Urinary Incontinence: Diagnose, Treatments & Prevention

The kidneys produce urine which carries waste products from the blood. Urine flows down the ureter to the bladder which eventually empties into the urethra.

When you eat and drink, the cells of your digestive tract absorb the liquid and send it to your bloodstream. The kidneys filter out waste products from the body fluids and make urine, which flows from the kidneys down tubes called ureters into the urinary bladder.

The bladder is basically a muscular sac that serves as a holding tank for urine. When the bladder becomes full, the brain triggers the urge to void, or empty, the bladder. Once you make it to the bathroom, your brain tells your urinary system to do two things: contract the bladder muscles to squeeze the urine out and relax the urethral sphincter. The urethral sphincter is a group of muscles that tightens around the urethra to hold urine in and loosens to let it flow out of the body.

Incontinence will occur if your bladder muscles uncontrollably contract or the sphincter uncontrollably relaxes.

How Common Is Urinary Incontinence?

Urinary incontinence, or the inability to hold your urine until you get to a toilet, affects people of all ages but is more prevalent among women and older people.

One study carried out by the Mayo Clinic and Mayo Foundation randomly selected 778 men and 762 women aged 50 or older and asked them to complete a confidential questionnaire designed to assess the occurrence of incontinence in that age group. Researchers found that more than one-quarter of the men (25.6 percent) and almost half (48.4 percent) of the women surveyed had experienced urinary incontinence during the previous year. Pregnancy and childbirth, hormonal changes associated with menopause, and the structure of the female urinary tract help explain why women experience incontinence about two times more often than men.

How Urinary Incontinence Is Diagnosed?

The first step toward relief is to consult a physician who is well-acquainted with incontinence to discover which type or types you have, as well as the underlying condition causing the problem. You may see a urologist, who specializes in treating problems of the urinary tract. If your incontinence is associated with pregnancy or childbirth, you may prefer to bring your complaint to your obstetrician. Another option is a urogynecologist, who specializes in the treatment of female urological problems. Your family practitioner or internist may be able to help or can refer you to the appropriate specialist.

To help uncover the cause of your incontinence, your physician will begin by taking a medical history and conducting a physical examination. Samples of your urine and blood will be tested for abnormalities. Additionally, the doctor may order one or more of the following exams:

  • Ultrasound – This uses high-frequency sound waves to detect any abnormalities, including blockages, in the urinary tract.
  • Cystoscopy – The doctor visually inspects the inside of the bladder using a narrow tube equipped with a tiny telescope. To reduce discomfort, you may be given some medication to relax you before the procedure.
  • Postvoid residual (PVR) measurement – This tests the amount of urine left in the bladder after urinating. It is done by placing a small, soft tube into the bladder or by using ultrasound.
  • Stress test – This measures urine loss when stress is placed on the bladder muscles. You will be asked to cough, lift or exercise for this test.
  • Urodynamic testing – This may involve inserting a small tube into the bladder or X-raying the bladder to assess bladder and urethral sphincter function.

Your doctor may also ask you to keep a “urination diary” to track your toileting schedule, urine volume, the time and frequency of accidents, whether your incontinence episodes are major or minor, the number pads or undergarments you use each day, and the type and amount of liquids you drink. Urine volume can be measured using a special pan that fits over the toilet seat.

Treating Incontinence

The following approaches have been shown to be effective:

Timed voiding. Timed voiding (urinating) involves charting your urination and leakage patterns for several days. This helps you discover which times of day you normally need to empty your bladder before you would otherwise leak. Timed voiding is most effective in cases of urge and overflow incontinence.

Kegel exercises. These exercises are designed to help women with stress incontinence strengthen weak pelvic muscles around the bladder. One Kegel exercise involves lying down and squeezing your lower pelvic muscles for 3 seconds, as though you were trying to halt the flow of urine. For the best results, do 10 to 15 repetitions three times a day. Another Kegel exercise uses weighted cones held within the vagina while standing to strengthen the sphincter muscles.

