Urinary Incontinence - Don't avoid treatment because of embarrassment

Urinary incontinence is defined as an involuntary loss of urine. 85% of the 13 million Americans suffering from urinary incontinence are women. Many women do not seek treatment for incontinence, perhaps because of embarrassment or the mistaken belief that nothing can be done. There are several different causes of incontinence. A medical evaluation is usually needed to determine which type of incontinence is present and to allow your physician to recommend appropriate treatments. This article will focus on the most common types of incontinence; stress and urge incontinence.

To understand how the bladder works it is helpful to think of a water balloon. The bulk of the balloon represents the bladder and the neck represents the urethra. Normally the bladder is relaxed and the urethra is contracted allowing urine to stay in the bladder. As the bladder fills with urine it communicates with the brain. Most people can initially suppress the urge to urinate until a convenient time. At that point the brain tells the bladder to contract and the urethra to relax and the bladder is emptied. Think of squeezing the water balloon while releasing its neck. When the bladder is in its normal anatomic position any pressure (squeezing) on the bladder is also transmitted to the urethra and no urine is lost.

The loss of urine with coughing, laughing or physical activity is most suggestive of stress incontinence. This occurs when the normal support of the bladder is weakened. Any increased pressure on the bladder results in loss of urine because the same pressure is not transmitted to the urethra. Think of squeezing the top of the balloon without tightening the neck of the balloon! The causes of stress incontinence are still being investigated but it is thought that a combination of nerve damage during childbirth, weakened pelvic muscles and the age-associated decline in connective tissue strength all contribute to decreased support of the bladder and urethra. Other factors contributing to stress incontinence include obesity, cigarette smoking, chronic cough and constipation.

Stress incontinence may respond to Kegel exercises, estrogen replacement therapy and behavioral therapies. Surgery is an option if conservative therapies don’t work. Many different surgical procedures to treat stress incontinence have been described. New techniques are continually being investigated. A common type of surgery called a retropubic urethropexy has about an 85% cure rate for stress urinary incontinence. As pelvic prolapse (where the uterus and vaginal walls protrude through the vagina) often coexists with stress urinary incontinence it is important to have a complete pelvic evaluation so that all structural defects can be identified and repaired at the same time. This offers the best chance for a cure.

Urge incontinence, also called an "overactive bladder" is quite different from stress incontinence although the symptoms often overlap. Special testing is often required to differentiate between stress and urge incontinence. Women with urge incontinence will have a sudden need to empty their bladder, which cannot be suppressed, resulting in urine loss. Often things such as running water or putting the key in the house door will provoke the loss of urine. Physical activity may also provoke bladder contractions. In urge incontinence the brain has lost control of bladder function resulting in uncontrolled contractions of the bladder and loss of urine. Urge incontinence is treated with a combination of bladder retraining and medications.

Treatment of urinary incontinence can be successful. However it is critical that the proper history, physical exam and tests are done to make the correct diagnosis. If you are suffering from urinary incontinence make sure you tell your physician so that the appropriate evaluation and treatment can be started.