Urinary incontinence is any involuntary leakage of urine, whether it's a large amount or just a few drops.
Tens of millions of men and women in the United States experience urinary incontinence at some point in their lives. There are several possible causes of UI, explored below.
The four most common types of urinary incontinence are:
- Stress urinary incontinence: leakage with physical activity (for example – with coughing, laughing, sneezing)
- Urge urinary incontinence: leakage preceded by a sudden urge to urinate
- Mixed urinary incontinence: a mix of both stress and urge incontinence
- Overflow urinary incontinence: involves leakage due to a bladder that is too full
Urinary incontinence is common, but it can be managed and even reversed, in some cases. The expert urologic team at Weill Cornell offers personalized care and will work closely with you to determine your best treatment option.
Risks and Causes
While the likelihood of experiencing urinary incontinence (UI) increases with age, it is not considered normal by any means, and can interfere with work, socializing, exercise and sexual function.
Causes of UI in women can include weak pelvic floor muscles, overactive bladder, neurogenic (nerves or nervous system-related) bladder, small capacity bladder, obesity (which can put excess pressure on the bladder and urethra) and chronic cough (which increases pressure on the bladder and pelvic floor muscles), among others.
Causes in men can include enlarged prostate, a history of prostate cancer treatment (which can lead to temporary or permanent UI), overactive bladder, neurogenic bladder, chronic obesity, poorly functioning bladder with overflow urinary incontinence or having a weak urinary sphincter, among others.
Symptoms and Evaluation
Patients with stress urinary incontinence experience leakage of a small to moderate amount of urine with activity, such as:
- Sneezing
- Running
- Bending over
- Simply changing positions
Symptoms of urge urinary incontinence include a moderate to large loss of urine immediately preceded by a sudden, strong urge to urinate. Patients with urge urinary incontinence are often not able to make it to the bathroom in time. Some patients experience urge urinary incontinence when they hear running water or get close to a bathroom. Certain foods or beverages may make urge urinary incontinence worse.
Patients with mixed urinary incontinence suffer from symptoms of both stress and urge urinary incontinence. Often, one type seems worse than the other.
Symptoms of overflow urinary incontinence include the continual loss of urine without a sense that bladder is full. Other symptoms associated with overflow incontinence are an incomplete emptying of the bladder, slow urine stream, difficulty starting urination or dribbling of urine after urination is complete. Urine leakage often increases with activity.
Treatment Options
Both non-surgical and surgical treatment options are available for urinary incontinence, depending on which form of incontinence the patient is diagnosed with. Just as in vaginal prolapse, patients are given the choice of non-surgical and surgical options depending on the severity of their condition and their personal wishes. With today's minimally invasive surgeries and excellent results, many are choosing to proceed with surgery; these procedures typically involve a one-week period for recovery and 6 weeks of restricted activity.
Non-surgical treatments:
Kegel exercises:
Kegel exercises are used to strengthen the muscles of the pelvic floor. These exercises can help control stress urinary incontinence, urge urinary incontinence, overactive bladder and fecal incontinence. In addition, they may be used to help slow the progression of vaginal prolapse. Kegel exercises must be done correctly and regularly in order to work.
Pelvic floor therapy:
Pelvic floor therapy consists of visits to a physical therapist with specialized training in pelvic floor disorders. These specialized physical therapists utilize a combination of various techniques, listed below, depending on the type of urogynecological condition they are treating.
Behavioral modification:
Behavioral modification consists of education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms.
Bladder training:
Bladder training consists of learning to use the pelvic floor muscles to suppress overactive bladder symptoms, including urinary urgency, frequency, nocturia and urge urinary incontinence.
Biofeedback:
Biofeedback uses an intravaginal device to train pelvic floor muscles to contract and relax properly.
Functional electrical stimulation:
Functional electrical stimulation utilizes a device that can be used intravaginally or externally, delivering a gentle electrical current to activate or relax the nerves and muscles in the pelvis.
Manual therapy:
Manual therapy uses pressure applied to and released from muscles in spasm, in order to relax them and increase blood flow to the area for healing.
Joint and tissue mobilization:
This therapy involves gentle manipulation to help calm the muscles and nerves of the pelvis.
Low-dose vaginal estrogen:
Low-dose vaginal estrogen replaces declining estrogen in vaginal and urethral tissues, easing symptoms of vaginal dryness, itching and irritation as well urinary urgency, frequency and incontinence. Low-dose vaginal estrogen comes in a variety of preparations including a cream, suppository or intravaginal ring.
Vaginal pessary:
A vaginal pessary is a removable, diaphragm-like device worn within the vagina to support the bladder or other organs that are prolapsing through the vagina. A vaginal pessary may also be used to decrease stress urinary incontinence. Pessaries come in a variety of types and sizes. Pessary fitting may require two or more office visits in order to select the proper type and size of pessary that will work for you.
Urethral insert:
A urethral insert is a small disposable device worn in the urethra to temporarily block leakage of urine due to stress incontinence. The device is removed for urination.
Various overactive bladder medications:
There are several brands of overactive bladder medications on the market to treat urge urinary incontinence. These medications work by relaxing the bladder muscle. Side effects are usually mild and include dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness or drowsiness. Changing the brand or dose of medication can decrease side effects.
Surgical treatments:
Midurethral sling:
A midurethral sling is a small strip of material that is placed beneath the urethra. It provides a firm surface against which the urethra can be compressed during physical activity to prevent stress urinary incontinence. In female patients, this procedure involves a small incision in the vagina. In men, the incision is made in the perineum (the area between the scrotum and the anus). There are a variety of types of midurethral slings.
Urethral injections:
A transurethral or periurethral injection is a simple outpatient procedure in which a substance is injected to narrow the urethra and prevent leakage.
Sacral nerve modulation:
Sacral nerve modulation is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. Sacral nerve modulation uses a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally.
Chemodenervation of the bladder (botulinum toxin type A):
Currently, it is considered third line therapy for overactive bladder/urge urinary incontinence. It can be very effective in patients with neurogenic bladder or urge urinary incontinence who are not responsive to anticholinergic medications.
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If you'd like to learn more about each of our providers that specialize in urinary incontinence, please visit the "Our Care Team" page.