Cornelius K. Smith, M.D.

Urologist at Dreyer Medical Clinic - Mercy Campus

Urinary incontinence, or loss of bladder control, can happen to anyone. It is more common in older people, although not an inevitable consequence of growing older. The involuntary leakage of urine affects more than 20 million Americans. Only about one in ten seek medical help. One in four women between the ages of 35 and 60 has had an episode of urine loss.

Because of the fear of having an accident, men and women alike will give up exercise, socializing with friends, going to the theater or traveling, or even enjoying a good laugh. Incontinence can disturb your sleep and worry you throughout the day.

The first and most important step is to see your doctor to get an accurate diagnosis, since any number of conditions can affect how well the bladder functions. Incontinence can occur if you have other medical problems like diabetes, Parkinson’s disease, or strokes. It could also be the result of a previous surgery such as a hysterectomy, prostatectomy, or rectal surgery. Multiple pregnancies, menopause (when a decrease of hormones occurs), and some medications, like diuretics and anti-depressants, can also cause incontinence.

Your doctor will take a detailed history, check urine samples, and perhaps refer you to a gynecologist or urologist. It may be a good idea to keep a voiding diary to keep track of the amount you urinate as well as the occurrences of incontinence to share with your doctor. A complete physical exam, including a rectal and/or vaginal exam, as well as diagnostic tests such as cystoscopy (a look in the bladder), urinalysis, ultrasound of the kidneys, and x-rays of the bladder might be done to determine what type of incontinence you have. How long the condition has been present and the frequency of leakage are also important in making a diagnosis.

There are five common types of urinary incontinence:

• Urge incontinence, or having an overactive bladder or a sudden sensation to void, can cause people to wet themselves trying to reach a toilet. Some of these patients may be suffering from other illnesses, such as diabetes or a neurological problem like multiple sclerosis.
• Overflow incontinence is due to incomplete bladder emptying with constant dribbling and frequent urination.
• Functional incontinence can happen to many older people who have normal control but difficulty getting to a toilet because of arthritis or some other disabling disorder.
• Stress incontinence occurs when someone leaks urine due to physical exertion during exercise, coughing, sneezing, laughing, or lifting heavy objects, and is most common in women. It has nothing to do with psychological stress.
• Mixed incontinence is having more than one type, typically stress incontinence and urge incontinence, for which the cause may or may not be related.

People with total incontinence are constantly wet, even at rest.

Treatment options available today are determined by the type of incontinence and include behavioral techniques, a wide range of medications, special exercises to help strengthen pelvic floor muscles, making lifestyle changes such as limiting alcohol and caffeine, bladder retraining, collagen injections, adding support to the bladder, and surgery. Your doctor can help you determine which type of treatment or combination is best for you.

To do the pelvic floor muscle exercises called Kegels, imagine you are trying to avoid passing gas. Squeeze the muscles you would use and hold for a count of five. Relax, count to five again, and repeat. You can do Kegels almost anywhere, while watching TV or cooking, driving, or sitting at your desk. Try to complete up to 50 a day.

The good news is that most cases of urinary incontinence can be successfully treated and controlled, if not completely cured. Up to 80% of cases of female incontinence are treatable.