Urinary Incontinence

Normally, people can hold urine in their bladders until they reach the bathroom. Incontinence – sometimes called "urinary incontinence" – is the inability to hold urine in the bladder.

The bladder, located in the pelvis, is a balloon-shaped organ that stores urine made by the kidneys. One end of the urethra is connected to the bladder; the other end is open. In women, the opening is located just above the vagina. In men, it is at the tip of the penis.

Communication between the urinary tract and the brain controls the storage and release of urine. Nerves that run from the bladder and surrounding muscles tell the brain that the bladder is full. The brain sends messages back to the muscles, telling them either to tighten or release. For the urinary system to work right, these muscles and nerves must work together to hold urine in the bladder and then release it at the right time.

When the bladder muscles tighten and the sphincter muscles relax, urine leaves the body by passing through the opening of the urethra. When this happens suddenly or uncontrollably, urinary incontinence is the result.

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Types of Incontinence

Urinary incontinence is not a disorder. It is actually a symptom of other conditions and has many possible causes.

There are several different types of urinary incontinence.

  • Stress Incontinence is the most common type of incontinence. It occurs when any movement that puts pressure on the bladder, such as coughing, sneezing, laughing or exercise, causes small amounts of urine to leak. It occurs more often in women, and is usually caused by weakened muscles in the bladder and abdomen.
  • Urge Incontinence is the inability to hold urine long enough to reach the bathroom. This sudden, uncontrollable urge to urinate is often found in people with other conditions, such as diabetes, stroke, dementia, Parkinson’s disease and multiple sclerosis.
  • Mixed Incontinence is a combination of stress and urge incontinence.
  • Overflow Incontinence can occur when the bladder doesn't empty completely during normal urination, so small amounts of urine leak out unexpectedly.
  • Functional Incontinence occurs when physical disabilities, external obstacles, or problems with thinking or communicating prevent a person from getting to a bathroom in time.
  • Reflex Incontinence, also called unconscious incontinence, occurs when a person is unaware of the need to urinate.
  • Transient Incontinence is caused by a temporary condition, such as an infection or medication.

Diagnosis

Diagnosing incontinence usually starts with a physical exam and a discussion of the patient's symptoms and urinating habits, followed by diagnostic tests.

Here are some of the common tests used to diagnose incontinence:

  • Postvoid Residual (PVR) Measurement. This test checks the bladder's capacity and the bladder's ability to completely empty itself.
  • Stress Tests. Your doctor will check for urine loss as you cough.
  • Urinalysis. A urine sample is collected from the patient and examined for evidence of urinary tract infection, urinary tract stones, or other causes of incontinence.
  • Blood Test. Examines blood samples for various chemicals, substances and other possible causes of incontinence.
  • Imaging of the Urinary Tract. Various imaging technologies are used to show abnormalities or problems with the urinary tract.
    • Ultrasound uses sound waves projected into the body to create pictures of the organs and areas being examined.
    • Cystoscopy allows a urologist to look directly into the bladder by inserting a thin, flexible cystoscope up the urethra and into the bladder.
  • Urodynamics. Various techniques used to examine many aspects of the urinary system, including pressure on the bladder, bladder muscle strength and functionality, bladder contractions, the bladder's ability to empty steadily and completely, and urine flow.

Treatment

Treatment for urinary incontinence depends on the type, cause and severity of the symptoms. Treatment options range from exercise and behavior modification to medication or surgery. Surgery is only recommended after other approaches have failed or when structural problems are identified. Various approaches can also be combined.

Treatment Options:

  • Behavioral techniques
  • Pelvic muscle exercises
  • Biofeedback
  • Bladder training
  • Electrical stimulation
  • Medication
  • Devices
  • Bulking agents
  • Dietary modifications
  • Surgery
  • Other approaches

Prevention of Incontinence

Many causes of incontinence can’t be avoided. But sometimes, incontinence can be prevented by avoiding things known to irritate the bladder. Here are a few suggestions:

  • Avoid caffeine
  • Avoid acidic fruit juices
  • Avoid alcohol
  • Limit or avoid certain medications such as diuretics, antihistamines and over-the-counter cough and cold treatments
  • Stop smoking
  • Drink plenty of water

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