Urinary Incontinence

The main symptom of urinary incontinence is the accidental release of urine. Symptoms depend on the type of incontinence. You may leak urine when you sneeze or cough, or you may always leak urine. Or you may feel a strong urge to urinate, but urine leaks because you can't reach the toilet in time.

Urinary incontinence may be caused by weak muscles in the lower urinary tract. They can also be caused by problems or damage either in the urinary tract or in the nerves that control urination. Another cause is bladder muscles that squeeze so hard that the sphincter muscle can't hold back the urine.

You may reduce your chances for urinary incontinence by:

• Doing pelvic floor (Kegel) exercises. They strengthen your pelvic muscles.
• Getting to and staying at a healthy weight.
• Quitting smoking. Smoking causes coughing, which can make it harder to control your urine.
• Limiting caffeine and alcohol.
• Avoiding constipation by eating a healthy, high-fiber diet.

To diagnose the cause of your urinary incontinence, your doctor will do a physical exam and ask about your past health.

Your doctor will ask about what and how much you drink. You will also be asked how much and how often you urinate and leak urine. It may be easier for you to answer questions if you keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.

Your doctor may do some simple tests to look for the cause of your bladder control problem. For example, your doctor may ask you to cough while you are standing to see if you leak urine. If your doctor thinks that your problem may have more than one cause, you will likely have more tests.

Here are some tests that may be done to find the type and cause of your urinary incontinence.

• Urinalysis and urine culture. These tests show whether you have a urinary tract infection (UTI) or blood or sugar in your urine. It can also show if a man has prostatitis.
• Bladder stress test. It simulates the accidental release of urine that may occur when you cough, sneeze, laugh, or exercise. Women may also get a Bonney test. It's similar to the bladder stress test, but the bladder neck is lifted slightly with a finger or tool inserted into the vagina while the bladder stress is applied.
• Pad test. This can help show how much urine is leaking. You are given an absorbent pad that has been weighed. You wear the pad until urine leaks, and then you return the pad to be weighed again. The increased weight of the pad gives an estimate of how much urine leaked.
• X-rays or ultrasound. These are used to examine changes in the position of the bladder and urethra when you urinate, cough, or strain.
• Urodynamic testing. It is typically done only if surgery is being considered or if treatment has not worked for you. The tests may include:
• Uroflowmetry. This test measures your rate of urine flow. A low peak flow rate can be a sign of a blockage or a weak bladder.
  • Pressure flow studies. This testing measures pressure changes in the bladder as the flow changes. It's often used when the cause of your symptoms isn't clear. It can help show if the cause may be a blockage or a problem with the bladder muscles or nerves.
  • Post-void residual volume. This test measures the amount of urine left after you empty your bladder.
  • Cystometry. This is a series of tests to measure bladder pressure at different levels of fullness.
• Electromyogram (EMG). This test records the electrical activity of muscles.
• Cystoscopic exam. This is a test that allows your doctor to see inside the urinary tract by using a thin, lighted tube.
• Cystourethrogram. This is an X-ray of your bladder and urethra while you are urinating.

Treatment for urinary incontinence depends on the type you have and how much it affects your life.

Treatments may include:

• Behavioral strategies such as bladder training or timed urination.
• Pelvic floor exercises (Kegels). They strengthen the muscles that control the flow of urine. Kegels are sometimes taught using biofeedback.
• Medicines.
• Changes in your diet and lifestyle.
• Medical devices. Women may use a device called a pessary. It can help with bladder control. Men may use a catheter to empty their bladder and control leaks. It's a thin, flexible, hollow tube that's inserted through the urethra into the bladder.
• Surgery.

When there is more than one cause for incontinence, the most significant cause is treated first. Then the secondary cause can be treated, if needed. Behavioral training and medicines are usually tried first. If the problem doesn't get better, your doctor may try another treatment or do more tests.