Urinary Incontinence
Urinary Incontinence in Men
Urinary Incontinence in Women
Treatments for Urinary Incontinence in Women
Urinary Incontinence in Men
Urinary incontinence (UI) is the accidental leakage of urine. Over a lifespan,
there are gender differences in the frequency of UI. In childhood, girls usually
develop bladder control at an earlier age than boys, and bedwetting (nocturnal
enuresis) is less common in girls than in boys. However, adult women are far
more likely to experience UI because of the anatomy of their urinary tract
and the stresses caused by pregnancy and childbirth. Nevertheless, men may
experience UI as a result of prostate problems, and both men and women can
experience nerve damage that leads to UI. Its prevalence increases with age,
but it is not an inevitable part of aging.
UI is a medical problem. To find a treatment that addresses the root of the
problem, you need to talk to your health care provider. The four forms of UI
are
- temporary or reversible incontinence related to urinary tract infection,
constipation, or delirium
- stress incontinence caused by weak pelvic and sphincter muscles
- urge incontinence caused by damaged or irritable nerves
- overflow incontinence that results when an individual is unable to empty
the bladder
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| Male urinary tract, front and side views |
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Nerves carry signals from the brain
to the bladder and sphincter. Any disease, condition, or injury that
damages nerves can lead to urination problems. |
For the urinary system to do its job, muscles and nerves must work together
to hold urine in the bladder and then release it at the right time. Babies
are not born with the ability to control urination. As children grow, they
learn to interpret nerve signals and develop the muscle control required to
stay dry. In children between the ages of 5 and 10, some incontinence may result
from limited bladder capacity or delayed development of the nerve pathways
that signal a full or emptying bladder. This form of incontinence fades away
as the bladder grows and nerves become mature. Other types of nerve problems,
however, can cause urination problems that are more difficult to overcome.
Nerve Problems
Any disease, condition, or injury that damages nerves can lead to urination
problems. Nerve problems can occur at any age.
- Men who have had diabetes for many years may develop nerve damage that
affects their bladder control as well as their sexual function.
- Stroke, Parkinson's disease, and multiple sclerosis all affect the brain
and nervous system, so they can also cause incontinence.
- Overactive bladder is a condition in which the bladder squeezes at the
wrong time. The condition may be caused by nerve problems, or it may occur
without any clear cause. A person with overactive bladder may have any two
or all three of the following symptoms:
- urinary frequency--urination eight or more times a day or two
or more times at night
- urinary urgency--the sudden, strong need to urinate immediately
- urge incontinence--urine leakage that follows a sudden, strong
urge
- Spinal cord injury can cause incontinence by interrupting the nerve signals
required for bladder control.
- In neural birth defects such as spina bifida or myelomeningocele, the backbone
and spinal canal do not close before birth. In severe cases, nerve damage
can result in many problems, including lack of control over urination.
The prostate is a male gland about the size and shape of a walnut. It surrounds
the urethra just below the bladder, where it adds fluid to semen before ejaculation.
- BPH: The prostate gland commonly becomes enlarged as a man ages.
This condition is called benign prostatic hyperplasia (BPH) or benign prostatic
hypertrophy. As the prostate enlarges, it may squeeze the urethra. The bladder
wall thickens and becomes irritable, and the bladder begins to contract even
when it contains only small amounts of urine. This results in more frequent
urination. BPH rarely causes symptoms before age 40, but more than half of
men in their sixties and up to 90 percent in their seventies and eighties
have some symptoms of BPH. The symptoms vary, but the most common ones involve
changes or problems with urination, such as a hesitant, interrupted, weak
stream; urgency and leaking or dribbling; more frequent urination, especially
at night; and urge incontinence. Problems with urination do not necessarily
signal blockage caused by an enlarged prostate. Other changes associated
with aging can cause urination problems experienced by both men and women.
- Radical prostatectomy: The surgical removal of the entire prostate
gland--called radical prostatectomy--may be recommended to treat prostate
cancer. The surgeon may approach the prostate through the abdomen or through
the perineal area (between the scrotum and the anus). The surgery may lead
to erection problems and UI, although nerve-sparing procedures in the abdominal
approach may make these side effects less likely.