Changing fluid intake. Some people need to increase or reduce their fluid intake or change the timing of their fluid intake, to gain more control over their bladder. Ask your doctor whether this approach is right for you.

Electrical stimulation. This technique uses a series of brief doses of electricity to stimulate contraction of the muscles in the lower pelvis. By strengthening the urinary muscles in this manner, electrical stimulation can reduce both stress and urge incontinence.

Biofeedback. Biofeedback uses electronic devices or diaries to help you track, and ultimately control, your incontinence when your bladder and urethral muscles contract. Biofeedback is often used in concert with Kegel exercises and electrical stimulation to relieve stress and urge incontinence.

Medications. Your doctor may prescribe drugs to inhibit contractions of an overactive bladder or to relax bladder muscles, leading to more complete bladder emptying during urination. There are also drugs to tighten muscles at the bladder neck and urethra to prevent leakage. Certain hormone supplements, including estrogen, are believed to cause muscles involved in urination to function more normally. Be sure to ask your doctor about the risks and benefits of long-term use of any of these medications.

Restricting intake of certain beverages. Restricting your intake of alcohol and coffee, cola and other caffeinated beverages can help reduce the amount of urine your body puts out.

Pessaries. A pessary is a stiff ring, which a doctor or nurse inserts into the vagina. There, the pessary puts pressure against the vaginal wall and, in turn, the nearby urethra. The pressure helps reposition the urethra, which usually reduces stress leakage. Pessary users should be monitored regularly for vaginal and urinary tract infections.

Implants. Implants are substances that are injected into the tissues around the urethra. The goal is to add enough bulk to close the urethra and reduce stress incontinence, but the procedure has only a partial success rate. The most common implants are cow collagen and fat from the patient’s body. (A skin test is used before a collagen implant to rule out allergy.) Injections must be repeated periodically because the body slowly eliminates the implanted substance.

Catheterization. Your doctor may recommend that you use a catheter if your bladder never empties completely (overflow incontinence) or if your bladder cannot empty because of poor muscle tone, past surgery, or spinal-cord injury. By inserting a tube through the urethra into the bladder, you can drain your own urine into the toilet or into a bag strapped to your leg. Catheter users should be closely monitored for bladder infections.

Surgery. If all else fails, your doctor may recommend surgery to alleviate incontinence. Perhaps the most common surgery for stress incontinence is lifting up a bladder that has dropped down toward the vagina. This procedure often can be performed transvaginally and has a high success rate.

Preventing Urinary Incontinence

You may be able to prevent incontinence by following these recommendations from The Simon Foundation for Continence:

  • Drink six to eight cups of fluids daily, more in hot weather or during exercise.
  • Don’t strain to empty your bladder or bowel.
  • Try to keep bowel movements regular, and don’t ignore the feelings that the bowel needs emptying.
  • Seek medical attention when any leakage of urine occurs from the bladder, if urination is painful, or if you see any blood in your urine.

Urination Log

INSTRUCTIONS

This chart helps document your urinary patterns and accidents over a 24-hour period. Make copies of the chart and fill in a new chart for three or four consecutive days. Bring all completed charts to your physician as well as a list of medications you are taking.

NOTE

Under “Circumstances of Incontinence Episode,” you might write, Couldn’t make it to the bathroom in time, Wet bed overnight or Leaked urine several seconds after urinating in the toilet & flushing. “Type and Amount of Most Recent Fluid Intake” might include, 2 cups of caffeinated coffee, 12-ounce bottle of water, or 1 glass of wine.

DATE:

Approximate Time Urinated in Toilet? Incontinence Episode? Circumstances of Incontinence
Episode

Type and Amount
of Most Recent Fluid Intake

a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
a.m. / p.m. Yes / No Yes / No
External Sources

Simon Foundation for Continence
National Kidney and Urologic Diseases Information Clearinghouse