Incontinence

Incontinence is diagnosed and treated by the members of the Urology Division as well as the Women’s Center for Continence and Sexual Health at Premier Medical Group.

What is incontinence?

Urinary incontinence (UI) is the involuntary loss of urine for any reason.

Urinary incontinence, or loss of bladder control, is a frustrating problem for more than 13 million Americans. Not knowing when or where you might have an accident and leak urine can affect everything you do, from work to social events, even exercise.

Urinary incontinence affects both men and women but is twice as common in women. Research suggests that half of older women may have some form of UI. Incontinence can be treated and often cured.

Click here to see if the research department has a current study for urinary incontinence. Research studies are available in our Poughkeepsie, Kingston and Newburgh offices.

What causes incontinence?

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There are five main types of UI, and each has a different cause. In many cases, individuals experience symptoms of more than one type of incontinence. Proper diagnosis of the type of urinary incontinence is an important factor in successful treatment.

Stress Incontinence

The most common bladder control problem for women is characterized by leaking urine during a physical activity like lifting, exercising, even just sneezing, or coughing. Stress incontinence is typically a result of urethral hypermobility or intrinsic sphincter deficiency. Hypermobility is a result of significant shifting of the urethra and bladder neck from their normal positions. Intrinsic Sphincter Deficiency (ISD) occurs when the urethral sphincter is unable to close tightly enough to hold urine in the bladder during exertion and typically results in significant leakage.

There are several reasons why these muscles may lose strength:

  • Weight gain
  • A sports injury
  • Multiple pregnancies and vaginal childbirths
  • Dropped bladder with dropped urethra
  • Hormone changes (such as menopause)
  • Damage to bladder nerves or muscles
  • Aging

Urge Incontinence

This condition occurs when there is over activity of the muscle surrounding the bladder. This over activity causes your bladder to contract frequently and creates an overwhelming need to urinate–even if you just went. This condition, often “overactive bladder” (OAB), makes it difficult to hold your urine long enough to reach a toilet. The sudden urge may be triggered by the sound of running water, by sipping a drink, or by nothing at all. With this type of incontinence, you may leak large amounts of urine. You may also find yourself running to the bathroom even when your bladder is mostly empty.

Causes of urge incontinence include:

  • Bladder irritation and infection
  • Damage to bladder nerves or muscles
  • Damage to the brain (such as from a stroke) or spinal cord injury
  • Certain medications

Overactive Bladder (OAB)

The symptoms of OAB are similar to those of urge incontinence in that you feel the same sudden, frequent need to urinate. If you are diagnosed with overactive bladder, it does not mean you will have incontinence; many women are able to “hold it” until they reach the toilet. The biggest challenge for these patients is not urine leakage, it’s the constant interruption in their activities with trips to the bathroom. Some people have symptoms only during the daytime, while others have frequency only at night, but most patients have issues both day and night.

Mixed Incontinence

A combination of stress incontinence and urge incontinence in which symptoms of both conditions are present.

Overflow Incontinence

When the bladder doesn’t empty properly, it can result in “spill over” and a constant “overflow” of urine. If nerves are damaged, the signal never reaches the bladder and it stays full. A weakened bladder muscle can have the same result, and the constant pressure of urine on the neck of the bladder can cause dripping and leaking.

Causes of overflow incontinence may include:

  • Stroke
  • Certain medications
  • Bladder outlet obstruction
  • Spinal cord injury
  • Diseases such as Parkinson’s and diabetes

Functional Incontinence

Factors other than the condition of the urinary tract – such as medical problems interfering with thinking, moving or communicating – may hinder people in getting to a toilet in time and cause this form of urinary incontinence.

Female Incontinence

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Treatment for Stress Incontinence

  • Kegel Exercises
  • Biofeedback
  • Medications
  • Timed Voiding
  • Injectables
  • Surgery

Treatment for Urge Incontinence

  • Kegel Exercises
  • Biofeedback
  • Medications
  • Timed Voiding
  • Dietary Changes
  • Neurostimulator Implants
  • Botox Injections

Treatment for Overflow Incontinence

  • Neurostimulator Implants
  • Self-Catheterization
  • Medications

Managing Mild Incontinence

  • Make certain diet changes. Some foods may make you need to urinate more often. Drink less. Pour your cups half-full, and avoid coffee, tea, and caffeinated sodas. Caffeine is a diuretic, which creates more urine.
  • Empty your bladder regularly, every two to four hours, even if you don’t feel the need.
  • Quit smoking.
  • Lose weight.

