily I the rectum, vagina, or behind your ankle to painlessly strengthen the pelvic floor muscles
- Pessaries – a doctor inserts a pessary (rubber ring) into the vagina to reduce leakage
Surgery and implanted devices
- Bulking agents – for stress incontinence, your doctor may inject a thick substance called a bulking agent into the area around the bladder to support it. This is usually done at an outpatient surgery center.
- Neurostimulator device – a device like a pacemaker is implanted into the tailbone area
- Sling surgery – a piece of your own tissue or a synthetic material is used to support the bladder neck and urethra
- Retropubic suspension –
the bladder is attached to structures behind the
pubic bone to provide support. This can be done