- External beam radiation: This therapy uses an x-ray machine to deliver
radiation to the prostate gland. The treatment is not painful but can cause
loss of bladder control as well as fatigue, skin redness and irritation,
rectal burning or injury, diarrhea, inflammation of the bladder wall (cystitis),
blood in the urine, loss of sexual function, and loss of appetite.
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Radical prostatectomy |
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If your prostate could be involved in your incontinence, you may be
asked a series of standardized questions, either the International
Prostate Symptom Score or the American Urological Association (AUA)
Symptom Scale. Some of the questions you will be asked for the AUA
Symptom Scale will be the following:
- Over the past month or so, how often have you had to urinate again
in less than 2 hours?
- Over the past month or so, from the time you went to bed at night
until the time you got up in the morning, how many times did you
typically get up to urinate?
- Over the past month or so, how often have you had a sensation of
not emptying your bladder completely after you finished urinating?
- Over the past month or so, how often have you had a weak urinary
stream?
- Over the past month or so, how often have you had to push or strain
to begin urinating?
Your answers to these questions may help identify the problem or determine
which tests are needed. Your symptom score evaluation can be used as
a baseline to see how effective later treatments are at relieving those
symptoms.
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The first step in solving a urinary problem is talking to your health care
provider. Your general medical history, including any major illnesses or surgeries,
and details about your continence problem and when it started will help your
doctor determine the cause. You should talk about how much fluid you drink
a day and whether you use alcohol or caffeine. You should also talk about the
medicines you take, both prescription and nonprescription, because they might
be part of the problem.
You may be asked to keep a voiding diary, which is a record of fluid intake
and trips to the bathroom, plus any episodes of leakage. Studying the diary
will give your health care provider a better idea of your problem and help
direct additional tests.
A physical exam will check for prostate enlargement or nerve damage. In a
digital rectal exam, the doctor inserts a gloved finger into the rectum and
feels the part of the prostate next to it. This exam gives the doctor a general
idea of the size and condition of the gland. To check for nerve damage, the
doctor may ask about tingling sensations or feelings of numbness and may check
for changes in sensation, muscle tone, and reflexes.
An electroencephalogram (EEG), a test where wires are taped to the forehead,
can sense dysfunction in the brain. An electromyogram (EMG) measures nerve
activity in muscles and muscular activity that may be related to loss of bladder
control.
For an ultrasound, or sonography, a technician holds a device, called a transducer,
that sends harmless sound waves into the body and catches them as they bounce
back off the organs inside to create a picture on a monitor. In abdominal ultrasound,
the technician slides the transducer over the surface of your abdomen for images
of the bladder and kidneys. In transrectal ultrasound, the technician uses
a wand inserted in the rectum for images of the prostate. Depending on your
symptoms, your doctor may recommend one of these tests.
Urodynamic testing focuses on the bladder's ability to store urine and empty
steadily and completely, and on your sphincter control mechanism. It can also
show whether the bladder is having abnormal contractions that cause leakage.
The testing involves measuring pressure in the bladder as it is filled with
fluid through a small catheter. This test can help identify limited bladder
capacity, bladder overactivity or underactivity, weak sphincter muscles, or
urinary obstruction. If the test is performed with EMG surface pads, it can
also detect abnormal nerve signals and uncontrolled bladder contractions.
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No single treatment works for everyone. Your treatment will depend on the
type and severity of your problem, your lifestyle, and your preferences, starting
with the simpler treatment options. Many men regain urinary control by changing
a few habits and doing exercises to strengthen the muscles that hold urine
in the bladder. If these behavioral treatments do not work, you may choose
to try medicines or a continence device--either an artificial sphincter or
a catheter. Finally, for some men, surgery is the best choice.
For some men, avoiding incontinence is as simple as limiting fluids at certain
times of the day or planning regular trips to the bathroom--a therapy called
timed voiding or bladder training. As you gain control, you can extend the
time between trips. Bladder training also includes Kegel exercises to strengthen
the pelvic muscles, which help hold urine in the bladder. Extensive studies
have not yet shown that Kegel exercises are effective in reducing incontinence
in men, but many clinicians find them to be an important element in therapy
for men.
Some people with nerve damage cannot tell whether they are doing Kegel exercises
correctly or not. If you are not sure, you may still be able to learn proper
Kegel exercises by doing special training with biofeedback, electrical stimulation,
or both. Biofeedback uses sensors to detect muscle activity and create a visual
or audio signal when the appropriate muscles are being used. A small probe,
about the size of a pen, is inserted in the anus to record muscle contractions
during the exercises. If you squeeze the right muscle, you will see a change
on a television screen or hear a tone from a speaker.
