Incontinence | MichaelFreyMD

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Types of Urinary Incontinence

Urge incontinence (also called overactive bladder or detrusor overactivity): is caused when the bladder muscle, the detrusor, begins to contract on its own, signaling your brain that you need to urinate...NOW! This is frequently followed by loss of urine before you can reach a bathroom. Even if you never have an accident, urgency and urinary frequency can interfere with work and social life because of the need to keep running to the bathroom.
Stress incontinence. Stress incontinence happens when physical movement or activity such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.
Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
Mixed incontinence. You experience more than one type of urinary incontinence.

Causes

Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate, and sometimes incontinence.
Certain food and beverages can irritate the bladder and cause incontinence.

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Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.
Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina.
Changes with age. Aging of the bladder muscle can decrease the bladder's capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.
Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones? hard, stone-like masses that form in the bladder? sometimes cause urine leakage.
Neurological disorders. Multiple sclerosis, Parkinson's disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Treatment

Pelvic Floor exercises

Kegel exercises, these exercises are especially effective for stress incontinence but may also help urge incontinence. A physical therapist can assist you with this if needed.

Double voiding

Empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.

Fluid and diet management

Cut back on or avoid alcohol, caffeine, or acidic foods.
Reducing liquid consumption.
Losing weight or increasing physical activity also can ease the problem.
Nothing to drink 2 hours before bedtime and empty your bladder right before bed.

Absorbent pads

Pads and protective garments. Most products are no bulkier than normal underwear and can be easily worn under everyday clothing.

Bladder training

This is where most treatment for urge incontinence starts.
Step one is to keep the bladder as empty as possible for a 2-week period.
Empty your bladder as soon as you get up in the morning. This act starts your retraining schedule.
Make toilet trips, to urinate every 1 to 2 hours rather than waiting for the need to go.
Be sure to empty your bladder even if you feel no urge to urinate. Follow the schedule during waking hours only. At night, go to the bathroom only if you awaken and find it necessary.
Step two in training is to start to build up the time in between voids.
Delaying urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel the urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every 2.5 to 3.5 hours.
When you feel the urge to urinate in step one try relaxation techniques like deep breathing. You can also try self-applied acupressure (see spleen 6 below). Focus on relaxing all other muscles. If possible, sit down until the sensation passes.
If the urge is suppressed, great! If not, wait five minutes then slowly make your way to the bathroom. After urinating, re-establish the schedule. Repeat this process every time an urge is felt.
When you have accomplished your initial goal, gradually increase the time between emptying your bladder by 15-minute intervals. Try to increase your interval each week.
It should take between six to 12 weeks to accomplish your ultimate goal. Don't be discouraged by setbacks. You may find you have good days and bad days. As you continue bladder retraining, you will start to notice more and more good days, so keep practicing.

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Medication

OKAY, you tried all the Kegel exercises in the world but aren't gonna keep your bladder in check. We can start some medications which are commonly used to treat incontinence.

Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL) which I like because it works really well and is covered by almost all insurance plans. Other medications include tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura).
Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.
Alpha blockers. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin.
Topical estrogen. For women, applying low-dose, topical estrogen in the form of a vaginal cream, ring, or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. Systemic estrogen? taking the hormone as a pill? isn't recommended for urinary incontinence and may even make it worse.

Surgery

If all else fails, it is time to consider surgery.

Sling procedures. Strips of your body's tissue, synthetic material or mesh are used to create a pelvic sling around your urethra and the area of thickened muscle where the bladder connects to the urethra (bladder neck). The sling helps keep the urethra closed, especially when you cough or sneeze. This procedure is used to treat stress incontinence.
Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done during general or spinal anesthesia.
Prolapse surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may include a combination of a sling procedure and prolapse surgery.
Sacral nerve stimulation. A small electrode is implanted in the abdomen or buttock to stimulate the sacral nerves in an attempt to manage urinary urge incontinence.

Types of Urinary Incontinence

Stress incontinence. Stress incontinence happens when physical movement or activity such as coughing, laughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder, causing you to leak urine.

Overflow incontinence. You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.

Functional incontinence. A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.

Mixed incontinence. You experience more than one type of urinary incontinence.

​

Causes

Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate, and sometimes incontinence.

Certain food and beverages can irritate the bladder and cause incontinence.

​

Pregnancy. Hormonal changes and the increased weight of the fetus can lead to stress incontinence.

Changes with age. Aging of the bladder muscle can decrease the bladder's capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.

Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.

Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence.

Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones? hard, stone-like masses that form in the bladder? sometimes cause urine leakage.

Neurological disorders. Multiple sclerosis, Parkinson's disease, a stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

​​​

Treatment

Pelvic Floor exercises

Kegel exercises, these exercises are especially effective for stress incontinence but may also help urge incontinence. A physical therapist can assist you with this if needed.

​

Empty your bladder more completely to avoid overflow incontinence. Double voiding means urinating, then waiting a few minutes and trying again.

​

Fluid and diet management

Cut back on or avoid alcohol, caffeine, or acidic foods.

Reducing liquid consumption.

Losing weight or increasing physical activity also can ease the problem.

Nothing to drink 2 hours before bedtime and empty your bladder right before bed.

​

Absorbent pads

Pads and protective garments. Most products are no bulkier than normal underwear and can be easily worn under everyday clothing.

​

Bladder training

This is where most treatment for urge incontinence starts.

Step one is to keep the bladder as empty as possible for a 2-week period.

Empty your bladder as soon as you get up in the morning. This act starts your retraining schedule.

Make toilet trips, to urinate every 1 to 2 hours rather than waiting for the need to go.

Be sure to empty your bladder even if you feel no urge to urinate. Follow the schedule during waking hours only. At night, go to the bathroom only if you awaken and find it necessary.

Step two in training is to start to build up the time in between voids.

Delaying urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel the urge to urinate. The goal is to lengthen the time between trips to the toilet until you're urinating only every 2.5 to 3.5 hours.

Medication

OKAY, you tried all the Kegel exercises in the world but aren't gonna keep your bladder in check. We can start some medications which are commonly used to treat incontinence.

Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.

Alpha blockers. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin.

​

Surgery

If all else fails, it is time to consider surgery.

​

Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done during general or spinal anesthesia.

Prolapse surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may include a combination of a sling procedure and prolapse surgery.

Sacral nerve stimulation. A small electrode is implanted in the abdomen or buttock to stimulate the sacral nerves in an attempt to manage urinary urge incontinence.

​​