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Ask Dr. Nancy: Urinary Incontinence, More than Just Embarrassing.

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Urinary incontinence in adults is a common, often undisclosed problem. This unwanted leakage of urine occurs in both men and women but is more common in women. It can range from mild leaking of urine to uncontrollable wetting. Unfortunately it worsens with age. What starts out as an annoyance can become a significant social and economic problem.

About 50% of nursing home admissions are related to some extent to urinary incontinence. It’s expensive for individuals and families. The direct cost of treating urinary incontinence in men and women of all ages was estimated at $26.3 billion in 1995 for bladder control products, healthcare costs and nursing home costs.

Most urinary incontinence is treatable. The first thing to do is to tell your primary care physician. Keep a diary of urination and bring it with you to your visit. Here is some information so you are organized for your visit.

The underlying mechanism: Keeping urine in the bladder is a balance between the pressure in the bladder and the pressure in the urethra, the tube that drains urine from the bladder to the outside of the body. If the pressure in the bladder is greater than the pressure in the urethra, urine exits. See if you recognize some of these symptoms.

Stress incontinence is the involuntary loss of urine during activities such as coughing, laughing or exercising. The underlying abnormality is typically poor support from the pelvic floor muscles which support the “bladder neck,” the junction between the bladder and the urethra. This decreases the pressure in the urethra, so activities like coughing, which increase pressure on the bladder from above, force urine out below. Lack of normal usual pressure within the urethra is another factor. Tissue thinning associated with age in women, previous vaginal surgery and certain neurologic lesions are associated with poor urethral sphincter function.

An overactive bladder causing the involuntary loss of urine preceded by a strong urge to void, whether or not the bladder is full, is a symptom of the condition commonly referred to as "urge incontinence." Some cases of overactive bladder can be attributed to specific conditions, such as urinary tract infection, bladder cancer and bladder stones, but most cases result from an inability to suppress bladder muscle contractions.

Overflow incontinence is urine loss associated with over stretching of the bladder. Frequent or constant dribbling can be present, sometimes in association with overactive bladder or stress incontinence. Over distension is typically caused by an underactive bladder muscle and/or obstruction of the urethra. The bladder muscle may be underactive secondary to drug therapy or conditions such as diabetic neuropathy. Outlet obstruction in women is almost always a result of urethral occlusion from pelvic organs sagging downward or previous anti-incontinence surgery. Outlet obstruction in men is commonly related to enlargement of the prostate gland.

Treatment

The treatment is determined by the type of incontinence. If the type isn’t obvious from the patient’s history, tests can be done to measure bladder dynamics. As with every medical problem, the appropriate treatment has to be matched up with the right diagnosis. Here are some simple suggestions to get started.

First possible reversible causes should be addressed such as infection and certain drugs.

For stress incontinence, conservative treatment works. Overweight women need to lose only 5% - 10% of their weight to achieve a 50% decrease in urinary leakage according to a recent New England Journal of Medicine article. Tampons can be effective, especially for exercise-induced incontinence. Exercises that strengthen the pelvic floor to provide support to the bladder neck are recommended based on good and consistent scientific evidence. See article Consider Physical Therapy.

Overactive bladder treatment involves bladder retraining. Some medications have been shown to have a small beneficial effect on improving symptoms.

Overflow incontinence requires a medication review to see if this is a side effect of medication. Evaluation for obstruction to urine flow is essential and oftentimes can be successfully treated by surgery.

The American College of Physicians, American College of Obstetricians and Gynecologists, and the American Urological Association offer great resources for more information.

The key to success is to start early on urinary incontinence treatment.

Consider Physical Therapy

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Do you experience symptoms of stress incontinence?

Many women believe the leakage of urine is a normal result of pregnancy, childbirth and aging; but this is not true. Exercises to strengthen the pelvic floor muscles may greatly reduce or even cure the problem.

Capital Health Plan has partnered with Tallahassee Memorial Outpatient Rehabilitation Services to provide a therapy program for urinary incontinence. Treatment includes strengthening exercises as well as education about posture, body mechanics and bladder fitness. Physical therapy can be an effective, non-invasive treatment option for those experiencing urinary leakage.

If you think you may benefit from physical therapy to treat your problem, consult your primary-care physician. When you are ready to schedule an appointment please call 431-6220.