Involuntary urine leakage can occur for a variety of reasons. It affects up to 1 in 3 women after the age of 40, and by the age of 60, 1 in 2 women suffer from the disorder. The incidence is not limited only to older women, as it can occur in men and people as young as 18 years of age.
At The University of Kansas Health System, we offer advanced diagnostic testing by fellowship-trained specialists to target the cause of incontinence. We offer a range of noninvasive therapies as well as surgical options to cater to each person's needs and condition.
What is urinary incontinence?
Urinary incontinence is defined by a loss of bladder control. This can result in urine leakage, urgency and frequency that disrupts a person's life. Urinary incontinence can be an embarrassing condition that may also be associated with depression and social isolation. Both men and women can suffer from urinary incontinence.
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Types of urinary incontinence
Mixed urinary incontinence refers to conditions where both urgency urinary incontinence and stress urinary incontinence may be present and impacting a patient’s life concurrently. Treatment often requires management of both, keeping in mind that each is treated differently.
It is important that the proper evaluation be made to determine the type of incontinence. Each type is treated differently. Some require only medical treatment, whereas other types require surgical management. Incontinence often has multiple causes. To achieve a successful outcome, each of the underlying causes must be identified and addressed in the treatment plan.
Stress urinary incontinence refers to loss of urine during a physical "stress" or activity where a force causes an increase in intra-abdominal pressure. Common examples include laughing, coughing, sneezing or jumping.
People with this condition are often limited in their ability to engage in exercise and sport activities due to their incontinence. This type of incontinence is caused by anatomic changes in the support of the urethra and bladder, and often is associated with weakness of pelvic floor muscles supporting the bladder.
Urgency urinary incontinence refers to urinary incontinence occurring with a sudden desire to urinate and loss of urine before reaching the bathroom. The incontinence episode is often triggered when hearing or feeling water, such as when washing hands, social situations, such as opening the door upon arriving home, or even commonly performed daily habits, such as standing from a seated position. The loss of urine is usually a larger amount and there is usually no way of stopping it.
Due to the uncontrolled urge to void (urinate), you may void more often than normal (more than 8 voids in 24 hours) and wake up more than once at night to void. This type of incontinence is often caused by bladder spasms. Some people may only have urgency and not necessarily have urine leakage when the compelling desire to urinate is noted; however, frequency and discomfort caused by this condition impacts their life negatively. This urgency is a component of overactive bladder syndrome.
Urinary incontinence symptoms and risks
The main symptom of urinary incontinence is a frequent, sudden urge to urinate – even if you've recently urinated. Leaking urine when coughing, sneezing, laughing or exercising is also very common.
Risk factors for urinary incontinence can vary depending on what type you have. However, the following may put you at risk:
- Being overweight (excessive weight may result in increased pressure on the bladder and pelvic muscles with activity).
- Changes in the anatomy of your urethra or bladder or pelvis after childbirth, menopause or prior surgery (changes in the normal bladder and urethral support can affect the integrity of the urinary system).
- Excessive intake of fluids (high water intake, such as when dieting or trying to satiate thirst, results in overfilling the bladder causing leakage).
- Medical conditions such as COPD and lower extremity swelling.
- Medications (whereas some medications can weaken the muscles of the urethra causing leakage, some others may weaken the bladder itself thus not allowing appropriate emptying. Also, some medications such as water pills cause your bladder to be overfilled rapidly causing leakage in some women).
- Menopause and hormonal changes (changes in estrogen levels and other hormones contribute to changes such as thinning in vaginal and urethral tissues).
- Recurrent bladder infections and bladder wall inflammation (recurrent infections often result in hypersensitivity of the bladder and the need for frequent emptying).
- Spine and neurological disease (some medical conditions, such as multiple sclerosis and stroke, affect the nerves and the function of the bladder and urethra directly).
- Weakness/deficits in pelvic floor strength and support (with age and deliveries, pelvic muscles often weaken despite performing Kegel exercises).
Urinary incontinence diagnosis and screening
Your initial evaluation with your physician begins with a comprehensive history and assessment of your ability to urinate. You may be asked to complete a voiding diary. Your visit will also include a pelvic examination as well as a visual assessment of the urethral anatomy.
Occasionally, urodynamic studies and/or cystoscopy are also needed. Additional testing may be recommended only if indicated and is scheduled at a time that is convenient for you.
Once your evaluation is complete, your physician will discuss the findings with you and suggest options for your treatment plan. These options often include nonsurgical interventions as the first choice. If surgery is needed, our fellowship-trained surgeons are specialized in minimally invasive surgery.
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Urinary incontinence treatment
Each type of urinary incontinence is treated differently. Some require only medical treatment, whereas other types require surgical management. Incontinence also often has multiple causes. To achieve a successful outcome, each of the underlying causes must be identified and addressed in the treatment plan.
Depending on the type of incontinence, treatments may vary. We offer many noninvasive state-of-the-art procedures. Treatment options include:
- Biofeedback techniques
- Bladder BOTOX® injections
- Bladder electrical stimulation
- Collagen injections
- Interstim/neuromodulation (pacemaker for the bladder)
- Noninvasive sling procedures
- Pelvic muscle strengthening