Mild electrical pulses delivered to the pelvic muscles cause them to contract
and grow stronger. This technique can also help you locate the right muscles
to use during Kegel exercises.
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The first step is to find the right muscles. Imagine that you are
trying to stop yourself from passing gas. Squeeze the muscles you would
use. If you sense a "pulling" feeling, those are the right muscles
for pelvic exercises.
It is important not to squeeze other muscles at the same time and
not to hold your breath. Also, be careful not to tighten your stomach,
leg, or buttock muscles. Squeezing the wrong muscles can put more pressure
on your bladder control muscles. Squeeze just the pelvic muscles.
Repeat, but do not overdo it. Pull in the pelvic muscles and hold
for a count of 3. Then relax for a count of 3. Work up to 3 sets of
10 repeats. Start doing your pelvic muscle exercises lying down. This
is the easiest because the muscles then do not need to work against
gravity. When your muscles get stronger, do your exercises sitting
or standing. Working against gravity is like adding more weight.
Be patient. Do not give up. It takes just 5 minutes, three times a
day. Your bladder control may not improve for 3 to 6 weeks, although
most people notice an improvement after a few weeks.
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Medicines can affect bladder control in different ways. Some medicines help
prevent incontinence by blocking abnormal nerve signals that make the bladder
contract at the wrong time, while others slow the production of urine. Still
others relax the bladder or shrink the prostate. Before prescribing a medicine
to treat incontinence, your doctor may consider changing a prescription you
already take. For example, diuretics are often prescribed to treat high blood
pressure because they reduce fluid in the body by increasing urine production.
Some men may find that switching from a diuretic to another kind of blood pressure
medicine takes care of their incontinence.
If changing medicines is not an option, your doctor may choose from the following
types of drugs for incontinence:
- Alpha-blockers: Terazosin (Hytrin), doxazosin (Cardura), tamsulosin
(Flomax), and alfzosin (Uroxatral) are used to treat problems caused by prostate
enlargement and bladder outlet obstruction. They act by relaxing the smooth
muscle of the prostate and bladder neck, allowing normal urine flow and preventing
abnormal bladder contractions that can lead to urge incontinence.
- 5-alpha reductase inhibitors: Finasteride (Proscar) and dutasteride
(Avodart) work by inhibiting the production of the male hormone DHT, which
is thought to be responsible for prostate enlargement. These 5-alpha reductase
inhibitors relieve voiding problems by shrinking an enlarged prostate. The
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
sponsored the Medical Therapy of Prostate Symptoms (MTOPS) trial, a multicenter
study that found that doxazosin and finasteride taken together reduced the
risk of BPH progression by 67 percent compared with placebo. The risk of
progression was reduced by 39 percent with doxazosin alone and by 34 percent
with finasteride alone.
- Imipramine: Marketed as Tofranil, this drug belongs to a class of
drugs called tricyclic antidepressants. It relaxes muscles and blocks nerve
signals that might cause bladder spasms. Imipramine is also used to treat
bedwetting in children.
- Antispasmodics: Propantheline (Pro-Banthine), tolterodine (Detrol
LA), and oxybutynin (Ditropan XL) belong to a class of drugs that work by
relaxing the bladder muscle and relieving spasms. Their most common side
effect is dry mouth, although larger doses may cause blurred vision, constipation,
a faster heartbeat, headache, and flushing.
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Clean intermittent catheterization |
If all other methods fail or are found unacceptable, you may consider controlling
incontinence by using a catheter, a thin tube inserted through the urethra
to drain the bladder. Catheters must be managed with great care to avoid infection
and stone formation.
- Clean intermittent catheterization: If you have problems emptying
your bladder because of an enlarged prostate or because of nerve damage,
you may use a catheter at regular times, or as needed, to drain urine and
prevent overflow incontinence. Depending on your situation, the catheterization
may be done for you, or you may learn to do it yourself. You will need to
learn sterile technique to avoid urinary tract infections.
- Condom catheter: Some men may prefer a drainage system that fits
over the penis like a condom. You must take the same care to avoid infection
as you do with other catheters. Condom catheters can also carry a risk of
skin breakdown.
