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Urinary Incontinence Guide: Causes, Types & Treatments
- 3. Today We Will Discuss: • Describe how the bladder works • Definition of urinary incontinence • Common causes of urinary incontinence • Treatment of urinary incontinence
- 4. How Do the Bladder and Urethra Work?
- 5. How do the bladder and urethra work ?
- 8. What Is Urinary Incontinence? • Urinary incontinence (UI) is the involuntary loss of urine
- 9. How Common Is Urinary Incontinence? • Over 12 million Americans suffer from urinary incontinence • Urinary incontinence is most common in women and people over the age of 50
- 10. How Common Is Urinary Incontinence? • About one in three people over the age of 60 is incontinent • 8.5 million do not seek treatment • Most people with urinary incontinence can be treated successfully and many can be cured
- 11. What Are the Causes of Urinary Incontinence? • Aging • Illness • Injury
- 12. Causes of Urinary Incontinence • Age: – Physical changes resulting from pregnancy, childbirth and menopause can cause urinary incontinence in women – Men over the age of 40 have a higher risk of developing prostate cancer – an early sign of the disease is urinary obstruction, a form of incontinence
- 13. Causes of Urinary Incontinence • Illness: – Removal of the prostate gland as a treatment for prostate cancer may cause urinary incontinence in men – Urinary tract infections, bladder irritants and other diseases (such as diabetes) may also cause urinary incontinence for both men and women
- 14. Causes of Urinary Incontinence • Injury: – Stroke, injury or damage to the nervous system may cause urinary incontinence
- 15. The Effects of Daily Habits on Urinary Incontinence • Fluid intake • Bathroom habits • Bladder irritants
- 16. The Effects of Daily Habits on Urinary Incontinence Potential bladder irritants: • Milk and milk products • Citrus fruit and juice • Tomato-based products • Spicy foods • Sugar and carbonated beverages • Caffeine and Alcohol
- 17. Types of Urinary Incontinence • Stress incontinence • Urge incontinence • Overflow incontinence • Mixed incontinence
- 18. Stress Incontinence • “I laughed so hard that the tears were running down my legs.” Patient of Dr. Baum
- 20. Types of Urinary Incontinence • Stress Incontinence: – Involuntary relaxation of the muscles supporting the bladder and urethra – Involuntary loss of small volumes of urine – Occurs during activities like coughing, sneezing, laughing, lifting heavy items or exercising – Occurs most frequently in women
- 22. Types Of Urinary Incontinence • Urge Incontinence or Overactive Bladder: – Urgent need to urinate and the inability to control it – a sudden bladder contraction is followed by the involuntary loss of urine – Involuntary loss of large volumes of urine
- 23. Types of Urinary Incontinence • Urge Incontinence: – Frequent urination, >8 times within a 24 hour period – Getting up >2 times during the night to urinate
- 24. Types of Urinary Incontinence • Overflow Incontinence: – Inability to empty bladder, causing the bladder to become overfilled and leak – Prostate enlargement in men over age 40 may cause this type of incontinence
- 25. Types of Urinary Incontinence • Mixed incontinence: – A combination of two different types of urinary incontinence – Usually affects older women
- 26. Incontinence in Men • Nerve problems Diabetes, Stroke, OAB • Prostate disorders Enlarged prostate gland Prostate cancer – surgery, radiation
- 27. How Is Incontinence Diagnosed? • Medical history and physical examination • Screening tests • Urologic evaluations
- 28. Diagnosis of Urinary Incontinence • Screening tests: – Urination diary – Urinalysis – Blood tests (glucose and calcium tests)
- 29. Diagnosis of Urinary Incontinence • Urologic evaluations: – Cystoscopy – Cystometrogram – X-rays or sonograms
- 30. Treatment of Urinary Incontinence • Behavior techniques • Drug therapy • Mechanical devices • Surgery
- 32. Treatment of Urinary Incontinence • Behavior therapy: – Bladder retraining – Pelvic muscle exercises • Kegel exercises (for men and women) – contracting the pelvic floor muscles • Vaginal cones – used in conjunction with Kegel technique to enhance the performance of the exercises in women
- 33. Treatment of Urinary Incontinence • Behavior therapy: – Advantages • Inexpensive • Useful for mild stress incontinence – Disadvantages • Requires high levels of motivation • Requires three to six months for results • May require life-long continuation of therapy
- 34. Treatment of Incontinence in Women • Drug therapy: – Bladder relaxants – Estrogen