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Kegel Exercises

Because stress incontinence often stems from weak pelvic muscles, Kegel exercises are an excellent mechanism to strengthen the muscles around the urethral closure. Clench the muscles you would use to stop the flow of urine. Hold the squeeze for 10 seconds, and then relax. Do three or four sets every day. As these muscles grow stronger, so will your bladder control.
As the pelvic floor muscles get stronger, small vaginal weights can help make Kegel exercises more effective. Holding the small weight in your vagina helps you contract the right muscles. You can speak to your urologist about vaginal weights.

Biofeedback

Biofeedback is a method that provides you real-time information about activity in your bladder and pelvic muscles. As you gain awareness of these functions, you may be better able to control them. A special tampon-shaped sensor is placed either just outside of or in your vagina or rectum. When you relax, your muscles give off signals and these sensors will read the signals. The technician can view them on a computer monitor and you will be able to see if, in fact, you are using the right muscles.

Collagen Injections

To boost the size of the urethra lining and create resistance against the flow of urine from the bladder, collagen injections are another alternative. Injections must be repeated every 12 to 18 months and are only helpful against stress incontinence.

Using Absorbent Products

Sometimes it may be necessary to use a product to absorb leakage. These are generally disposable and can be used, until your treatment begins to work, to help keep you more comfortable and dry.

Bladder Training

Bladder training can be effective against stress incontinence and urge incontinence. Begin by making a chart of the times you urinate and when you leak. You can train the bladder to hold out for longer and longer periods between bathroom visits. Try re-training your bladder by using Kegel exercises. When you feel the urge to urinate, try to stop the feeling by contracting your pelvic floor muscles. Try to hold your urine a little longer each time. Soon you will begin to see a pattern and can avoid accidents by heading to the bathroom before a leak is likely to occur.

Self-Catheterization

This procedure is painless and easy to learn, and when you drain your bladder on a regular basis, you will be able to control overflow incontinence. You will insert a thin tube through the urethra into the bladder, and drain the urine.

Neurostimulator Implants

Used for urge incontinence, a small stimulator device is implanted under the skin, either in your buttocks or midsection, which gives off electrical signals to the nerves that control your bladder. This helps your bladder work more normally by blocking abnormal nerve signals to and from the bladder muscle.

Medications for Incontinence Include:

  • For urge incontinence: anticholinergic and anitspasmodic medications
  • Alpha-adrenergics
  • Estrogen
  • Antibiotics (to treat urinary tract infections if one is present)

Surgery for Incontinence

An option for stress incontinence is to place a “sling,” a piece of tissue or material that acts as a backstop for the hypermobile urethra and prevents leaks. Your urologist can also lift your bladder up to a more normal position (cystocele repair). For urge incontinence, surgery may be used to boost the bladder’s storage capacity or to implant a device that controls bladder spasms with electrical signals, a so-called pace maker for the bladder. Surgery for stress incontinence is often done as an outpatient procedure.

Care for Your Skin

Urine can be very irritating to the skin. Your doctor may suggest special cleansers and protective ointments. Keeping yourself dry and clean will help reduce the possibility of a rash, as will using non-deodorant soap or harsh detergents on your skin.

Preventing Incontinence

There are ways to reduce your risk of developing incontinence. Maintaining a healthy weight and doing daily Kegel exercises top the list. Smoking can lead to chronic coughing, which can stress the bladder and trigger leaks.

  • Plan your fluids: It’s important to drink fluids to stay hydrated, but controlling when and how much will help incontinence.
  • Drink fluids only when you know you have access to a bathroom, and drink during the day.
  • Limit your fluids at night and when traveling and you know a bathroom is not close by.

What is Pelvic Floor Prolapse?

This refers to the drooping (prolapse) of any of the pelvic floor organs, including bladder, uterus vagina small bowel, or rectum. Some women notice no symptoms while others report pressure in the pelvic area, lower back pain, painful intercourse, urine leakage, or feeling that something is falling out of the vagina.

Treatments for prolapse include Kegal exercises, mechanical treatments such as inserting a small plastic device into the vagina to support the drooping organs (pessary) or surgical treatment to repair the affected tissue or remove the organ (such as uterus by hysterectomy).

Dr. Daniel Katz specializes in female urinary incontinence. He sees patients in the St. Francis Atrium Poughkeepsie office.

Male Incontinence

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Incontinence is the involuntary loss of urine or the inability to control urine for any reason. During childhood, bladder control usually develops sooner in girls than in boys, and bedwetting is more common in boys, but urinary incontinence is about twice as common in adult women as in adult men. Approximately 17% of American men over the age of 60 will be affected with some type of incontinence.