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Urethral injections. Adding bulk to
the tissue around the bladder opening helps keep the urethra closed. |
Another method to help keep the urethra closed is to inject a fat-like substance
into the area that surrounds the opening of the bladder into the urethra. A
variety of bulking agents are available for injection. Your doctor will discuss
which one may be best for you. Collagen, for example, is a natural tissue from
cows. After using local anesthesia or sedation, a doctor can inject the material
in about half an hour. Over time, the body slowly eliminates the collagen,
so you may need repeat injections. Before you receive collagen, a doctor will
perform a skin test to determine whether you could have an allergic reaction
to the material.
Some men may eliminate urine leakage with an artificial sphincter, an implanted
device that keeps the urethra closed until you are ready to urinate. This device
can help people who have incontinence because of weak sphincter muscles or
because of nerve damage that interferes with sphincter muscle function. It
does not solve incontinence caused by uncontrolled bladder contractions.
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Artificial sphincter |
Surgery to place the artificial sphincter requires general or spinal anesthesia.
The device has three parts: a cuff that fits around the urethra, a small balloon
reservoir placed in the abdomen, and a pump placed in the scrotum. The cuff
is filled with liquid that makes it fit tightly around the urethra to prevent
urine from leaking. When it is time to urinate, you squeeze the pump with your
fingers to deflate the cuff so that the liquid moves to the balloon reservoir
and urine can flow through the urethra. When your bladder is empty, the cuff
automatically refills in the next 2 to 5 minutes to keep the urethra tightly
closed.
Surgery can improve some types of urinary incontinence in men. In a sling
procedure, the surgeon creates a support for the urethra by wrapping a strip
of material around the urethra and attaching the ends of the strip to the pelvic
bone. The sling keeps constant pressure on the urethra so that it does not
open until the patient consciously releases the urine.
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Urinary diversion |
If the bladder must be removed or all bladder function is lost because of
nerve damage, you may consider surgery to create a urinary diversion. In this
procedure, the surgeon creates a reservoir by removing a piece of the small
intestine and directing the ureters to the reservoir. The surgeon also creates
a stoma, an opening on the lower abdomen where the urine can be drained through
a catheter or into a bag.
UI should not cause embarrassment. It is a medical problem like arthritis
or diabetes. Your health care provider can help you find a solution. You may
also find it helpful to join a support group. In many areas, men dealing with
the aftereffects of prostate cancer treatment have organized support groups.
Other organizations to help people with incontinence exist as well.
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Urinary Incontinence in Women
Urinary incontinence is an inability to hold your urine until you get to a
toilet. More than 13 million people in the United States--male and female,
young and old--experience incontinence. It is often temporary, and it always
results from an underlying medical condition.
(In this fact sheet, the term "incontinence" will be used to mean urinary
incontinence.)
Women experience incontinence twice as often as men. Pregnancy and childbirth,
menopause, and the structure of the female urinary tract account for this difference.
But both women and men can become incontinent from neurologic injury, birth
defects, strokes, multiple sclerosis, and physical problems associated with
aging.
Older women, more often than younger women, experience incontinence. But incontinence
is not inevitable with age. Incontinence is treatable and often curable at
all ages. If you experience incontinence, you may feel embarrassed. It may
help you to remember that loss of bladder control can be treated. You will
need to overcome your embarrassment and see a doctor to learn if you need treatment
for an underlying medical condition.
Incontinence in women usually occurs because of problems with muscles that
help to hold or release urine. The body stores urine--water and wastes removed
by the kidneys--in the bladder, a balloon-like organ. The bladder connects
to the urethra, the tube through which urine leaves the body.
During urination, muscles in the wall of the bladder contract, forcing urine
out of the bladder and into the urethra. At the same time, sphincter muscles
surrounding the urethra relax, letting urine pass out of the body (see figure
1). Incontinence will occur if your bladder muscles suddenly contract or muscles
surrounding the urethra suddenly relax.
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Figure 1.--Front view of bladder and sphincter muscles
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If coughing, laughing, sneezing, or other movements that put pressure on the
bladder cause you to leak urine, you may have stress incontinence. Physical
changes resulting from pregnancy, childbirth, and menopause often cause stress
incontinence. It is the most common form of incontinence in women and is treatable.
