Chronic incontinence is categorized according to the circumstances under which urine is lost. Stress incontinence is the loss of urine during contractions of the abdomen caused by sneezing, laughing, coughing, exercising and other such actions.
Overactive Bladder is a condition in which the urge to urinate is sudden and extreme, and urine is often expelled before a bathroom is reached. This occurs even when there is a minimal amount of urine in the bladder.
The challenge is identifying the origins of urinary incontinence. Diagnosis begins with a detailed medical history. The pattern and nature of the leakage will help determine the type of incontinence. A physical examination, including reflex testing and palpation of areas around the urinary tract will offer additional information suggesting the cause of the incontinence.
Bladder scanning in the office setting represents a painless, noninvasive way to visualize the bladder contents. A physician can assess emptying ability with this test, similar to an ultrasound.
Urine and blood samples may be taken and analyzed for evidence of infection, kidney stone or metabolic imbalances. A urodynamic study may be conducted in which bladder pressure and flow rates are determined. Cystoscopy involves inserting a thin hollow tube into the urethra and advancing it into the bladder. Miniature lights and lenses at the tip of the tube allow the walls of the urethra and interior of the bladder to be examined.
Creating a urination diary is a simple and informative task. The patient is given a pan that fits across a toilet seat. The date, time and quantity of urine expressed are recorded for several days to a week.
Not all of these tests are utilized in every patient. Testing stops as soon as the origin of the incontinence is reliably determined.
Acute urinary incontinence associated with infections, kidney stones or medication side effects often resolves when the primary problem is successfully treated.
As noted, chronic incontinence can originate from a variety of circumstances. The nature and mix of therapeutic measures are tailored to the individual patient.
A simple exercise routine involving Kegel exercises can strengthen pelvic floor and sphincter muscles to reduce or eliminate leakage.
Electrical stimulation can also strengthen muscles in cases of stress and urge incontinence. This therapeutic approach, also called transcutaneous electrical nerve stimulation (TENS), temporarily places small electrodes on the surface of the skin adjacent to targeted muscles or inside vagina or rectum. Minute pulses of electricity stimulate pulses of muscle contraction and strengthens them. Another form of electrical therapy involves placing a small sacral nerve stimulator (a sort of pacemaker about the size of a stopwatch), beneath the skin with wires leading to the sacral nerve in the lower back. Pulses from the stimulator offset hyperactive nerve activity around the bladder. The sensation has been described as a slight pulling in the pelvic area.
Biofeedback involves what might be called 'electronic training wheels'. Electronic sensing devices are placed to record nerve impulses and muscle contractions. These offer the patient more information concerning voiding impulses than she would normally be aware of. By monitoring these impulses and learning to control them, additional control over urination can be gained.
There are a number of medications that can reduce leakage. Some of these drugs inhibit an overactive bladder’s activities by stabilizing muscle contractions and others have the opposite effect of relaxing muscles to permit more complete bladder emptying. Hormone replacement therapies, usually involving estrogen, may help restore normal bladder function.
Several devices and procedures help reposition and stabilize the bladder and urethra. A pessary is a semi-rigid ring placed in the vagina to reposition the urethra and reduce stress incontinence leakage. Bulking substances such as collagen (fat) or specially formulated artificial substances may be injected to provide support and bulk around the urethra. These substances compress the urethra near the bladder outlet to reduce the effects of stress incontinence. The procedure may need to be repeated at annually or more frequent intervals.
Several other surgical procedures have been shown to have high success rates. Stress incontinence often results from the bladder losing support and gradually dropping toward the vagina. The bladder can be returned to a more normal position with sutures that stabilize it by attaching it to nearby structures such as muscle, stable tissue or bone. Another procedure that provides bladder support involves placing a pubo-vaginal sling, a sort of hammock, beneath the bladder. The sling is sutured to adjacent structures. Excellent results with the pubo-vaginal sling have been achieved in women with stress urinary incontinence.
An artificial sphincter is a novel device that mimics the musculature of the sphincter. It is a surgically implanted ring that encircles the urethra. It can be manually inflated to close around the urethra and prevent urine leakage. Sphincter implantation is not a common procedure but one that can be successfully employed in carefully selected patients.
Indwelling catheterization is a procedure employed in women whose bladder fails to empty completely as a result of loss of muscle tone, prior surgery, or spinal cord injury. The catheter (thin tube) is inserted in the urethra and allowed to drain into a bag attached to the leg.
This range of therapies briefly described here should suggest to the reader a single therapy is seldom employed to treat the UI. Instead combinations of these therapies are tailored to meet the condition and needs of the patient after extensive consultation, usually with several specialists in the varying aspects of UI therapy.
Additional Treatment Information
Further information on our therapy options and surgical procedures are available in our latest guide publication.
Life's events can weaken pelvic muscles. Pregnancy, childbirth, and being overweight can do it. Luckily, when these muscles get weak, you can help make them strong again. Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women can regain bladder control through pelvic muscle exercises, also called Kegel exercises. Ask your physician for information on these exercises.