“Don’t make me laugh until I can cross my legs…” “I gave up running because it was too embarrassing to have to wear pads…” If you can relate, then you are not alone. Over 50% of adult women in the United States experience urinary incontinence, which is loss of bladder control or leaking urine. Men suffer from this as well, with 11-34% prevalence reported in various studies, and more common with advancing age.
In order to understand why urinary incontinence occurs, you need to know what is involved in normal function. Urine is made by the kidneys and stored in the bladder. The bladder has muscles that tighten when you need to urinate. When the bladder muscles tighten, urine is forced out of your bladder through a tube called the urethra. At the same time, sphincter muscles around the urethra relax to let the urine out of your body. Pelvic floor muscles contract at the same time and assist the bladder in emptying urine and also support the urethra position.
The pelvic floor muscles that support the bladder, urethra, uterus, and bowels may become weaker or damaged with certain health conditions and with aging. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate. This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.
- Stress incontinence. This is the most common type of incontinence. Stress incontinence can happen when weak pelvic floor muscles put pressure on the bladder and urethra by making them work harder. Everyday actions that use the pelvic floor muscles, such as coughing, sneezing, or laughing, can cause you to leak urine. Sudden movements and physical activity can also cause you to leak urine. This is more common in women.
- Urge incontinence. Urine leakage usually happens after a strong, sudden urge to urinate and before you can get to a bathroom. Urge incontinence is sometimes called “overactive bladder.” This is more common in older men.
- Mixed incontinence. Urinary incontinence with components of both stress and urge incontinence.
Causes of Urinary Incontinence
In women, the most common causes of urinary incontinence include pregnancy, vaginal childbirth as well as previous hysterectomy. With aging and onset of menopause, even women without pregnancy or surgical history can suffer from urinary incontinence.
In men, the most common cause urge incontinence is enlarged prostate which constricts the urethra, causing back up of urine in the bladder. Aging changes but also surgery for enlarged prostate or prostate cancer result in damage and weakening of the pelvic floor muscles and cause stress incontinence.
Other causes of urinary incontinence in both women and men include:
- Having excess weight puts pressure on the bladder, which can weaken the muscles over time.
- Chronic constipation, or straining to have a bowel movement, can put stress or pressure on the bladder and pelvic floor muscles. This weakens the muscles and can cause urinary incontinence or leaking.
- Damaged nerves may send signals to the bladder at the wrong time or not at all. Health problems like diabetes and Parkinson’s disease or multiple sclerosis can cause nerve damage in the bladder, urethra, or pelvic floor muscles.
Sometimes urinary incontinence lasts only for a short time and happens because of other reasons, including:
- Urinary incontinence may be a side effect of medicines such as diuretics, sedatives, muscle relaxants and often goes away when you stop taking the medicine.
- Drinks with caffeine can cause the bladder to fill quickly, which can cause you to leak urine. Studies suggest that women who drink more than two cups of drinks with caffeine per day may be more likely to have problems with incontinence.
- Infections of the urinary tract and bladder may cause incontinence for a short time. Bladder control often returns when the infection goes away.
Making the diagnosis
Studies have reported that less than half of women who suffer with UI actually seek help. This is even lower for men. Usually based on symptoms, your doctor is able to make the correct diagnosis. Often, keeping a diary for 2-3 days to track when you empty your bladder or leak urine can show patterns in the incontinence that clarify the possible cause. Sometimes, additional tests, such as urine test, ultrasound or bladder stress test is performed. Less frequently, cystoscopy or urodynamics tests are required for further analysis.
Treatments for Urinary Incontinence
You can take some relatively simple actions at home to help treat urinary incontinence.
Fluid management: Timing food and drink consumption around your activities may help you better control your urge to go. Instead of drinking large amounts of water or other beverages at once, drink smaller amounts at regular intervals throughout the day.
Bladder training: Bladder training requires you to actively delay a trip to the toilet each time you get the urge. You can help control overactive bladder or urge incontinence by going to the bathroom at set times. Start by tracking how often you go to the bathroom each day in a bladder diary. Then slowly add about 15 minutes between bathroom visits. Urinate each time, even if you do not feel the urge to go. By gradually increasing the amount of time between visits, your bladder learns to hold more urine before it signals the need to go again.