Pelvic floor muscles support your bladder (see figure 2). If these muscles
weaken, your bladder can move downward, pushing slightly out of the bottom
of the pelvis toward the vagina. This prevents muscles that ordinarily force
the urethra shut from squeezing as tightly as they should. As a result, urine
can leak into the urethra during moments of physical stress. Stress incontinence
also occurs if the muscles that do the squeezing weaken.
Stress incontinence can worsen during the week before your menstrual period.
At that time, lowered estrogen levels might lead to lower muscular pressure
around the urethra, increasing chances of leakage. The incidence of stress
incontinence increases following menopause.
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Figure 2.--Side view of female pelvic muscles
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If you lose urine for no apparent reason while suddenly feeling the need or
urge to urinate, you may have urge incontinence. The most common cause of urge
incontinence is inappropriate bladder contractions.
Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Your
doctor might call your condition "reflex incontinence" if it results from overactive
nerves controlling the bladder.
Urge incontinence can mean that your bladder empties during sleep, after drinking
a small amount of water, or when you touch water or hear it running (as when
washing dishes or hearing someone else taking a shower).
Involuntary actions of bladder muscles can occur because of damage to the
nerves of the bladder, to the nervous system (spinal cord and brain), or to
the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's
disease, stroke, and injury--including injury that occurs during surgery--all
can harm bladder nerves or muscles.
People with functional incontinence may have problems thinking, moving, or
communicating that prevent them from reaching a toilet. A person with Alzheimer's
disease, for example, may not think well enough to plan a timely trip to a
restroom. A person in a wheelchair may be blocked from getting to a toilet
in time. Conditions such as these are often associated with age and account
for some of the incontinence of elderly women in nursing homes.
If your bladder is always full so that it frequently leaks urine, you have
overflow incontinence. Weak bladder muscles or a blocked urethra can cause
this type of incontinence. Nerve damage from diabetes or other diseases can
lead to weak bladder muscles; tumors and urinary stones can block the urethra.
Overflow incontinence is rare in women.
Stress and urge incontinence often occur together in women. Combinations of
incontinence--and this combination in
particular--are sometimes referred to as "mixed incontinence."
"Transient incontinence" is a temporary version of incontinence. It can be
triggered by medications, urinary tract infections, mental impairment, restricted
mobility, and stool impaction (severe constipation), which can push against
the urinary tract and obstruct outflow.
| Stress |
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Leakage of small amounts of urine during physical movement
(coughing, sneezing, exercising). |
| Urge |
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Leakage of large amounts of urine at unexpected times, including
during sleep. |
| Functional |
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Untimely urination because of physical disability, external
obstacles, or problems in thinking or communicating that prevent
a person from reaching a toilet. |
| Overflow |
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Unexpected leakage of small amounts of urine because of a full
bladder. |
| Mixed |
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Usually the occurrence of stress and urge incontinence together. |
| Transient |
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Leakage that occurs temporarily because of a condition that
will pass (infection, medication). |
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The first step toward relief is to see a doctor who is well acquainted with
incontinence to learn the type you have. A urologist specializes in the urinary
tract, and some urologists further specialize in the female urinary tract.
Gynecologists and obstetricians specialize in the female reproductive tract
and childbirth. A urogynecologist focuses on urological problems in women.
Family practitioners and internists see patients for all kinds of complaints.
Any of these doctors may be able to help you.
To diagnose the problem, your doctor will first ask about symptoms and medical
history. Your pattern of voiding and urine leakage may suggest the type of
incontinence. Other obvious factors that can help define the problem include
straining and discomfort, use of drugs, recent surgery, and illness. If your
medical history does not define the problem, it will at least suggest which
tests are needed.
Your doctor will physically examine you for signs of medical conditions causing
incontinence, such as tumors that block the urinary tract, stool impaction,
and poor reflexes or sensations, which may be evidence of a nerve-related cause.
Your doctor will measure your bladder capacity and residual urine for evidence
of poorly functioning bladder muscles. To do this, you will drink plenty of
fluids and urinate into a measuring pan, after which the doctor will measure
any urine remaining in the bladder. Your doctor may also recommend
- Stress test--You relax, then cough vigorously as the doctor watches for
loss of urine.
- Urinalysis--Urine is tested for evidence of infection, urinary stones,
or other contributing causes.