- 35. Treatment of Incontinence in Men • Drugs: alpha blockers, drugs to shrink the prostate bladder relaxants
- 36. Treatment of Urinary Incontinence • Drug therapy: – Advantages • Simple to use • Inexpensive • Most effective for urge incontinence or overactive bladder – Disadvantages • Requires continuous use • Side effects
- 37. Treatment of Urinary Incontinence • Drug Therapy: – Side effects of bladder relaxants: • Dry mouth • Constipation (rare) • Blurred vision (rare) – If you take medication for other conditions, such as glaucoma or diabetes, talk to your doctor about the possible risks of drug interactions
- 38. Treatment of Urinary Incontinence • Drug therapy: – Estrogen therapy: • For stress and urge incontinence in post-menopausal women • Restores blood supply to the lining of the vagina and urethra • Premarin cream and tablets
- 39. Treatment of Urinary Incontinence • Mechanical devices: – Pessary (for women) – Bladder neck support device – a prosthesis used to restore the normal anatomic relationship between the bladder and urethra – Urethral insert – a small plug inserted into the urethra and removed for urination
- 40. Treatment of Urinary Incontinence • Medical devices: – Advantages • Inexpensive • Painless – Disadvantages • Must be worn continuously
- 41. Treatment of Urinary Incontinence • Surgery: – For mixed and stress incontinence – Returns bladder and urethra to normal anatomical position
- 42. Treatment of Incontinence in Women • Types of surgical procedures: – Open surgery – Needle bladder neck suspension – Tension free vaginal tape (sling)
- 43. Treatment of Urinary Incontinence • Types of surgical procedures: – Tension free vaginal tape: • Advantages: – Most effective treatment for stress and mixed incontinence – Procedure can be performed using local or general anesthesia (in 20 to 30 minutes) – Immediate results
- 44. Treatment of Incontinence in Women • Types of surgical procedures: – Tension free vaginal tape: • Advantages: – Most women require no pain medication – 85 percent success rate • Disadvantages – Recovery period is one to two days – Six weeks to return to normal activities
- 45. Take Home Message • There is no such thing as an average women. Each woman is unique and requires her own special attention.
- 46. Treatment of Incontinence in Men • Artificial sphincter
- 47. Treatment of Incontinence in Men • Male Sling
- 48. Summary • Urinary incontinence is not a normal part of aging, it is a symptom of something else • Talk to your doctor • Evaluation of urinary incontinence is easily accomplished by your doctor • Medication, exercises and surgery can help restore bladder control
- 49. Questions
Editor's Notes
- Welcome! Today’s topic is urinary incontinence.
- We will learn the definition of urinary incontinence; common causes of urinary incontinence; what you can do to find out if you have urinary incontinence; and ways to treat it.
- You have urinary incontinence when you are not able to keep urine from leaking from your urethra. The urethra is the tube that carries urine out of your body from your bladder. The bladder stores urine until you are ready to go to the bathroom to empty it. The bladder is a round organ that swells like a balloon when full, and shrinks to a smaller size when empty. The opening of the bladder contains circular muscles called sphincters, which keep urine from leaking out. The sphincter relaxes to allow the flow of urine when you go to the bathroom.
- Urinary incontinence, also referred to as UI, is the involuntary loss of urine. Your bladder leaks and you cannot control it. The bladder normally stores urine until you want to empty it. But if you leak urine when you do not intend to, you may have urinary incontinence.
- Over 12 million Americans suffer from various types of urinary incontinence. Although anyone can be affected, women are twice as likely as men to suffer from urinary incontinence and it is most common in people over the age of 50. The loss of bladder control is a common problem that affects both men and women at any age. It can be embarrassing and distressing to a person, which is why the problem often remains unreported to doctors. The severity of incontinence ranges from occasionally leaking urine, to a sudden and strong urge that leaves no time to get to the bathroom.
- About one in three people over the age of 60 is incontinent. Due to the embarrassment of the condition, 8.5 million people do not seek treatment. Many people learn to live with the symptoms of urinary incontinence and avoid situations where they may have an accident. Fortunately, most people with urinary incontinence can be successfully treated and many can be cured.
