Anyone who has suffered from urinary incontinence knows that just laughing can bring on the embarrassing symptom: urine leakage. Primarily a female condition, it is a huge problem with one study suggesting that more than 35 percent of women will experience some type of incontinence in their lifetime.
Whether you are male or female, incontinence can wreak havoc in all areas of life. Careers, relationships and overall self-esteem can suffer from the effects of an unpredictable bladder.
“The good news is that you do not have to live with it,” says obstetrician/gynecologist Dane M. Shipp, MD, from Scripps Memorial Hospital Encinitas. “Urinary incontinence is a medical problem, and it can be treated.”
As early as the 1400s, physicians were concerned about urinary incontinence, and surgical procedures for the condition were developed in the 1500s. In 1987, more than 400,000 operations for urinary incontinence were performed in the U.S. Today, with an estimated 11 percent lifetime risk of needing surgery for the condition, more than 7 million surgeries are projected by 2030.
Urinary incontinence is classified into four main categories — urge, stress, mixed and overflow. Urge incontinence results when an overactive bladder contracts unexpectedly. An individual may feel the need to urinate, but can’t wait until she gets to the bathroom.
Stress incontinence has nothing to do with emotional stress, but rather is determined by urine leakage during physical activity such as lifting, walking, laughing, sneezing or coughing. The lack of bladder control may be due to poor bladder support by the pelvic muscles or a weak or damaged urethral sphincter muscle.
Mixed incontinence is a combination of urge and stress incontinence. Overflow incontinence occurs when the bladder becomes so full that it overflows. A weakened bladder or a blocked urethral sphincter muscle can interfere with normal urine flow. The condition is often seen in heavy alcohol users or individuals with diabetes. An enlarged prostate can also create this condition in men.
Besides the obvious leakage of urine, other symptoms can include a bulge in the vagina. Pain in the pelvic area with strain, activity or sex may also be indicators. Dr. Shipp recommends that you see your physician right away if you experience any of these symptoms.
“Often, I see patients who have suffered for a long time before they came in to see me, and all they had was a urinary tract infection that could have been cleared up easily,” says Dr. Shipp.
Although urinary incontinence has traditionally been seen as an inevitable part of aging, today there are therapies to help prevent and treat the disorder.
The determination of the true nature of a urinary tract problem requires a complete history and physical exam that may include basic urodynamic evaluation and testing. The evaluation can often rule out the most easily fixed problem, a urinary tract infection. A patient’s personal history helps the physician take into account what medication side effects may be producing or contributing to incontinence.
During the exam, estrogen-related incontinence symptoms in menopausal women would be identified. The evaluation can also discover problems such as abnormal organ connections, known as fistulas, in the lower urinary tract or bulges in the intestine. Often, urologs, or bladder diaries, are used to track intake and outflow of fluids.
After a proper work-up, the causes of symptoms can be determined. Problems related to infection, bladder stones or tumors, metabolic factors such as diabetes, polydipsia (excess water consumption) and medication interactions would be assessed.
Cystoscopy/urethroscopy provides a visual look inside the bladder by inserting a small camera, enabling the physician to see inflammation, bulges, growths and even cancer. In uroflowmetry, a small monitor placed in the commode records the rate of urine flow over a period of time.
Multichannel cystometry testing, typically used to diagnose urge incontinence, is able to provide information on the dynamics of the bladder and related organs. The information recorded in multichannel cystometry testing helps the physician determine exactly what is causing the condition and the best medical or surgical procedure for optimum results.
Many times, lifestyle changes or medications can eliminate or improve the condition. Weight loss, limiting fluid intake, eliminating diuretic fluids and scheduled bathroom visits are lifestyle changes that can help. Pelvic muscle exercises known as Kegels have an 84 percent success rate, with 40 percent of patients deciding to forgo surgery after seeing the results. Developed by Arnold Kegel, MD, in the 1940s, the exercises are easy to do and can be completed at home.
The Scripps Rehabilitation Center at Scripps Memorial Hospital Encinitas has an established bladder control therapy program. The inpatient program is for people with neurological conditions from stroke or brain injury. A variety of methods are used to retrain individuals how to control their bladder and bowels.
The outpatient bladder control program can be accessed with a prescription from your physician. Specially trained physical therapists will help you learn to regain control of your bladder. Treatments may include Kegel exercise training, bladder retraining, and computer assisted-biofeedback or dietary modifications. Medicare and most insurance cover treatment.
Surgery is the last option when behavior modification, lifestyle changes or medications have not been sufficient.
“We like patients to try the simple things that they can do themselves first,” says Dr. Shipp. “That way we know with full confidence that we have tried everything else before we go to surgery.”