Answers to Your Questions About Urinary Incontinence

Urinary Incontinence (UI) is simply any loss of control of your bladder. Any amount of urine that leaks out when you don’t want it is called urinary incontinence. Urine leakage can be a few drops that leak when you are exercising or a large amount that can soak through even the heaviest pads. There are several types of urinary incontinence, the most common of which are Stress Incontinence (SUI) and Urgency Incontinence (UUI). Many people have both stress and urgency incontinence and this is called Mixed Incontinence (MUI). Both men and women can experience urinary incontinence including SUI and UUI. However, men most commonly have stress incontinence following prostate surgery or radiation while women experience stress incontinence during or after pregnancy or sometimes with advancing age. While incontinence is very common, it is never considered “just a normal part” of life, whether you are younger or older.

Urinary Incontinence is a source of considerable distress for millions of people. Given how drastically it can alter your life, you deserve to have your complaints about incontinence taken seriously and treated appropriately. But, most of the time, you do not need to worry about a more serious condition causing the incontinence. For most people, asking questions about your history and symptoms and perhaps performing a urine test, can be useful in ruling out a more serious concern. There are some bladder warning signs that may prompt a more in-depth evaluation of your bladder symptoms.

Incontinence is often described as either Stress Incontinence (SUI) or Urgency Incontinence (UUI) because these names help describe what is occurring at the time of the leakage. In SUI, the “stress” refers to increases in abdominal pressure that occur when coughing, laughing, sneezing, exercising, or even just bending over. These activities increase the pressure in the bladder and can force urine out if the muscles that keep urine in the bladder are not working appropriately. While most people associate this kind of incontinence with exercising or coughing or laughing, it is helpful to note that anything that increases abdominal pressure can cause stress incontinence. Lifting up a child, reaching over to pick up something, getting up out of a chair - all of these increase abdominal pressure and can lead to stress incontinence. It can help to think (or even write down) what you are doing when incontinence occurs. This can help to identify whether you leak with stress, urgency or both.

Like many diseases, it is often difficult to assign just one cause for SUI in any one person. Research has suggested that, in women, several factors such as advanced age, pregnancy/childbirth, obesity, smoking or genetics can all contribute to your risk of SUI. Some of these factors, such as smoking or obesity can be reversed (although, it can be very difficult to quit smoking or lose weight). Other factors such as age and genetics, we can do nothing about. SUI in men is most often the result of prostate surgery or radiation therapy to treat prostate cancer.

Treatment for SUI often begins with pelvic floor exercises (commonly referred to as Kegel Exercises). These exercises help to strengthen the muscles that are responsible for keeping the urine inside of you as the pressure in your bladder rises (such as from sneezing). Many people find that pelvic floor exercises can be even more effective if guided by a specialist called a pelvic floor physical therapist. Others may be able to perform the exercises well on their own with some education. It can take several weeks for daily exercise to see a response to pelvic exercises so be patient with yourself. It is important to remember that pelvic floor exercises should be continued on a regular basis to maintain the benefits.

Another non-surgical treatment for SUI are incontinence pessaries. These are small devices that are placed within the vaginal canal and compress the urethra. The compression helps to prevent urine loss with increases in abdominal pressure. Incontinence pessaries can be fitted in a doctor’s office but more recently over-the-counter incontinence pessaries have become available. Pessaries do have to be removed frequently and can cause discomfort in some women. However, they have low risk for harm and can provide improvement in SUI in appropriate patients.

Surgical Therapies

Unfortunately, some people either do not see satisfactory improvement or do not tolerate more conservative therapies like pelvic floor exercises. Surgical therapy for SUI may be appropriate in these cases. There are several types of surgical therapy for stress incontinence but the most common of these are synthetic slings. Slings help to support the urine urethra and help to improve incontinence. There many options for the type of sling to choose from, though most have fairly similar effectiveness and safety. Even though slings are generally safe, there are some risks for any surgical incontinence surgery and these should be considered. You should try to balance how much improvement you can expect from a sling against any risks that are involved.

From pelvic floor exercises that you can do on your own to surgical therapies performed by a doctor, there are many options for treatment of SUI. If you are bothered by your symptoms, there is a lot that. you can do and many resources to help you to be successful.

Urgency Incontinence (UUI) is urine leakage that is often associated with a strong need to urinate with patients unable to reach a bathroom in time to prevent urine leak. It is usually distinguished from SUI that occurs specifically with activities that increase abdominal pressure such as exercise. Urgency incontinence is a component of Overactive Bladder (OAB) for many. Some people report sudden incontinence without noticing much of an urgency to urinate. This may occur while sleeping or while awake and is not caused by strenuous activity. This may be a type of Urgency Incontinence as well.

Most people with Urgency Incontinence (UUI) have a condition called Overactive Bladder (OAB) that causes frequent and urgent urination. There are a lot of factors that are thought to be associated with OAB and UUI (age, diet, smoking, genetics) but none of these are likely to fully explain having UUI in any one individual. There is still a lot that is unknown about OAB. There are other, less common, causes of Urgency Incontinence that are occur with neurological disorders. These conditions which cause a “neurogenic bladder” most often have symptoms elsewhere in the body.

Treatment of Urgency Incontinence (UUI), when it is caused by Overactive Bladder (OAB), usually begins with behavioral therapies. These therapies include avoiding foods that irritate the bladder (like caffeine), bladder training by urinating at specific intervals and exercises for the pelvic muscles that can help suppress the urge to urinate. Many patients will improve by taking medications if behavioral therapies alone are not enough. Finally, some patients are not improved with either behavioral therapies or medications. If symptoms are moderate to severe, then patients may wish to consider treatments that target the nerves to the bladder more directly. These treatments include neuromodulation and botulinum toxin injections of the bladder. At the bottom of our guide to Overactive Bladder, you will find links with detailed information about all of the treatments for urgency incontinence.

While it seems easy to classify urine leakage as either Stress Incontinence (SUI) or Urgency Incontinence (UUI), the reality for many people is not so simple. It is common, especially in women, to experience both SUI and UUI. It can be helpful to determine if one type of incontinence is more bothersome than the other to help focus therapy. However, it is frequently necessary to treat both types of incontinence. This may mean that some patients may need to have two different types of treatment at the same time. It can be helpful to note that some therapies (such as weight loss or pelvic floor exercises) may be able to help with both Stress Incontinence and Urgency Incontinence.