- Urinary incontinence is usually caused by aging, illness or injury.
- Urinary incontinence is not a normal part of aging, it is a symptom of another issue. As women age, the physical stress and changes from pregnancy, childbirth and menopause can cause urinary incontinence. As men age, they have a higher risk of developing prostate cancer. Urinary incontinence in men may be an early symptom of the disease.
- Urinary incontinence may be caused by the removal of the prostate gland in men being treated for prostate cancer. It may also be caused by other illnesses such as, urinary tract infections or diabetes for both men and women.
- Stroke, injury or damage to the nervous system may also cause urinary incontinence.
- Bladder function can also be influenced by many aspects of daily life. Fluid intake can affect bladder function. Adequate fluids are vital to normal function of the urinary tract, inadequate fluid intake can result in concentrated urine that is irritating to the bladder. Good bathroom (toileting) habits can also make a difference. Chronic holding of urine can over-stretch the bladder. However, going too often may lead to the bladder’s inability to hold normal amounts of urine. Certain foods can also be irritating to the bladder and cause urinary incontinence.
- Potential bladder irritants include milk, milk products, citrus fruits and juices (grapefruit, orange, lemon and lime), tomato-based products, spicy foods, sugar, artificial sweeteners, carbonated beverages and alcohol. If you think you may be having a problem with bladder irritants, remove certain foods from your diet for a week to see if your urinary incontinence symptoms improve. You may not have to eliminate these foods entirely, just eat them less frequently in smaller amounts.
- Incontinence can be a short-term or long-term problem. Two types of incontinence, stress and urge, are related to the body’s failure to store urine. Overflow incontinence is a result of the body’s inability to empty urine. Some people may have symptoms of both stress and urge incontinence simultaneously – this is called mixed incontinence.
- Stress incontinence is the involuntary relaxation of the muscles supporting the bladder and urethra, releasing small volumes of urine. This type of incontinence normally occurs during exercise, coughing, sneezing, laughing or any movement that puts pressure on the bladder. It occurs most often in women and is often thought to be the result of pelvic relaxation of tissues from childbirth or aging.
- Urge incontinence or overactive bladder is characterized by a strong, urgent need to urinate followed by instant bladder contraction and the involuntary loss of urine. Once you realize you need to urinate, you don’t have enough time to exercise any control before you actually urinate. Urge incontinence or overactive bladder involves the involuntary loss of large volumes of urine.
- Urge incontinence is also characterized by frequent urination, such as using the bathroom eight times within a 24 hour period. If you find yourself getting out of bed more than twice during the night to use the bathroom, you may have this type of incontinence
- Overflow incontinence occurs when a person cannot completely empty their bladder. The bladder then becomes overfilled and leaks. Those suffering with overflow incontinence find they constantly have a full bladder requiring frequent urination, a constant dribbling of urine – or both. An enlarged prostate in men over age 40 may cause this type of incontinence.
- Mixed urinary incontinence is having the symptoms of two types of incontinence, usually stress incontinence and urge incontinence, at the same time. It tends to occur in older women.
- A comprehensive medical history and physical examination are necessary to diagnose incontinence. Your doctor needs to find out about the circumstances associated with the onset of your incontinence and determine any medical conditions that may affect urinary tract function. A physical exam is performed to assess any abnormalities. To determine the type and severity of incontinence, a number of screenings and urologic evaluations are used.
- There are several screening tests used to assess urinary incontinence. A urination diary can help determine if you have UI. It records the timing, symptoms and associated factors of incontinence. A urinalysis can evaluate how well the urinary tract functions and test for infection. Blood, glucose and calcium tests are also conducted to make an accurate diagnosis.
- Urologic evaluations examine the bladder more closely. A cystoscopy inspects the inside of the lower urinary tract (including the bladder, urethra and prostate gland) in search of abnormalities. A cystometrogram measures bladder activity, pressure and sensation. X-rays and sonograms take computerized pictures that can reveal detailed information about the bladder, such as size, thickness, the presence of blockages or any abnormalities.
- Because urinary incontinence is a symptom and not a disease, the method of treatment depends on the diagnosis. Sometimes urinary incontinence can be cured by changes in diet or fluid intake. Sometimes other types of treatments are needed. These treatments include: behavior techniques, drug therapies and mechanical devices that may be used alone or together to treat incontinence. Surgery may be considered when other options fail.
