Incontinence

• Incontinence affects all ages, both sexes, and people of every social and economic level
• An estimated 12 million Americans have some problem controlling urination
• It is treatable and generally does not require surgery

Answer the following questions:

• Do you leak urine with coughing, sneezing, and/or lifting?
• Do you leak urine before you make it to the bathroom?
• Do you need to wear protective undergarments for urine leakage?

If you answered yes to one or more of these questions, you may have urinary incontinence.

• Urinary tract or vaginal infections
• Effects of medicine
• Constipation
• Weakness of certain muscles
• Blocked urethra due to an enlarged prostate
• Diseases and disorders involving nerves and/or muscles
• Some types of surgery

• Stress incontinence — Leak urine with exercise, coughing, and/or sneezing
• Urge incontinence — Loss of urine as soon as you sense the need to use the toilet (e.g., "Can't get there quickly enough.")
• Mixed incontinence — Combination of the above issues
• Overflow incontinence — Feeling of incomplete emptying, and losing small amounts of urine day and night

Is the problem bothersome? Does it alter your quality of life?

If so, tell your doctor! They can help diagnose and treat urinary incontinence problems.

• Urinalysis to examine for presence of infection, blood or other abnormalities
• Post-void residual measurement to see if any urine remains after an attempt has been made to completely empty the bladder
• Ultrasound to determine the size and shape of the kidneys, bladder and prostate
• Cystoscopy using a thin telescope allows the physician to see inside the bladder
• Stress test examines bladder and sphincter muscle function
• Urodynamics specialist test to see how the bladder is working

• Incontinence products — Absorbent products and devices (e.g., protective undergarments and pads)
• Behavioral therapy — Special exercises and training to strengthen the sphincter muscles
• Medications — Prescribed to help manage incontinence by relaxing the bladder, tightening the sphincter or bladder neck, or reducing bladder contractions
• Surgery — Surgical intervention if other procedures are unsuccessful (e.g., an artificial urinary sphincter can replace a damaged or absent sphincter muscle)
• For men — An operation to relieve the blockage caused by an enlarged prostate
• For women — An operation to restore the support of the pelvic floor muscles, or to reconstruct or compress the sphincter
• Timed voiding — Gradually increases the interval between voids
• Kegel exercises — For both urge and stress, these exercises improve the ability of pelvic muscles to control leakage
• Biofeedback — An extension of Kegels that helps patients focus on pelvic floor muscles
• Electrical stimulation — Stimulation of the pelvic floor muscles, typically carried out with biofeedback
• Extracorporeal magnetic innervation — The Neotonus Chair is a non-invasive, non-surgical therapy that provides electromagnetic stimulation of the pelvic floor muscles
• Catheterization — If the bladder does not empty, patients may evacuate their bladders by catheterizing themselves

Surgical procedures are available if simple measures don't work for your urinary incontinence issues, including: 

• Slings and suspension procedures — If you undergo surgery using GYNECARE TVT Tension-free Support for Incontinence, your surgeon will restore the normal position of the urethra by weaving a sling of mesh tape beneath it. After surgery, the tape supports the urethra during a sudden movement such as a cough or sneeze. This allows the urethra to remain closed and prevents the involuntary loss of urine.
• Peri-urethral bulking agents
• Artificial urinary sphincters — This is a small, inflatable prosthesis device. The cuff is filled with fluid and gently squeezes the urethra closed to keep urine in the bladder.
• Pelvic floor stimulators

Jennifer G. Rothschild, M.D., M.A./M.P.H.
Professor

• Consult your physician
• Incontinence is a treatable condition
• For more information, call the UC Davis Urologic Surgery Clinic at 916-734-2222 or 800-770-6930