Male urinary incontinence can be acute, temporary, or chronic and result from a number of factors such as:

  • Benign prostatic hyperplasia (BPH, enlarged prostate)
  • The condition can be congenital (i.e., present at birth)
  • Acquired (develop as a result of injury or disease)

Types of Male Incontinence

The types of urinary incontinence are the same in men and women, stress, urge, mixed, and overflow.

  • Stress Incontinence – Occurs when you leak urine during a physical activity like lifting, exercising, sneezing, and coughing.
  • Urge Incontinence – Occurs when there is overactivity of the muscle surrounding the bladder. This overactivity causes your bladder to contract frequently and creates an overwhelming need to urinate – even if you just went. This condition is often is associated with “overactive bladder” and makes it difficult for you to hold your urine long enough to reach a toilet.
  • Mixed Incontinence – A combination of stress incontinence and urge incontinence, in which you have symptoms of both conditions.
  • Overflow Incontinence – When your bladder never completely empties, causing urine to leak by overflowing. If nerves are damaged, the signal never reaches the bladder and it stays full. A weakened bladder muscle can have the same result, and the constant pressure of urine on the neck of the bladder can cause dripping and leaking. This is more common in men with who have an enlarged prostate.

Treatment for Male Incontinence

Treatment for male incontinence depends on the type of incontinence and what the cause is. The patient’s age, overall health, and severity of the condition are all taken in to consideration. Often, by treating the patients’ medical condition (e.g., benign prostatic hyperplasia [BPH, enlarged prostate], urinary tract infection [UTI], and diabetes) can resolve the incontinence issue.

Treatment may include the following:

  • Bladder training, timed voiding
  • Electric stimulation
  • Medications
  • Self-catheterization (particularly for those who have spinal cord injuries)
  • Surgery
  • Pads and other external devices (disposable or reusable adult diapers, male incontinence drip collectors) may be helpful. Other external devices include penile clamps and compression rings, which can be used to stop urine flow.

Behavioral Therapy

Types of behavior therapy include biofeedback and bladder retraining with timed voiding. Kegel exercises, which can strengthen pelvic floor muscles, also may be helpful. In bladder retraining, the patient keeps a voiding diary of urination and leakage and the physician analyzes the information to help the patient learn to empty the bladder before accidental urine loss occurs.

Biofeedback

Biofeedback is a method that provides you real-time information about activity in your bladder and pelvic muscles. As you gain awareness of these functions, you may be better able to control them. When you relax, your muscles give off signals and these sensors will read the signals. The technician can view them on a computer monitor and you will be able to see if you are using the right muscles.

Neuromuscular Electrical Stimulation

This can be used to cause urinary muscles to contract and to retrain and strengthen weak urinary muscles and improve bladder control. A probe is inserted into the anus and current is passed through the probe at a level below the pain threshold (not felt by the patient), causing the muscles to contract. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions last approximately 20 to 30 minutes.

Medications

The most common medications that may be prescribed are Anticholinergic agents, antispasmodic medications, and alpha blockers.

Surgery

Three types of surgery may be used to treat urinary incontinence in men. In some cases, mild symptoms can be treated using injectable fillers such as collagen or a synthetic material. A device called a male sling can also be used to treat moderate to severe urinary incontinence. This treatment is often performed following prostate surgery and involves surgically implanting a mesh-like material to compress the urethra and reduce urine leakage.

Severe male incontinence that does not respond to other therapies may require an artificial urinary sphincter. This treatment involves a device that has three components that are filled with fluid (e.g., saline): a pump, a balloon reservoir, and a cuff that encircles and closes the urethra.

The cuff is connected to the pump, which is surgically implanted in the scrotum and is activated by squeezing or pressing a button. The fluid in the cuff empties into the reservoir, the urethra opens, and the bladder empties. Fluid from the reservoir returns to the cuff, which again closes the urethra.

Prevention

  • Maintain a healthy weight.
  • Quit smoking.
  • Limit intake of bladder irritants (alcohol, caffeine).
  • Exercise regularly.
  • Manage existing medical conditions such as benign prostatic hyperplasia, kidney disease, diabetes.

To learn more about male incontinence, click here.

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Using this helpful chart will assist your doctor with a more accurate diagnosis. It will help you track your pattern of urine leakage. Fill this out for two (2) consecutive 24-hour periods. Record both day and night.

Click here to print a bladder diary

  •  Begin with first urination upon arising.
  •  Record intake amount in ounces and type of fluid (i.e., coffee, juice, water, etc.)
  •  Record urine output and time of urination.
Fluid Intake Fluid Output
Day Time Amount/Type of Fluid Large or Small incontinence spill? Amount Voided (oz.) Reason for Incontinence episode
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Conquering Incontinence

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