- Behavior therapy involves using a few different techniques. Bladder retraining helps prevent accidents by going to the bathroom on a schedule, with the length of time between bathrooms trips gradually increased. Pelvic muscle exercises help strengthen weak muscles around the bladder to prevent leakage. Doing simple pelvic exercises, like the Kegel technique, several times daily will strengthen your pelvic floor muscles. Vaginal cones are used in conjunction with Kegel exercises to enhance the performance of these exercises in women.
- There are some advantages and disadvantages with behavior therapy. The advantages are that behavior therapy is inexpensive and useful for mild incontinence. The disadvantages of behavior therapy is that it requires a high level of motivation, it takes three to six months to see results and it may require life-long behavior changes.
- Certain medications can be prescribed to improve incontinence. Drug treatment for urge incontinence helps calm the overactive bladder by suppressing urges and contractions, therefore helping the bladder hold larger amounts of urine. Bladder relaxants block certain receptors in the bladder and reduce symptoms, such as frequent urination and sudden urges. Your doctor may prescribe Detrol® LA, Ditropan XL® (generic name oxybutynin ER) or Flavoxate to help with these symptoms. For women who are postmenopausal, hormone replacement therapy with estrogen may help reduce symptoms.
- The advantages of bladder relaxants are that they are simple to use, inexpensive and are the most effective treatment option for urge incontinence or overactive bladder. However, the disadvantages of bladder relaxants are that they require continuous use and have side effects.
- The side effects of bladder relaxants are: dry mouth, constipation (rare) and blurred vision (rare). It is very important to inform your doctor if you are taking medications for other conditions, such as glaucoma or diabetes, because of possible drug interactions.
- Estrogen drug therapy may be used for stress and urge incontinence in post-menopausal women to restore the blood supply to the lining of the vagina and urethra. Hormone replacement therapy is available in oral preparations, such as Premarin tablets, as well as vaginal creams, such as Premarin cream.
- There are a few mechanical devices used to treat urinary incontinence. One is a mechanical device called the pessary, which is inserted in the vagina to hold up the bladder and prevent leakage. It helps reduce leakage by pressing against the wall of the vagina and nearby urethra. Other devices include: the bladder neck support device (a prosthesis used to restore the normal anatomic relationship between the bladder and urethra) and the urethral insert (a small plug that is inserted into the urethra and removed for urination).
- The advantages of using mechanical devices to treat UI is that they are inexpensive and painless, however they must be worn continuously which is viewed as a disadvantage.
- If incontinence does not respond to lifestyle changes or medication, surgery may be needed. The type of surgery performed will depend on the type and cause of incontinence. Surgical procedures are most often performed for mixed and stress incontinence to remove blockages or return the bladder and urethra to a normal anatomical position.
- There are a few types of surgical procedures for mixed or stress incontinence. Open surgery is the traditional method in which a surgeon makes an incision through the abdomen and uses special instruments to perform a procedure that corrects or eases urinary incontinence. Urinary surgery includes a variety of procedures depending on the diagnosis. Needle bladder neck suspension surgery supports the urethra by stitching it to tissues on the pelvic floor. A new surgical approach uses tension free vaginal tape (also called OB-tape) to help support the urethra.
- Tension free vaginal tape supports a sagging urethra with a mesh-like tape that acts as a sling or hammock to hold the urethra in its normal position. When you cough or move vigorously, the urethra will remain closed and there will be no accidental leaking of urine. The advantages of tension free vaginal tape are: it is the most effective treatment for stress and mixed incontinence, the procedure can be performed using general anesthesia (in 20 to 30 minutes) and it has immediate results.
- More advantages of tension free vaginal tape are that most women require no pain medication and there is an 85 percent success rate. The disadvantages of tension free vaginal tape are a recovery period of one to two days, six weeks to return to normal activities and possible catheterization (rare).
- Thank you for joining us today. Please remember that urinary incontinence is not a normal part of aging, it is a symptom of something else. Don’t just learn to live with UI, talk to your doctor. Evaluation of urinary incontinence is easily accomplished by your doctor and there are many effective treatments that can help restore bladder control.
- Are there any questions?