- Blood tests--Blood is taken, sent to a laboratory, and examined for substances
related to causes of incontinence.
- Ultrasound--Sound waves are used to "see" the kidneys, ureters, bladder,
and urethra.
- Cystoscopy--A thin tube with a tiny camera is inserted in the urethra and
used to see the inside of the urethra and bladder.
- Urodynamics--Various techniques measure pressure in the bladder and the
flow of urine.
Your doctor may ask you to keep a diary for a day or more, up to a week, to
record when you void. This diary should note the times you urinate and the
amounts of urine you produce. To measure your urine, you can use a special
pan that fits over the toilet rim.
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Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter
muscles can reduce or cure stress leakage. Women of all ages can learn and
practice these exercises, which are taught by a health care professional.
Most Kegel exercises do not require equipment. However, one technique involves
the use of weighted cones. For this exercise, you stand and hold a cone-shaped
object within your vagina. You then substitute cones of increasing weight to
strengthen the muscles that help keep the urethra closed.
Brief doses of electrical stimulation can strengthen muscles in the lower
pelvis in a way similar to exercising the muscles. Electrodes are temporarily
placed in the vagina or rectum to stimulate nearby muscles. This will stabilize
overactive muscles and stimulate contraction of urethral muscles. Electrical
stimulation can be used to reduce both stress incontinence and urge incontinence.
Biofeedback uses measuring devices to help you become aware of your body's
functioning. By using electronic devices or diaries to track when your bladder
and urethral muscles contract, you can gain control over these muscles. Biofeedback
can be used with pelvic muscle exercises and electrical stimulation to relieve
stress and urge incontinence.
Timed voiding (urinating) and bladder training are techniques that use biofeedback.
In timed voiding, you fill in a chart of voiding and leaking. From the patterns
that appear in your chart, you can plan to empty your bladder before you would
otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can
alter the bladder's schedule for storing and emptying urine. These techniques
are effective for urge and overflow incontinence.
Medications can reduce many types of leakage. Some drugs inhibit contractions
of an overactive bladder. Others relax muscles, leading to more complete bladder
emptying during urination. Some drugs tighten muscles at the bladder neck and
urethra, preventing leakage. And some, especially hormones such as estrogen,
are believed to cause muscles involved in urination to function normally.
Some of these medications can produce harmful side effects if used for long
periods. In particular, estrogen therapy has been associated with an increased
risk for cancers of the breast and endometrium (lining of the uterus). Talk
to your doctor about the risks and benefits of long-term use of medications.
A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina,
where it presses against the wall of the vagina and the nearby urethra. The
pressure helps reposition the urethra, leading to less stress leakage. If you
use a pessary, you should watch for possible vaginal and urinary tract infections
and see your doctor regularly.
Implants are substances injected into tissues around the urethra. The implant
adds bulk and helps to close the urethra to reduce stress incontinence. Collagen
(a fibrous natural tissue from cows) and fat from the patient's body have been
used. Implants can be injected by a doctor in about half an hour using local
anesthesia.
Implants have a partial success rate. Injections must be repeated after a
time because the body slowly eliminates the substances. Before you receive
collagen, a doctor must perform a skin test to determine whether you would
have an allergic reaction to the material.
Doctors usually suggest surgery to alleviate incontinence only after other
treatments have been tried. Many surgical options have high rates of success.
Most stress incontinence results from the bladder dropping down toward the
vagina. Therefore, common surgery for stress incontinence involves pulling
the bladder up to a more normal position. Working through an incision in the
vagina or abdomen, the surgeon raises the bladder and secures it with a string
attached to muscle, ligament, or bone.
For severe cases of stress incontinence, the surgeon may secure the bladder
with a wide sling. This not only holds up the bladder but also compresses the
bottom of the bladder and the top of the urethra, further preventing leakage.
In rare cases, a surgeon implants an artificial sphincter, a doughnut-shaped
sac that circles the urethra. A fluid fills and expands the sac, which squeezes
the urethra closed. By pressing a valve implanted under the skin, you can cause
the artificial sphincter to deflate. This removes pressure from the urethra,
allowing urine from the bladder to pass.
If you are incontinent because your bladder never empties completely (overflow
incontinence) or your bladder cannot empty because of poor muscle tone, past
surgery, or spinal cord injury, you might use a catheter to empty your bladder.