Pelvic floor muscle strengthening exercises: These exercises are also known as Kegel exercises. They can help you rebuild strength and tighten muscles in your pelvis and urinary tract system. Ideally, if you are consistent about doing Kegel exercises 3-5 sessions each day, you should see improvement in urinary incontinence within 3-6 months.
Other lifestyle changes may include:
- Lose weight: extra weight puts more pressure on your bladder and nearby muscles which can lead to problems with bladder control.
- Treat constipation: eat foods with lot of fiber, be more physically active.
- Cut back on alcohol, caffeine and carbonated drinks. These substances can stimulate your bladder.
- Stop smoking.
If steps you can take at home do not work to improve your stress incontinence, your doctor may talk to you about these other options:
- After menopause, applying vaginal creams, rings, or patches with estrogen can help strengthen the muscles and tissues in the urethra and vaginal areas.
- For men with enlarged prostates, alpha-blockers like tamsulosin (Flomax) can help with urge or overflow incontinence to more fully empty their bladder.
- For urge incontinence, anti-muscarinic agents and beta-adrenergic agonists help relax the bladder muscle and increase the amount of urine your bladder can hold. Common side effects of anti-muscarinics include tachycardia, edema, confusion, constipation and blurry vision. Adverse effects of beta-adrenergic agonists include GI upset, dizziness, headache and increased blood pressure.
- Botox. Botox injections in the bladder can help if other treatments don’t work for urge incontinence. Botox helps relax the bladder and increases the amount of urine your bladder can hold. Botox effect is temporary and treatments may be repeated every 3-6 months.
- Vaginal pessary. For women, a reusable pessary is a small plastic or silicone device (shaped like a ring or small donut) that you put into your vagina. The pessary pushes up against the wall of the vagina and the urethra to support the pelvic floor muscles and help reduce stress incontinence.
- Bulking agents. The urologist can inject a bulking agent, such as collagen, into tissues around the bladder and urethra to cause them to thicken. This helps keep the bladder opening closed and reduces the amount of urine that can leak out. These injections are temporary and require repeat procedures; frequency depends on agent used.
- Surgery. The two most common types of surgery for urinary incontinence are:
- Sling procedures. The mid-urethral sling is the most common type of surgery to treat stress incontinence. The sling is either a narrow piece of synthetic mesh or a piece of tissue from your own body that your surgeon places under your urethra. The sling acts like a hammock to support the urethra and hold the bladder in place. Serious complications from the sling procedure include pain, infection, pain during sex, and damage to nearby organs, such as the bladder.
- Colposuspension. This surgery also helps hold the bladder in place with stitches on either side of the urethra. This is often referred to as a Burch procedure.
At Inner Vitality in Bellevue, Dr. Alice Kuntz has specifically sought out treatments to help with urinary incontinence that are safe, effective and minimally to non-invasive. We are pleased to offer a variety of treatments to help you gain control over your urine leakage and enhance your quality of life.
- Medical weight loss program to help you shed unwanted fat, especially visceral fat that accumulates in your abdomen, placing more pressure on the bladder and pelvic floor.
- Bioidentical hormone replacement therapy to help balance your hormone levels.
- BTL Emsella™ chair that focuses on strengthening the pelvic floor muscles. Emsella™ has been cleared for treatment of stress urinary incontinence and overactive bladder in women and men. This device is a chair that delivers High-Intensity Focused Electromagnetic technology (HIFEM) to the deep pelvic floor muscles. This energy produces strong pelvic floor muscle contractions, resulting in muscle growth but also is important for re-education and restoration of the neuromuscular control.
- For women, laser vaginal treatment that utilizes gentle laser generated heat to stimulate new blood supply and thicker mucosa in the vaginal wall and thereby help support the bladder and urethra to reduce urinary incontinence.
We welcome you to come in for a comprehensive consultation with Dr. Alice Kuntz. Start your journey to live your best life today.