Urinary Incontinence

Urinary incontinence is the accidental loss of urine and bladder control. This condition affects more than 15 million men and women but is twice as common in women. Urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having a sudden and strong urge to urinate. 

Several types of urinary incontinence can occur:

  • Stress incontinence - Leaking urine during certain activities like coughing, sneezing, laughing, exercising or heavy lifting
  • Urgency incontinence - Involves a strong, sudden and intense urge to urinate, followed by involuntary accidental loss of urine, also known as overactive bladder (OAB). Overactive bladder is a condition characterized by a sudden, uncomfortable need to urinate with or without urine leakage usually with daytime and nighttime frequency.
  • Overflow incontinence - Leaking of urine, with the inability to empty your bladder. In men, overflow incontinence can be associated with prostate gland problems.
  • Mixed incontinence - This type of incontinence is common and includes more than one type, such as stress incontinence and urgency incontinence.

Urinary Incontinence — Dr. Julie Stewart

Julie Stewart, MD, a neuro-urologist at Houston Methodist’s Center for Restorative Pelvic Medicine, explains the differences in urinary incontinence in women and describes treatment options.
Causes of Urinary Incontinence

Causes of incontinence can vary between men and women, though the most common are the following:

  • Aging
  • Childbirth
  • Chronic disease, such as diabetes
  • Urinary tract infection
  • Obesity
  • Prior pelvic surgery
  • Prostate cancer treatment
  • Neurological disease, such as multiple sclerosis, Parkinson's disease or stroke
  • Spinal cord injury

Symptoms of Urinary Incontinence
Depending on the type of incontinence, patients may leak a small amount or have large accidents of urine with sudden urges to urinate or with stress activities, such as coughing, laughing and sneezing. 

Some patients may also experience bladder problems, such as difficulty with bladder emptying. Urinary retention (inability to urinate) is a common complication for men with benign prostatic hyperplasia (BPH) or enlarged prostate. Women with vaginal prolapse of the bladder also have the same difficulty emptying their bladder.
Diagnostic Testing for Urinary Incontinence
Cystoscopy is a procedure to see the inside of the bladder and urethra (the opening of the bladder). Cystoscopy is performed with a cystoscope, which is a specialized tube with a small camera on the end. The urethra is cleansed, and a numbing medicine is applied to the skin lining the inside of the urethra, without using any needles. The scope is then inserted through the urethra into the bladder. Water or salt water (saline) flows through the cystoscope to fill the bladder. As fluid fills the bladder, it stretches the bladder wall. This lets your doctor see the entire bladder wall. You may feel an urge to urinate when the bladder is full. However, it must remain full until the examination is complete. The procedure usually takes 5 to 10 minutes and is usually performed in the clinic, but can also be performed in the operating room.

Why is this test performed? 
  • To check for cancer of the bladder or urethra
  • To diagnose and evaluate urinary tract abnormalities, such as a fistula
  • To diagnose a possible cause of recurrent bladder infections
  • To help determine the cause of pain during urination

Urodynamics is a test to assess the function of the bladder — how much it can hold and why there may be leakage. No special preparations are necessary for this test.

A urodynamics test is important for the evaluation of many urinary problems:
  • Incontinence (leakage of urine)
  • Retention of urine or incomplete bladder emptying
  • Symptoms such as frequent need to urinate or a constant, urge need to urine
  • A weak or intermittent urinary stream
  • Neurological conditions affecting the bladder
  • Urinary conditions associated with prolapse of the pelvic organs, such as with cystocele

The following will be recorded:
  • The amount of urine you can hold in your bladder
  • The size, force, and continuity of your urinary stream
  • How long it took you to empty your bladder
  • Any straining, hesitancy or dribbling that occurred

A thin, flexible tube (catheter) is gently placed in your bladder. The catheter measures the volumes of fluid in your bladder, along with the pressures there. A smaller catheter is then placed in your rectum. Water flows into the bladder at a controlled rate. You will be asked to tell your health care provider when you first feel the need to urinate. You may be asked to cough or push so they can check for urine leakage. When the bladder is full, you will be told to urinate. The pressure of your urine flow is recorded. The bladder is again drained of any urine or water, and the catheter is removed. In some cases, X-rays are taken during the test.

This test is performed to help determine the cause of bladder dysfunction and incontinence. This test should not be done if you have a known urinary tract infection. Existing infection increases the possibility of false test results.

Treating Urinary Incontinence
Treatments are different for each person, and depend of the type of incontinence you have and how much it affects your life. Genearl treatment options may include lifestyle changes such as cutting back on caffeinated drinks, timing voiding or urinating on a schedule, smoking cessation, maintaining a healthy weight and pelvic floor exercises.

For stress incontinence, treatments can include:
For urgency incontinence, treatments can include:
  • Bladder medications
  • Botox injections into the bladder
  • Sacral nerve stimulator (Sacral Neuromodulation)
  • Percutaneous tibial nerve stimulation
  • These issues can be embarrassing but can be resolved. Your first step is to talk with one of our specialists.

Devices and Treatments for Urinary Incontinence
Pessaries (vaginal support devices)
A pessary is a silicone device, that usually is ring shaped and is placed in the vagina to help with pelvic support. Pessary instruments can be extremely useful for conditions resulting from pelvic floor prolapse (dropping of the pelvic floor) and can also be used to treat stress urinary incontinence. There are several types of pessary instruments available to meet your specific condition and need. Our physicians at Houston Methodist are well versed and familiar with the use of pessaries to manage various pelvic support defects.

Many conditions can be treated with pessary instruments:
  • Stress urinary incontinence
  • Vaginal vault prolapse
  • Cystocele
  • Enterocele
  • Rectocele
  • Uterine prolapse
  • Preoperative preparation

Pelvic Floor Physical Therapy
The goal of pelvic muscle exercises is to isolate the pelvic floor muscles and make them stronger, thus preventing prolapse, or dropping of the pelvic floor. One of the most common rehabilitation methods is the use of Kegel exercises, developed by Dr. Arnold Kegel. The patient tightens and relaxes the pelvic floor muscles over and over again, to strengthen the pelvic region. Studies have concluded that the use of these techniques actually reduces both stress and urgency incontinence compared to patients who did not do any kind of exercises at all.

A typical Kegel exercise routine includes several steps:
  • Contract the pelvic floor muscles
  • Hold position for three to five seconds (keep breathing)
  • Release
  • Rest for three seconds
  • Repeat 10 times

Remember to breathe deeply (do not hold your breath) and rest between contractions.

As the muscles become stronger, patients should be able to increase the holding time in small increments up to 10 seconds at a time. These short exercises can be done any time of the day, during everyday activity including at work or while eating, watching television or even driving. Click here to learn more about other pelvic floor physical therapy.

Kegel Exercises for Pelvic Health — Dr. Uchenna Ossai

Uchenna Ossai, the pelvic health physical therapy manager at Houston Methodist’s Center for Restorative Pelvic Medicine, explains how to perform a Kegel exercise routine.

Advanced Care from Specialty Physicians

Houston Methodist combines the expertise of urogynecologists — specialty physicians trained in the areas of urology and gynecology — as well as traditional gynecologists and colorectal surgeons to provide the most advanced care available for women and men with problems related to the lower urinary tract and the pelvic floor. The Center for Restorative Pelvic Medicine at Houston Methodist Hospital is the first of its kind in the Greater Houston area and is one of the few centers in the country that offers a single-center location for the diagnosis and treatment of complex pelvic-floor disorders.

Center for Restorative Pelvic Medicine Locations