Urinary Incontinence

Urinary Incontinence, What is it?

Urinary incontinence describes a condition in which urine unexpectedly leaks out from the bladder. For some, this occurs with a cough or laugh, while for others it means leaking when they feel the sensation of urgency and feel they need to find a restroom immediately.

The exact number of people who suffer from urinary incontinence is not fully known, because many cases go unreported.  Many people don’t discuss it due to embarrassment or the mistaken belief there is nothing that can be done to help. It is estimated about 25% of the adult population suffers from incontinence, a majority of whom are women. It is not a disease, but a symptom of several conditions.

For women, the risk factors for incontinence include multiple pregnancies and deliveries, being postmenopausal, being overweight, and having weak pelvic muscles. For men, the risk relates to prostate health. For both men and women, certain medications, smoking, and diseases such as diabetes and high blood pressure can also increase the risk of incontinence.

There are five main types of incontinence:

  • Functional Incontinence-a functional or environmental limitation resulting in urine leakage because the individual was not able to make it to the bathroom in time
  • Mixed Incontinence-includes both stress and urge incontinence
  • Stress Incontinence-urine leaks with increased pressure on the bladder (e.g. laughing, sneezing, coughing, or during exercise)
  • Urge Incontinence- leaking that occurs when the patient experiences a very strong need to go to the bathroom and may occur frequently each day or with specific triggers
  • Overflow Incontinence- more urine is present than the bladder can hold and leaking occurs. The patient may also not be able to feel the bladder is leaking due to other medical conditions

Functional incontinence relates specifically to physical or environmental factors. Such factors may include confusion or dementia, joint pain and stiffness causing slow movements, or environmental factors such as the distance to the bathroom being far or individual needing assistance to use the bathroom.

Stress incontinence (SUI) is common and relates to weak or injured pelvic floor muscles which may be caused by pregnancy, childbirth, injury, or vaginal or rectal surgery.  The pelvic muscles are like a hammock. These muscles help with movement and stability, as well as supporting organs including the bladder. When these muscles become weak and overstretched, they don’t properly support the bladder; therefore, any forceful activities like sneezing, coughing, laughing, or exercising causes leakage.  In contrast to overstretched tissues, sometimes the pelvic floor muscles are too tight or are unable to relax, contributing to a muscle imbalance that results in leakage as well.  Muscles that are too tight are also often weaker.

With urge incontinence, the brain and bladder are not communicating properly, and the bladder often seems to feel full, even if the person just went to the restroom.  The person who is experiencing these symptoms will feel a frequent sense of urgency, and will often leak when that urge occurs, such as upon arriving home from the grocery store and putting the key in the door of the house, hearing water running, feeling chilled, or while doing dishes.

Mixed incontinence is when an individual suffers from both stress and urge incontinence.  Leaking occurs with both coughing, sneezing, laughing, and when the person feels the strong, frequent urge to void.

Overflow incontinence happens when the bladder gets too full, which causes slow leakage.  Oftentimes, the person experiencing overflow incontinence does not even realize the leaking is happening because the sensation in the bladder and pelvic regions is diminished.   This is often seen with patients who are diabetic and those who have neurological conditions.  In some cases, there is a blockage to the flow which also results in the poor release of urine, leaving the bladder partially emptied.

Seeking medical attention for incontinence is important for overall health and well-being, and can be treated very effectively.

The effects of incontinence can be life-altering and risky to one’s general health.  Rashes, skin irritation, and frequent urinary tract infections can occur due to constant moisture in the area.  Some people also begin to isolate themselves from social activity or community events as they are afraid a leak will happen while in the company of family, friends, or while out in public.

Many people, some of whom are already limited by osteoporosis, general immobility, or an injury are at greater risk of falling due to incontinence.  People who have difficulty balancing and handling their clothing or moving quickly to the bathroom are at risk as well, as the falls will often occur while they are rushing to try to get to the restroom before they begin to leak.

What causes urinary incontinence?

The most common type of incontinence for women is stress incontinence, which occurs due to muscle weakness or imbalance.

For men, the most common cause is a change in prostate health whether by age or caused by another medical condition. Men are more likely to have overflow incontinence which means they have difficulty emptying their bladder completely which causes slow urine leakage, also called dribbling.

Additional causes of symptoms of urinary incontinence are foods and beverages that can irritate the bladder, such as the following:

  • Artificial sweeteners
  • Alcohol
  • Caffeine
  • Carbonated drinks
  • Coffee and tea (both caffeinated and decaffeinated)
  • Citrus foods
  • Spicy foods

A few examples of physical conditions that can contribute are:

  • Constipation
  • Confusion or dementia
  • Enlarged prostate
  • Hysterectomy surgery
  • Menopause
  • Muscle weakness and/or excessively tight muscles of the pelvic floor
  • Poor balance
  • Pregnancy and childbirth
  • Prostate cancer
  • Some types of Medications
  • Tumor
  • Urinary tract infection

 

Symptoms of Urinary Incontinence

Depending on the type of incontinence an individual suffers from, the symptoms will vary.

