Urinary Incontinence: Learning About the Different Types
By: Dr. Gary Bellman on November 4, 2016
Urinary incontinence, the most common pelvic floor disorder, is the involuntary loss of urine. Its severity varies from person to person. Some may ‘leak’ a few drops of urine when they cough. Some may feel strong, sudden urges to urinate that can’t be controlled. While others may lose some urine during sexual activity. All of these types of urinary incontinence can be very stressful. Fortunately, they can be treated.
Stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH).
Stress incontinence: If you leak urine with laughing, sneezing, coughing or exercise, you may have stress incontinence. Stress incontinence is caused by weakness in the muscles and ligaments that support the bladder and urethra. This results in urine leakage with any "stress" or movement that puts pressure on the bladder. Obesity also puts increased pressure on the bladder, which may cause stress incontinence.
Overactive bladder and urge incontinence: If you go to the bathroom frequently, wake up at night to urinate, feel strong urges to urinate or cannot get to the toilet in time, you may have overactive bladder and urge incontinence. These conditions occur when nerves along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously controlled. Urge incontinence is a common symptom of overactive bladder.
Mixed incontinence: If you have symptoms of both stress and urge incontinence, then you may have mixed incontinence. For example, you may experience urine leakage during exercise and also when you feel a strong urge. Mixed incontinence is very common. Symptoms of one type of incontinence may be more severe than the other. Treatment may include a combination of therapies for either urgency or stress incontinence and will depend on which symptoms are more bothersome to you.
Behavioral treatment: Some people with urinary incontinence may get relief by making simple changes to their lives. If you have stress incontinence, for instance, in which you leak urine when you cough, sneeze, or laugh, your doctor may tell you to limit how much you drink. If you have urge incontinence, in which you get the sudden urge to urinate and can't always make it to the bathroom in time, your doctor may tell you to avoid spicy foods, caffeine, and carbonated drinks, because they can irritate the bladder and make the problem worse.
Exercises to strengthen the pelvic floor muscles, known as Kegels, can help people with stress incontinence. Kegels can also help people with urge incontinence. Sometimes, Kegels are combined with biofeedback techniques to help you know if you are doing the exercises properly. For urge incontinence, bladder training, sometimes called bladder retraining, can also help. This involves gradually increasing the interval time between trips to the bathroom, working up to longer and longer intervals between bathroom stops.
Absorbent products: Protective pads and panty liners can help avoid embarrassing situations.
Medications: For urge incontinence, medications known as anticholinergics (Detrol, DitropanXL, Enablex, Oxytrol, and Vesicare) can prevent bladder spasms. Oxytrol, Detrol, Ditropan XL, and Vesicare are approved for women with overactive bladder (OAB) as well. OAB is a condition in which the bladder squeezes too often or without warning, resulting in incontinence. Also, Botox injected into the bladder muscle causes the bladder to relax, increasing its storage capacity and reducing episodes of urinary incontinence. It can be used for adults who do not respond to or can't use the medications listed above.
Surgery: If the above treatments for urinary incontinence don't provide enough relief, surgery may help.
**If you notice more urine leaking than previously, are avoiding social events, withdrawing from life, or feeling depressed, it's time to see a doctor.
To set an appointment with Board Certified Urologist, Dr. Gary C. Bellman, please call our office at 818.912.1899. We look forward to speaking with you today!
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