Urinary incontinence: Frequently asked questions

Urinary incontinence is also known as urinary leakage or the loss of bladder control.

Incontinence tends to be somewhat more common as patients age, but certainly it cuts across all age groups and sexes. The good news is that incontinence is generally a very treatable problem. However, it is important to have a complete evaluation prior to treatment.

Patients should not feel embarrassed or apprehensive about talking to their physicians about this condition. The majority of patients can be successfully treated using either conservative or surgical therapy. Incontinence should not be considered an inevitable part of getting older. 

Family physicians are the best source for incontinence information. Physicians can either diagnose and treat the problem or make an appropriate referral for the patient. 

What are the types of incontinence?

Generally speaking, incontinence falls into several categories.

Overflow incontinence 

One can have overflow incontinence where the bladder fills, doesn’t empty, and reaches its capacity and then the patient leaks urine more or less on a continuous basis. 

Stress incontinence 

This type is usually associated with leaking urine with activity such as lifting, coughing, or running. 

Urge incontinence 

This type is caused by a bladder contraction that occurs when the patient is not trying to empty their bladder. Typically, patients will complain that they feel the need to empty their bladder but begin leaking before they can reach a bathroom. 

How are incontinence cases diagnosed?

Taking a history and performing a physical examination are used to diagnose patients with urinary incontinence. 

Usually a urinalysis is performed and, depending on the findings of the history and physical, further testing with either x-ray studies or a urodynamics study may be appropriate. 

Get a full evaluation prior to any treatment because the treatments are different due to the cause of the incontinence.

What are some treatment methods for urinary incontinence?

The treatments for these different types of incontinence generally fall into two categories: conservative management—with either medications, devices such as a pessary, and sometimes biofeedback—and more invasive forms of therapy, such as surgery. 

Your doctor may recommend physical therapy as a means of conditioning muscles that support the pelvic floor.

The type of incontinence, which is diagnosed during the evaluation, will dictate which type of treatment is appropriate.

What are common medications for incontinence?

Probably the most common medications used for the treatment of incontinence fall into the general category of anticholinergics or drugs designed to “relax” the bladder.

What are some newer treatments for incontinence?

Neuromodulation or electrical stimulation of the nerves to the bladder is a newer treatment that holds some promise, especially for those patients with urge incontinence that does not respond to more conservative forms of management. There are also injectable agents, which may be useful in some forms of stress incontinence. These injectables are placed around the urethra to help it coat.

How does incontinence relate to age?

Incontinence should not be considered to be a normal condition of aging. Elderly patients should be evaluated in essentially the same way that patients of any age should be evaluated. Incontinence is certainly more common as patients age, but incontinence can be seen in children, adolescents, and adults.

Is incontinence a problem seen in diabetes?

Incontinence can certainly be seen in people with diabetes. Diabetics tend to have decreased bladder emptying and are somewhat prone to having overflow incontinence, but may also have stress or urge incontinence and therefore need a complete evaluation prior to treatment.

Does pregnancy leave a lasting problem with urinary incontinence?

Certainly not all pregnant patients have incontinence following delivery. But pregnancy can predispose to urinary incontinence, especially in the case of a vaginal delivery.

What are the main causes of urinary incontinence in men and women?

In men, prostate issues are probably the most common reason we see patients for urinary incontinence. In women, pregnancy and vaginal delivery is probably the most common cause of urinary incontinence.

Can incontinence come and go?

Yes, incontinence can come and go depending on its cause. For instance, some patients will complain of stress incontinence only when they have a severe cold with coughing or during periods of excessive activity. 

Patients with urge incontinence frequently report increased leakage during cold weather and sometimes related to dietary factors such as excessive fluid intake, particularly with products containing caffeine such as coffee.

What are Kegel exercises and whom do they benefit?

Kegel exercises are also known as pelvic floor muscle strengthening exercises and are designed to strengthen the muscles that support the pelvic floor and maintain continence. 

Kegel exercises will benefit patients with stress or urge incontinence and are very worthwhile treatments as they have virtually no side effects and a relatively high degree of success.