Dealing With Urinary Incontinence

For the 25 million Americans who suffer from urinary incontinence, the symptoms can be painful and annoying. And many times, the condition is just downright embarrassing.

Urinary incontinence is involuntary leakage of urine, but there are different types.

“Stress incontinence is if you cough, sneeze, laugh, lift, you leak urine,” said Dr. Philippa Cheetham, a urologist at Columbia University Medical Center in New York City. “You also have urge incontinence, so before you leak you have the urgency or the sudden need to void.”

Some patients have a combination of both the stress and urge forms of the condition, called mixed incontinence. In men, a condition called overflow incontinence is fairly common, where the prostate affects the bladder’s to empty.

In a normal bladder, urethral pressure is higher than bladder pressure, until you empty your bladder. But with stress incontinence, often the urethral pressure and pelvic floor muscles are abnormal. This causes the bladder pressure to overcome the pelvic floor support, causing urine to leak.

With urgency incontinence, it’s not related to pelvic floor support, it’s related to the bladder muscle being overactive and contracting, and overwhelming the sphincter control of the urethra down below, Cheetham said.

There are a number triggers that can cause urgency incontinence:
* Bladder irritation
* Infection
* Bladder stone
* Tumor
* Sometimes cause goes unknown

There are many risk factors for stress incontinence. Anything that increases the pressure in the abdomen will increase the risk of leakage, so sometimes, simple lifestyle changes may be enough to help you find relief.

“If you’re a smoker and you cough a lot, you’re more likely to leak urine. The heavier you are, the more pressure there is on your abdomen, the more likely you are to leak,” Cheetham said. “We know the more children you’ve had, the weaker the pelvic floor support, so that is another factor related to stress incontinence.”

Menopause can also be a risk factor for stress incontinence. Pelvic floor muscles are affected by levels of estrogen, so as women approach menopause, they may be more likely to deal with some involuntary leakage issues.

But diagnosing incontinence and finding the cause can be tricky because the symptoms are often the same for many different kinds of bladder conditions.

“Sometimes patients think they have one set of symptoms, and we think they may have stress incontinence, but they may also have a component of overactive bladder -- so history is important,” Cheetham said. "We examine the patient, see if they have a bladder we can feel that may suggest they’re not emptying. We do a urine culture to make sure there’s no infection, we might send the urine for a cytology to make sure there’s no suspicious cancer cells in the urine.”

Urologists may also perform urodynamic testing, to assess how the bladder and urethra are working in storing and releasing urine. It’s like an electrocardiogram of the bladder, so doctors can see how the muscles are functioning. Urololgists may sometimes use sonograms to look at the kidneys or a simple, out-patient procedure using a cystoscope, to look inside the bladder.

Recent studies have showed that Botox can be used to treat symptoms of urinary incontinence in some patients with certain neurological disorders or for those that haven't found relief from oral medications. The treatment option even received approval from the U.S. Food and Drug Administration.

“What we can do with Botox is we can put a telescope into the bladder, a cystoscope, and through that we can inject various parts of the bladder. And so the areas that we inject become paralyzed, and the areas we have not injected remain normal,” Cheetham said. “So if the bladder is overactive and contracting continuously, with Botox, it allows the bladder to fill and empty.”

Cheetham said there are some natural ways to help find relief from – or even prevent – urinary incontinence for some patients.

“With stress incontinence, lifestyle issues would be try and lose weight, stop smoking so you stop coughing . . . pelvic floor exercises, kagel exercises can help for people who have mild stress incontinence.”

With the overactive bladder, there are certain foods that can aggravate it. Some patients find that they are better off avoiding spicy foods and tomatoes. In addition to that, there are training exercises, where instead of running to the bathroom, patients are encouraged to hold their urine to help curb the feeling of urgency.