  • Functional – a physical limitation (e.g. walking with a walker and can’t move fast enough to get to the bathroom quickly) which causes urine leakage
  • Stress – leakage occurs with forceful activities such as coughing, laughing, sneezing and during exercise
  • Urge – leaking when the sensation to empty occurs
  • Overflow – the inability to fully empty the bladder causing urine to dribble out or not sensing the bladder is full and the bladder leaking as a result
  • Mixed -a combination of leaking with urgency and with physical activities

How is urinary incontinence diagnosed?

Diagnosis of urinary incontinence starts with the individual seeking medical attention.  Some, but not all, medical providers will ask about this at routine exams, but the patient benefits most by being honest and discussing the concerns and symptoms.  It is estimated that most people have symptoms for many years before actually seeking help for the condition.

Properly diagnosing urinary incontinence is important as treatment is specific to the type that the patient is experiencing.  It is important to understand the pattern of symptoms and how long it has been occurring.  A medical provider and physical therapist may also want to know about the results of the following:

  • Urinalysis – a test ordered by a doctor, physician assistant, or nurse practitioner checking for an infection
  • Diary – a record intake of liquids, activity, and how often urination occurs. It will be important to note whether it was controlled or an incontinence episode
  • Post-void residual measurement – a test ordered by the medical provider that involves an ultrasound. The patient empties the bladder, then the ultrasound checks to see how much urine is left in the bladder.  This can help identify blockage or other conditions resulting in urine retention.

Treatment of Urinary Incontinence

There are several conservative treatment approaches to urinary incontinence.  Physical therapy is a great place to start.  PT’s who treat incontinence have advanced, specialized training in the condition and great care is taken for patient comfort and privacy.  The PT will guide the patient with the most appropriate interventions for the individual’s condition.

  • Bladder training is used to reduce the urge to go to the bathroom. The goal is to extend the amount of time one waits to go to the bathroom. This technique is used for urge incontinence, and is done to retrain the body and bladder communication and response to urgency. A PT will guide the patient on the specific directions of this technique and the timing.
  • Double voiding is used to only help with overflow incontinence. The technique is to empty the bladder then in a short time, return and void again. The goal is to empty the bladder to avoid dribbling.  A PT will guide the patient on the specific directions of this technique and the timing.
  • Scheduling trips to the toilet more regularly, which can be a technique used for functional incontinence. The goal is to not rush to the bathroom, but instead go more frequently to avoid an accident. Although many people think this might a good way to manage urgency, it can make the urgency worse.
  • Dietary considerations to reduce foods and beverages which irritate the bladder may be recommended for all types of urinary incontinence.
  • Pelvic muscle evaluation and a specific exercise program tailored to each patient’s individual needs is highly recommended and has been found to be successful with incontinence. A physical therapist who specializes in the pelvic floor can teach a proper pelvic-floor program, with very specific exercises. The exercises may be different for each patient, depending on what is identified on the evaluation.

No matter the type of urinary incontinence, a few lifestyle changes may help with managing incontinence symptoms:

  • Changing your diet, including eating more fiber and drinking less caffeine
  • Cessation of smoking
  • Maintaining a healthy weight
  • Exercise regularly, beginning with walking or another low-impact activity

In some cases, conservative treatment does not improve the patient’s symptoms. For these cases, a physician will discuss the options.  This includes benefits and risks of appropriate medications, medical device usage, injections, or possibly surgery.  Family practice providers, gynecologists, and urologists are frequently involved in the care of urinary incontinence.

Several types of medications taken by mouth and topical medications are available to help with reducing the symptoms of incontinence.  Medication use is best discussed with a medical provider experienced in the treatment of incontinence.

In rare cases, surgery is indicated. The type of surgery will depend on the cause of incontinence.  Goals, expected outcomes, risks, and benefits of any surgery are best discussed with the surgeon.

Next Steps

Most cases are treated with conservative care including physical therapy.  A physician may wish to do some basic testing first before referring to PT to ensure there is no infection or other more serious condition.  The PT will evaluate the condition and recommend making any lifestyle changes in addition to the best exercise program based on the findings.

All states have direct access in some form to a physical therapist, meaning patients can go directly to a physical therapist without a physician order.  However, the guidelines for every state are different, and can be found here:  Physical Therapy Direct Access By State.

Finding a skilled PT with good pelvic floor outcomes can be done by clicking on Find A Clinic.

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