Incontinence

Urinary incontinence, which is the loss of bladder control, affects more than 15 million Americans. It is very often a side effect of childbirth or surgery, and it is associated with aging. Urinary incontinence can range from mild leakage to uncontrollable urine loss. Common types of incontinence include:
  • Stress incontinence arises from a weakness in the muscles that keep your bladder closed. As a result, you may experience leakage of urine when you laugh, sneeze, cough or try to lift a heavy object.
  • Urge incontinence, or overactive bladder, occurs when the bladder muscles are overactive, causing you to feel the urge to urinate, but with very little warning. Often these urges cause you to leak urine before you can reach the bathroom.
  • Mixed incontinence occurs when both urge incontinence and stress incontinence are present
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Causes of Incontinence
Incontinence is a symptom, not a disease in itself. Incontinence can be caused by many different conditions and factors:
  • Age
  • Previous surgery to the bladder or vagina in women
  • Previous surgery to the bladder or prostate in men
  • Stretched and weakened pelvic muscles after childbirth
  • Side effects of certain medications
  • Diabetes mellitus
  • Neurological illness such as stroke, spinal cord injury or multiple sclerosis

Diagnosing Incontinence
Your urologist will conduct a thorough physical examination and obtain your medical and surgical history as well as your voiding habits and patterns. A urinalysis will be performed, and you may have to undergo cystoscopy (a procedure in which a small scope with a camera is used to visualize the bladder) or urodynamic testing (various procedures that measure how your bladder holds and empties urine).

Treating Incontinence
The most effective treatment will depend on the type of incontinence your doctor determines you have, its severity and its cause(s), as well as other factors such as your age and gender. The most common treatments for incontinence include the following:
  • Behavioral techniques
  • Physical therapy
  • Medications
  • Surgery

For some types of urinary incontinence, you may only need to use some behavioral techniques and lifestyle modification.
  • Bladder retraining “teaches” your bladder to control the urge to urinate through delayed urination, “double voiding” (waiting a few minutes after you urinate and trying again), relaxation exercises and other practices.
  • Timed voiding involves urinating on a set schedule, usually every two to four hours, rather than waiting until you feel the urge.
  • Fluid and diet management necessitates cutting back on or eliminating alcohol, caffeine or acidic foods from your diet, which may help you regain control of your bladder.
  • Weight reduction can also help lessen urinary incontinence.

To help strengthen the muscles that control your bladder, your doctor may recommend pelvic floor physical therapy. Physical therapy often works very well when used in combination with behavioral techniques and/or medications.
 
Medications known as anticholinergics can calm an overactive bladder and may be effective in controlling urge incontinence. Many different anticholinergic drugs are available. For women, topical low-dose estrogen vaginal cream, ring or patch may reduce symptoms of overactive bladder.
 
When nonsurgical techniques fail to lessen or stop incontinence, your doctor may recommend surgery. Surgical techniques used to treat incontinence include the following:
  • A urethral bulking agent can be injected into the urethra (opening of the bladder) that will make the opening smaller and help to prevent urine leakage.
  • In a sling procedure, your surgeon uses your body’s tissue or a synthetic material to create a “sling” to support the urethra during stress maneuvers (such as a cough or sneeze) and prevent urine leakage.
  • An artificial urinary sphincter (a doughnut-shaped, fluid-filled device) may be placed around the neck of the bladder in men whose urinary sphincter has been weakened from prostate cancer treatments or other causes of incontinence. Pressing a valve causes the ring to deflate and allows urine to flow.

TREATMENT LOCATIONS

Our physicians at Houston Methodist specialize in managing incontinence at the following convenient locations.