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Urinary Incontinence Tests and Treatments

Urinary incontinence is an uncontrolled loss of urine. It is not a disease. It is a sign of problems in the urinary tract or in the nerves that connect the urinary tract to the spinal cord and brain. Some conditions of urinary incontinence are temporary, while others may last for a longer time. Incontinence can lead to hygiene and/or social problems. It occurs 3 times more often in women than in men. Only 1 in 12 people who has this condition seeks medical help.

Urinary incontinence can be treated and, in most cases, cured.

Types of urinary incontinence

There are 3 types of urinary incontinence: stress, urge, and overflow. Each causes an involuntary loss of urine and exhibits different signs and symptoms.

 

Stress incontinence

Stress incontinence  is the involuntary loss of urine caused by doing something that puts additional pressure on your bladder. Sneezing, coughing, laughing, jumping, and jogging are some activities that can trigger stress incontinence.

Stress incontinence occurs more often in women than it does in men. Pregnancy and childbirth may weaken women’s pelvic floor muscles (the muscles that surround the bladder). Excess weight, pelvic surgery, and menopause also can cause stress incontinence.

Urge incontinence

Urge incontinence is the sudden need to urinate even when the bladder contains a small amount of urine. Patients with urge incontinence may have urine leakage if they can’t get to the bathroom quickly or when they hear water running. Urge incontinence can be caused by nerve damage or an infection. A loss of estrogen (the hormone produced by the ovaries) also can cause urge incontinence.

Overflow incontinence

Overflow incontinence occurs when the bladder is full and small amounts of urine leak out. This can happen even when you are not doing any stressful activities. Symptoms include getting up often at night to go to the bathroom or feeling like your bladder is full and passing only a small amount of urine.

Symptoms of urinary incontinence

  • Urgency, or a strong need to urinate whether or not the bladder is full; this often occurs along with pelvic discomfort, pressure, and pain
  • Frequency, or urinating more than every 2 hours or a total of 7 times a day
  • Getting up to urinate 2 or more times during the night
  • Painful urination
  • Bed-wetting

 

Patients can have more than 1 type of incontinence at a time. They also can have a combination of these symptoms.

Causes of urinary incontinence

  • Urinary tract infections
  • Medications that interfere with the body’s ability to store urine (such as diuretics or antidepressants)
  • Abnormal growths in the pelvic area or urinary tract
  • Lack of pelvic support caused by pregnancy, childbirth, obesity, or chronic coughing
  • Disorders caused by stroke, spinal cord injuries, or diseases such as multiple sclerosis or Parkinson’s disease
  • Injury or surgery in the pelvic region
  • Age-related factors, such as weakening of the muscles that support the bladder; age alone is not a cause

 

In addition, people who have diabetes, who are bedridden, or whose movements are limited may have incontinence.

Testing for urinary incontinence

The doctor who treats this condition is a urologist. The doctor will take a detailed medical history and perform a complete physical exam. This will include an examination of the pelvic and rectal area. You also may undergo various tests.

 

The following tests can be done in your doctor’s office or at a hospital on an outpatient basis:

  • In a urine culture, a urine sample is tested for signs of bacterial infection.
  • A cystoscopy [sis-TOSS-cuh-pee] allows the doctor to see and detect any abnormal conditions. A sterilized medical instrument called a cystoscope is gently inserted through the urethra (the small tube that carries the urine from the bladder out of the body) and into the bladder.
  • Urodynamic [YOUR-o-die-NAM-ik] studies provide information about the amount of urine the bladder can hold. They can also show the strength of the sphincter muscle (the muscle that controls emptying the bladder). These studies test the patient’s ability to recognize a full bladder.

A small thin tube called a catheter is inserted into the bladder. It is then connected to a machine that measures bladder function. In some patients, the bladder is filled with contrast dye so the doctor can better see what is going on in the bladder.

  • A cystogram [SIS-toh-gram], also called cystourogram [SIS-toh-YOUR-uh-gram], is a test that uses an x-ray and contrast dye to detect bladder problems.
  • In an intravenous pyelogram (IVP), a contrast dye is injected into the bloodstream. Several x-rays are taken as the dye moves through the kidneys. This test can detect kidney and bladder size, shape, and function, and the presence of any kidney stones, cysts, obstructions, or tumors.

Treatments

Many effective treatments are available for urinary incontinence. After diagnosis and evaluation, your doctor may recommend one or more of the following treatments:

 

Medications are usually the first course of treatment and can include:

  • Antibiotics to clear infections
  • Medications to help control bladder contractions
  • Hormone therapy for women who are past menopause

Bladder training

Bladder training and muscle conditioning are often helpful with urge incontinence. The patient keeps a specific schedule of fluid intake and urination. This helps “train” the bladder to empty at certain times.

Pelvic-floor exercises

Pelvic-floor exercises (Kegel) are simple exercises that can help strengthen the sphincter muscle.

Biofeedback

Biofeedback uses special instruments to provide information from the brain about the action of the sphincter muscle. Biofeedback is sometimes used with bladder training and pelvic floor exercises.

Special devices

Special devices  may be used to strengthen the pelvic muscles. A pessary (a device that is placed into the vagina) helps support the pelvic organs. It also prevents leakage by pressing against the urethra. Electrical stimulation may be used to contract the pelvic muscles to help women who have not benefited from other treatments.

Surgery

Surgery usually is considered only after other treatments have been unsuccessful.

If incontinence cannot be completely corrected, it may still be managed. Protective products are available to keep you dry. These include protective pads, undergarments, and urine collection devices.

Urinary incontinence may have significant emotional effects on patients. Shame, depression, frustration, anger, and anxiety often occur. Incontinence can be cured or its symptoms reduced. With a complete evaluation, a treatment plan, and follow-up care, patients can lead active lives, free of the physical and emotional problems caused by urinary incontinence.

Revised September 2011

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