This is Part One of a two-part series about different types of urine leakage (incontinence)
Urinary leakage (or incontinence) is a problem for millions of men and woman alike. This problem can affect almost every aspect of our lives and often has a profound impact on daily activities and enjoyment. The costs can add up when calculating not just the price of pads but increased risk of urinary tract infections, loss of productivity at work and clothing and other supplies. But the real measure may be the psychologic toll urine leakage exacts. Not dollars, but missed family events, church activities, sporting events, group trips. A cost in strained relationships, social avoidance, even depression.
And despite how common urine leakage is across all ages and abilities, it remains a topic often not discussed. So it is no wonder that for many people there isn’t a real understanding of the types of urinary incontinence or how that impacts evaluation or treatment.
To begin from the more general, urinary incontinence is simply the involuntary or unwanted loss of urine. You want to stay dry, but can’t. Conservative estimates are that 13 million people in the United States suffer from urinary incontinence, though given the reluctance to report incontinence the number is likely larger. For context, that is enough people to fill up 167 Superdomes. But all urinary leakage is not alike and the type of leakage that you suffer from has an enormous impact on the evaluation and treatment options. And it can be hard to tell the difference, especially as many people will have more than one type of incontinence. It is not uncommon for me to see patients who can’t immediately tell me what type of leakage they have. It can be very difficult for their health providers to distinguish as well.
Urinary leakage that occurs when you cough, sneeze, laugh, or exercise is called stress urinary incontinence (or just stress incontinence). It is certainly stressful anytime you leak, but that’s not the kind of stress that’s being talked about. The stress refers to the increase in abdominal pressure that is forcing the urine out. And while laughing or exercising are common causes, I see people who leak while bending over, getting up from a chair or getting out of bed too quickly. This is the kind of incontinence that will keep you from staying active.
It is thought that stress incontinence can result from two related, but somewhat different problems. In one case, the tube that allows urine out of the bladder (the urethra) is not as well supported by the surrounding tissues as a result of age, pregnancy, or the types of tissue we genetically inherit. This excessive movement of the urethra (urethral hypermobility) allows urine to escape the bladder when the pressure in the abdomen increases and we call that incontinence. This is the most common cause of stress incontinence in women.
There is a muscle that surrounds the urethra that squeezes the tube closed when abdominal pressure is trying to force the urine out. We call this the external urethral sphincter and it is among the muscles that are exercised when doing a pelvic floor (or Kegel) exercises. This muscle and its associated tissues may be weakened in some people, which can contribute to stress incontinence as well. This problem may be more commonly found resulting from surgeries on the urethra or neurologic conditions.
Knowing whether you are suffering from stress incontinence can be helpful because the type of incontinence determines how incontinence is treated. If the problems leading to stress incontinence involve excessive movement of the urethra or weakness of the muscle that closes off the urethra, treatments will try to either strengthen the muscles surrounding the urethra, limit the movement of the urethra or partially close off the urethra. The initial therapy for stress incontinence typically involves exercises, either on your own or guided by a pelvic floor physical therapist, intended to strengthen the muscles that surround and support the urethra. If the muscles are strong enough pinch the tube leaving the bladder when you cough, you may not leak anymore.
For some patients, a surgery to stop the excessive movement of the urethra (often this is a mid-urethral sling) is appropriate if they have failed the more conservative therapy and are bothered enough by the leakage. There are other procedures that try to partially close (or bulk) the urethra to maintain closure, as well.
Check back in a couple of days to discuss other types of urinary incontinence, especially as many patients will experience more than one type of incontinence. It may be that by better understanding what type of urine leakage you have, it may be easier to know what treatment options are available and what you can do to gain some control over this problem.