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A. Urinary incontinence is any involuntary or unwanted loss of urine and is considered a medical condition.
The risk of developing incontinence increases with age, but younger people may also develop it. Women are more likely to suffer from this condition than men.
Incontinence is common and causes distress and embarrassment. Many people go without treatment because they feel uncomfortable discussing incontinence with their doctor. If incontinence affects your quality of life, it is important to seek medical advice.
In most cases, incontinence can be treated or cured with various treatment options. These include pelvic floor exercises, drug treatment, or surgery. Together with your doctor you can discuss which treatment is best for you.
A. Some of the causes of urinary incontinence are:
A. There are different types of urinary incontinence, depending on how and when you lose urine.
Stress urinary incontinence: Stress urinary incontinence (SUI) means that you lose urine during certain activities, like:
This happens because during these kinds of activities the pressure on your bladder increases. If your urethra or urinary sphincter are weak, they cannot resist the pressure of a full bladder, and will leak urine.
Urgency urinary incontinence: Urgency urinary incontinence (UUI) happens when you get a sudden need to urinate which you cannot postpone. The bladder muscle involuntarily contracts and you urinate when you do not want to.
Mixed incontinence: Your doctor may diagnose you with mixed urinary incontinence if you suffer from both SUI and UUI symptoms.
A. Urinary incontinence is a problem that needs to be diagnosed correctly so that you get the appropriate treatment.
Medical history: Your doctor might take a medical history to understand what type of urinary incontinence you have. As part of the medical history your doctor might ask about any other conditions you may have, or medication you take. This can be related to the incontinence or have an effect on your symptoms.
Your doctor may ask you:
Your doctor might also ask you about the impact of incontinence on your daily life, for example:
Physical examination: The doctor may perform a physical examination of your abdomen to detect an enlarged bladder. He or she may ask you to cough with a full bladder, in order to see if you suffer from stress urinary incontinence (SUI). The doctor also needs to test how well the pelvic floor muscles work. For men, this is done through a digital examination of the rectum and the prostate. Women may get a gynaecological examination.
Patient questionnaires: The doctor may ask you to fill out a questionnaire to better understand your symptoms and how they affect your everyday life. Questionnaires can also be used to monitor your symptoms over time, so you may need to fill them out more than once.
Urine test: You may need to give some of your urine for testing. The test will show if you have a urinary tract infection.
Bladder diary: Your doctor may ask you to keep a bladder diary for a few days. Here you will note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.
Assessment of residual urine: Residual urine is the amount of urine that is left in the bladder after urinating. It is also known as post-void residual urine (PVR). It is usually measured with the help of an ultrasound.
Residual urine can worsen incontinence and may point to other urological conditions, such as a urinary tract infection. It can also help your doctor to better understand the causes of your incontinence.
Pad test: Your doctor may also need to know the weight of the pads that you wear during a period of time, which is called the pad test. Your doctor will explain in detail how to perform the test. A pad test is not always easy to do, and your doctor will need your full cooperation.
Urodynamic evaluation: A urodynamic evaluation might be necessary to get more information about your urination cycle and how your bladder muscles and urinary sphincter work. Urodynamic evaluation may consist of uroflowmetry or invasive urodynamic tests.
Uroflowmetry: Uroflowmetry consists of electronically recording the rate of your urine flow. It is easily done in privacy at the hospital or clinic. You will urinate into a container, called a uroflowmeter. This test helps your doctor to check whether there is any obstruction to the flow of urine out of the bladder.
Invasive urodynamic tests: If you are scheduled to undergo surgery for urinary incontinence, an invasive urodynamic test may be done. The test may also be needed when your diagnosis is uncertain. During an invasive urodynamic test, your doctor or nurse inserts catheters in your urethra and rectum to measure the pressure in your bladder and abdomen. The bladder is slowly filled with sterile water through the catheter in the urethra. This is done to simulate the filling of the bladder with urine. When your bladder is full, you will urinate into a uroflowmeter.
The test results are shown on a screen which is connected to the catheters.
Cystoscopy: With a cystoscopy, the doctor can look inside the urethra and the bladder with the help of a small camera. Cystoscopy is not a common test during initial assessment for urinary incontinence. It may be needed when you suffer from other symptoms, such as blood in the urine or if your diagnosis is unclear.
Imaging: The doctor or nurse may scan your urinary tract with ultrasonography or magnetic resonance imaging.
A. There are many different ways of coping with urinary incontinence. Seek help if your symptoms bother you: consult your family doctor, general practitioner, or a urologist. It may be uncomfortable to discuss your condition with a doctor, but it is the most effective way to deal with your concerns.
Treatment for urinary incontinence depends on the type of incontinence, how severe it is, and what may cause it. There is no single solution to incontinence that works for everyone.
Discuss with your doctor or specialist nurse which measures can help you. It is common to try different options to figure out which one works best for you.
Sometimes, conservative measures can significantly improve your condition and lead to a better quality of life. These measures include lifestyle changes, bladder training and pelvic floor muscle exercises.
Other treatment options, such as medication and surgery, should be considered if conservative management is not effective.
The most used drugs to treat urinary incontinence are the antimuscarinic (or anticholinergic) drugs and mirabegron. Both intend to ameliorate urgency urinary incontinence. In some cases, other drugs like desmopressin, duloxetine or vaginal oestrogens could be appropriate.
Discuss with your doctor if some of these drugs can help you and which benefits and adverse effects you can expect with any of them.
A. Sometimes conservative or pharmacological treatment do not improve your urinary incontinence. In these cases, other treatment options are available. Together with your doctor you can decide which approach is best for you and which are the expected benefits and side effects that you can expect with every one of the different options.
Surgical treatment options for urgency urinary incontinence are:
Surgical treatment options for stress urinary incontinence:
A. Prostate surgery increases the risk of stress urinary incontinence (SUI). This is because the prostate surrounds the urethra, helping it to resist the pressure of a full bladder. If your prostate is partially or completely removed this may have an effect on how much pressure the urethra can resist.
There are several treatment options to improve SUI after prostate surgery. The most common treatments are:
A. General lifestyle changes can help manage your symptoms and improve your quality of life. Follow the advice of your doctor.
Try to make sure you always know where the nearest toilet is. Never be afraid or embarrassed to ask where the toilet is when you are away from home. Plan to empty your bladder every 2 to 4 hours and before going to bed at night. Install a night-light and grab bars in your bathroom to help prevent falls when you are in a hurry.
There are many products to help contain urine leakage, such as pads, drip collectors, and external collection devices. Discuss with your doctor which type of continence product best fits your lifestyle needs.
There are many absorbent pads available to help you manage urine loss. There are different products for men and women.
Most products are no bulkier than normal underwear, and you can wear them easily under everyday clothes. Absorbent incontinence pads are different from menstrual pads, ask if you are unsure about which product to use. Regularly change your pad to keep the groin area clean and as dry as possible. This will help prevent skin irritation and control odour. Pads are generally available at pharmacies.
Men who have problems with dribbles of urine can use a drip collector, or a small pad. Drip collectors are worn over the penis and held in place by your underwear. Men also have the option to wear an external adhesive device over the penis, attached to a leg bag and worn under the trousers.
A. It can be stressful to have to work when you worry about your incontinence. There are certain things you can do to make you feel more in control and worry less:
A. Travelling, especially long distances, can be difficult when you suffer from urinary incontinence. To make travel more comfortable you can: