Urinary Incontinence

1. Stress Urinary Incontinence

This condition is caused by damage to the connective tissue supporting the urethra allowing small amounts of urine to leak when stress is placed on the bladder. This is the leakage that happens with coughing, laughing, sneezing, jumping and running. It is usually the result of vaginal deliveries. Treatment involves an outpatient surgery called a suburethral sling. The sling is a small, thin ribbon of plastic that acts as a hammock to support the urethra during stress.

2. Urge Incontinence

This condition is caused by overactive dyschronous nerves in the bladder wall triggering involuntary muscle contractions with resultant frequency and leakage. This problem increases in incidence with advancing age. The leakage can be large in amounts with the inability to stop it once it starts. Multiple voiding episodes at night is a common complaint. There are multiple treatment options that typically follow a step-by-step process. Treatments may include fluid restrictions, timed voiding, mediation, pelvic floor biofeedback, neuromodulation, or Botox.

3. Overflow Incontinence

This is caused by incomplete bladder emptying with subsequent leakage. This leakage occurs with no sense of urgency. This can occur during sleep and may be associated with hesitancy and difficulty initiating a stream. This leakage is common in patients with diabetes or multiple sclerosis. It is also a problem of men with prostate hypertrophy. Medicines to enhance bladder contraction and better emptying are useful as in prostate resection.

Incontinence of all types increases in incidence with advancing age. In fact, many patients have more than one type of incontinence. Other common diseases tend to aggravate incontinence. In particular, weight gain, obesity, diabetes and smoking tend to aggravate incontinence. Treatment depends on making the correct diagnosis.