Urinary Incontinence

There are several different types of urinary incontinence. It often takes a visit to your doctor’s office to receive the testing necessary to confirm your diagnosis and form the best treatment plan for your urinary leakage.

There are two main kinds of chronic incontinence: stress incontinence and urge incontinence.

Stress Incontinence

Stress incontinence is the most common type of bladder control problem in women — especially after childbirth — but, it also occurs in men.

This type of urinary leakage occurs when a person coughs, sneezes, or participates in exercises or activities that increase abdominal pressure.

Urge Incontinence

Urge incontinence happens when you have a strong need to urinate but can't reach the toilet in time.

Mixed Incontinence

Mixed incontinence is a combination of different types of bladder control problems, usually stress and urge incontinence.

Bladder obstruction

A blockage of the outflow of urine from the bladder

Potential causes:

• Benign prostatic hypertrophy

• Strictures that cause narrowing of the urethra

• Diseases that affect the nerves associated with urinary sphincter function; common example: multiple sclerosis

Loss of contractility

When the bladder loses its contractile power, and can no longer efficiently squeeze out urine.

Potential causes:

• Pelvic surgeries such as a hysterectomy or major bowel surgery

• Lower back surgeries

• Diseases that affect the nerves associated with bladder function; common examples: multiple sclerosis, diabetes

Loss of bladder control is an important health problem known to affect a large number of women. Since many women do not seek help for symptoms of urinary incontinence, it is impossible to know exactly how many suffer with unintended urine loss.

Adult women are twice as likely as adult men to experience bladder and pelvic health problems due to:

• Physical differences in the pelvic anatomy
• Physical changes after pregnancy and childbirth
• Physical changes related to the loss of estrogen after menopause

There is no one cause for female urinary incontinence, but several risk factors do exist, such as:

• Childbirth

• Urinary tract infections

• Menopause

• Prior pelvic surgeries, such as radical hysterectomy

• Increased weight

• Neurologic illnesses, such as multiple sclerosis, diabetes, or stroke

• Advanced age

Men can experience loss of bladder control after certain illnesses or surgeries or simply as a result of aging.

Although male incontinence may have many causes, men are much more likely than women to suffer from overflow incontinence. This is because men have prostates that may become enlarged with age and block the outflow of urine from the bladder.

Some risk factors for male incontinence:

• Prostate enlargement

• Urinary tract infections

• Prior pelvic surgeries, such bowel resection or prostatectomy

• Neurologic illnesses, such as multiple sclerosis, diabetes, or stroke

• Advanced age

Male Incontinence & Prostate Cancer

Many men experience incontinence caused by an enlarged prostate gland, surgical removal of the prostate or external beam radiation to treat prostate cancer.

Particularly if you have stress incontinence, your physician will likely recommend a non-surgical approach and medication. Our physical therapists specialize in teaching techniques on an individual basis to help women and men regain bladder control.

Components may include:

• Simple, effective exercises to help strengthen the pelvic floor muscles, also known as Kegel exercises. These exercises, which can be done at home, are highly successful for many individuals with urinary incontinence.
• Biofeedback, a painless technique for learning to control pelvic floor muscles
• Education on lifestyle changes to decrease bladder irritability including fluid and diet management
• Maintaining a voiding diary and making scheduled bathroom trips
• Relaxation and breathing techniques
• Various types of medication including anti-spasmodic drugs that help calm an overactive bladder

If your condition requires surgery, our urogynecology and urology experts offer several minimally invasive procedures using today's most advanced surgical techniques. Individual treatment depends on the type of problem you have and what best fits your lifestyle. 

Treatment for Female Incontinence

Pessary

A pessary is a ring that the physician or nurse inserts into the vagina. This helps reposition the urethra to help reduce stress incontinence.

Urethral Bulking

Another option for some women is a minor procedure during which the physician injects a substance into the wall of the urethra to “bulk it up” to help reduce leakage. During this procedure, the doctor inserts a thin tube called a cystoscope into the urethra and injects collagen or a similar substance into the tissue around the urethra.

Vaginal Sling (Midurethral Sling)

One of the most common surgeries for stress incontinence is the placement of a "sling" under the urethra. During this minimally invasive outpatient procedure, the surgeon inserts a strip of lightweight mesh under the urethra through a small incision in the vagina. The mesh helps the urethra remain closed when appropriate, preventing involuntary urine leakage.

Treatment for Male Incontinence

Artificial Sphincter

This implanted device that keeps the urethra closed until men are able to urinate. The device includes a cuff that fits around the urethra, a small balloon inserted in the abdomen and a pump placed in the scrotum. When it is time to urinate, the man squeezes the pump to open up the cuff so that urine moves into the balloon and flows out the urethra.

Male Sling

The surgeon wraps a strip of material round the urethra and attaches the ends to the pelvic bone. This puts more pressure on the urethra, providing extra support so it doesn’t release urine accidentally.