A catheter is a tube that you can learn to insert through the urethra into
the bladder to drain urine. Catheters may be used once in a while or on a constant
basis, in which case the tube connects to a bag that you can attach to your
leg. If you use a long-term (or indwelling) catheter, you should watch for
possible urinary tract infections.
Many women manage urinary incontinence with pads that catch slight leakage
during activities such as exercising. Also, you often can reduce incontinence
by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many women who could be treated resort instead to wearing absorbent
undergarments, or diapers--especially elderly women in nursing homes. This
is unfortunate, because diapering can lead to diminished self-esteem, as well
as skin irritation and sores. If you are an elderly woman, you and your family
should discuss with your doctor the possible effectiveness of treatments such
as timed voiding, pelvic muscle exercises, and electrical stimulation before
resorting to absorbent pads or undergarments.
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- Urinary incontinence is common in women.
- All types of urinary incontinence can be treated.
- Incontinence can be treated at all ages.
- You need not be embarrassed by incontinence.
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Treatments for Urinary Incontinence in Women
Front view of female urinary tract. |
Millions of women experience loss of bladder control, also called
urinary incontinence (UI). Some women may lose a few drops of urine
while running or coughing. Others may feel a strong, sudden urge to
urinate just before losing a large amount of urine. UI can be
slightly bothersome or totally debilitating. For some women, the
risk of public embarrassment keeps them from enjoying many
activities with their family and friends.
UI is a medical problem. Your doctor or nurse can help you find a
solution. No single treatment works for everyone, but most women can
be treated without surgery. The treatment you select depends on your
lifestyle and your preferences. Many women try the simpler treatment
options first, such as changing a few habits and doing exercises to
strengthen the muscles that hold urine in the bladder. If these
behavioral treatments do not work, you may choose to try medicines
or vaginal devices. Sometimes mild electrical stimulation to the
pelvic nerves may help. And for some women, surgery is the best
solution.
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Your doctor or nurse may ask you to keep a bladder diary--a
record of your fluid intake, trips to the bathroom, episodes of
urine leakage, and an estimate of the amount of leakage. By looking
at this record, the doctor may see a pattern and suggest making it a
point to use the bathroom at regular timed intervals, a habit called
timed voiding. As you gain control, you can extend the time between
scheduled trips to the bathroom. Behavioral treatment also includes
Kegel exercises to strengthen the muscles that help hold in
urine.
The first step is to find the right muscles. Imagine that you are
sitting on a marble and want to pick up the marble with your vagina.
Imagine "sucking" the marble into your vagina.
Try not to squeeze other muscles at the same time. Be careful not
to tighten your stomach, legs, or buttocks. Squeezing the wrong
muscles can put more pressure on your bladder control muscles. Just
squeeze the pelvic muscles. Don't hold your breath. Do not practice
while urinating.
Repeat, but don't overdo it. At first, find a quiet spot to
practice--your bathroom or bedroom--so you can concentrate. Pull in
the pelvic muscles and hold for a count of 3. Then relax for a count
of 3. Work up to 3 sets of 10 repeats. Start doing your pelvic
muscle exercises lying down. This is the easiest position to do them
because the muscles do not need to work against gravity. When your
muscles get stronger, do your exercises sitting or standing. Working
against gravity is like adding more weight.
Be patient. Don't give up. It takes just 5 minutes a day. You may
not feel your bladder control improve for 3 to 6 weeks. Still, most
people do notice an improvement after a few weeks.
Some people with nerve damage cannot tell whether they are doing
Kegel exercises correctly or not. If you are not sure, ask your
doctor or nurse to examine you while you try to do them. If it turns
out that you are not squeezing the right muscles, you may still be
able to learn proper Kegel exercises by doing special training with
biofeedback, electrical stimulation, or both.
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Overactive bladder occurs when abnormal nerves send signals to
the bladder at the wrong time, causing its muscles to squeeze
without warning. Normal women may void up to 12 times a day, but
women with overactive bladder may find that they must urinate more
frequently. Specifically, the symptoms of overactive bladder
include
- urinary frequency--urination 13 or more times a day or
2 or more times at night
- urinary urgency--the sudden, strong need to urinate
immediately
- urge incontinence--leakage or gushing of urine that
follows a sudden, strong urge
If you have an overactive bladder, your doctor may prescribe a
medicine to block the nerve signals that cause frequent urination
and urgency.
