Urinary incontinence - the uncontrollable loss of urine - is more than just a physical problem. It can have emotional consequences, too. Whether you leak only a few drops when you cough or laugh, or dribble constantly, or find your entire bladder emptying without warning, incontinence can be so embarrassing it interferes with living a normal, full life. It is a common condition experienced by millions of Americans. Fewer than half the people with incontinence seek help, often because they don't realize that help is available. Fortunately, there are several options to help keep it under control.

Types of Incontinence

ou may not realize it, but there are 3 different types of incontinence. You may have stress incontinence, overflow incontinence, or urge incontinence. You may also experience a combination of incontinence types. Although all people with incontinence experience a loss of bladder control, each type has its own pattern and symptoms. You will be able to identify the type you have by comparing the 3 typical patterns: 

  • STRESS INCONTINENCE is frequently found with women, especially after childbirth, hysterectomy, or other pelvic surgery. Being overweight is also a factor. Coughing, laughing, or sneezing increases pressure on the bladder, which puts pressure on the bladder neck to open. The bladder neck is not able to stay closed and the external sphincter cannot compensate, so leakage occurs. People with stress incontinence may:
    • Leak urine when they sneeze, cough, or laugh.
    • Go to the bathroom more frequently in order to avoid accidents.
    • Avoid exercise because they are afraid this will cause leaks.
    • Sleep through the night, but leak upon getting up from bed in the morning. 
    • Sometimes leak urine when they get up from a chair.
  • OVERFLOW INCONTINENCE may be caused by medical conditions such as a stroke, diabetes, or Parkinson's. Certain medications such as over the counter cold and hay fever pills and tranquilizers may also cause these symptoms. The urethra is narrowed, usually by scar tissue or a prolapsed pelvic organ. The bladder never empties completely, so it is constantly filling. The pressure becomes so great that the external sphincter cannot prevent the leakage of urine. This type of incontinence is important to treat. If the urine remains long enough in the bladder, infections may occur. These infections could affect the kidneys and may become serious in nature. People with overflow incontinence may:
    • Get up frequently during the night to urinate.
    • Take a long time to urinate and have a weak dribbling stream with no force.
    • Urinate small amounts and not feel completely empty afterward.
    • Dribble urine throughout the day. 
    • Feel the urge to urinate, but sometimes can't.
  • URGE INCONTINENCE may be associated with medical conditions such as diabetes, Parkinson's disease and multiple sclerosis. This is because these conditions affect the nervous system. It is the nervous system that controls the messages sent from the bladder to the brain via the spinal cord when it is time to urinate. Bladder infections may also cause urgency and urge incontinence. The brain perceives the urge to urinate although the bladder contains only a small amount of urine. Even if the external sphincter can prevent leakage temporarily, the bladder continues to contract, and the urge to urinate persists. People with urge incontinence may:
    • Wet themselves if they don't go to the bathroom immediately.
    • Get up frequently during the night to urinate.
    • Go to the bathroom at least every 2 hours.
    • Feel they have a weak bladder and that each drink of coffee, cola, or alcohol seems to cause urination out of proportion to the amount they actually drink. 
    • Wet the bed at night.

Diagnosing the Problem 

A proper evaluation will help your physician determine the type of incontinence you have. It also helps rule out other medical problems. A careful, accurate diagnosis is the essential first step in successful treatment. Your evaluation will consist of a medical history, followed by a thorough physical screening that includes a pelvic exam and a rectal exam. Your physician may also order tests to confirm the diagnosis.  At The Center for Women's Health, we have state-of- the-art urodynamics testing equipment to diagnose female incontinence problems.

Urodynamics

When simple, basic tests do not provide enough information for your physician to make an accurate diagnosis and plan appropriate therapy, Urodynamic testing may be done. Urodynamics is a series of simple tests that are performed in our office using specialized testing equipment.

The testing takes approximately 1–1/2 hours. There is no special preparation for Urodynamic testing, but you will be asked to come with a comfortably full bladder in order to complete the first part of the test. Catheters will be inserted during the testing so that fluid can be placed in the bladder to simulate what you normally experiences. This provides the physician with information, helping to diagnose the problem and then offer appropriate treatment options.

No special preparations or medications are needed before the testing. You may eat and take regularly prescribed medications unless informed otherwise. There will be no limitations or restrictions after the testing is completed.

Some of the typical tests done with this equipment are: 

  • CYSTOSCOPY: This test allows the physician look into your urethra and bladder with a small, lighted telescope-like tool.
  • CYSTOMETROGRAM:  In this test, a small, thin tube called a catheter is inserted into the urethra and bladder in order to measure and record bladder pressure.
  • UROFLOWMETRY: This test measures and records the amount and speed of urine as it leaves your bladder.
  • CYSTOMETROGRAM: This test mainly measures how well your bladder stores and lets out urine. It also tests the sensations you feel as your bladder fills.
  • LEAK POINT PRESSURE: This test measures how much pressure it takes to open your urethral sphincter and allow urine to leak.

Treatment

Your treatment plan will depend upon the severity of your problem. Your symptoms, age, and any underlying problems that are found will affect your treatment. You may also wish to make certain lifestyle changes to help make treatments work and ease your symptoms. These lifestyle changes may include quitting smoking, losing weight, and making certain dietary changes.