Drugs that relax muscles and prevent bladder spasms include
oxybutynin chloride (Ditropan) and tolterodine tartrate (Detrol),
which belong to the class of drugs called bladder relaxants. Their
most common side effect is dry mouth, although larger doses may
cause blurred vision, constipation, a faster heartbeat, and
flushing. Ditropan XL and Detrol LA are long-acting drugs that can
be taken once a day.
Imipramine hydrochloride (Tofranil), a tricyclic antidepressant
that relaxes bladder muscles and tightens urethral muscles, may be
used instead of or in combination with Ditropan XL or Detrol LA.
Side effects may include fatigue, dry mouth, dizziness, blurred
vision, nausea, and insomnia.
If you take medicine to treat an overactive bladder, you should
take several precautions.
- Wear sunglasses if your eyes become more sensitive to
light.
- Take care not to become overheated.
- Chew gum or suck on sugarless hard candy to avoid dry mouth.
Different medicines can affect the nerves and muscles of the
urinary tract in different ways. Pills to treat swelling (edema) or
high blood pressure may increase your urine output and contribute to
bladder control problems. Talk with your doctor; you may find that
taking an alternative to a medicine you already take may solve the
problem without adding another prescription.
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Mild electrical pulses can be used to stimulate the nerves that
control the bladder and sphincter muscles. Depending on which nerves
the doctor plans to treat, these pulses can be given through the
vagina or by using patches on the skin. Other forms of electrical
stimulation or neuromodulation are also available.
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Front view of bladder. Weak pelvic muscles
allow urine leakage.
|
Strong pelvic muscles keep the urethra closed. |
Stress incontinence is urine leakage that occurs when an action
puts pressure on the bladder. Laughing, sneezing, coughing, rising
from a chair, lifting an object, and running can all cause the
stomach muscles to press down on the bladder and force urine out.
Stress incontinence usually results from weak pelvic muscles, the
muscles that hold the bladder in place and keep urine inside.
A pessary is a stiff ring that is inserted by a doctor or nurse
into the vagina, where it presses against the wall of the vagina and
the nearby urethra. The pressure helps reposition the urethra,
leading to less stress leakage. If you use a pessary, you should
watch for possible vaginal and urinary tract infections and see your
doctor regularly.
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Collagen, one of the bulking agents used for injections, is a
natural tissue from cows. It is injected into tissues around the
bladder neck and urethra to add bulk and close the bladder opening
to reduce stress incontinence. After using local anesthesia or
sedation, a doctor can inject the material in about half an hour.
Over time, the body slowly eliminates the collagen, so you may need
repeat injections. Before you receive collagen, a doctor will
perform a skin test to determine whether you could have an allergic
reaction to the material. A variety of bulking agents are available
for injection. Your doctor will discuss which one may be best for
you.
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In some women, the bladder can move out of its normal position,
especially following childbirth. Surgeons have developed different
techniques for supporting the bladder in its normal position. The
two main types of surgery are retropubic suspension and the sling
procedure.
Retropubic suspension uses sutures (surgical threads) to support
the bladder neck. The threads are secured to the pubic bone and
other structures within the pelvis to form a cradle for the bladder.
To place the sutures, the surgeon makes an incision in the abdomen a
few inches below the navel.
Sling procedures are performed through a vaginal incision. The
conventional sling procedure uses a strip of material to support the
bladder neck. The sling may be made of natural tissue or synthetic
(man-made) material. Both ends of the sling are attached to the
pubic bone or tied in front of the abdomen just above the pubic
bone. Another sling method uses a synthetic tape, but the ends are
not tied but rather pulled up above the pubic bone.
Surgeons report that the retropubic suspension and sling
procedures cure stress incontinence for at least 4 years in more
than 80 percent of their cases. Possible side effects include
persistent stress incontinence, bladder overactivity, and voiding
changes.
Talk with your doctor about whether surgery will help your
condition and what type of surgery is best for you. The procedure
you choose may depend on your own preferences or on your surgeon's
experience. Ask what you should expect after the procedure. You may
also wish to talk to someone who has recently had the procedure.
Side view. Supporting sutures in place following
retropubic or transvaginal suspension. |
Sling in place, secured to the pubic bone. |
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