Incontinence
Incontinence refers to the involuntary leakage of urine. The bladder is a muscular organ in the pelvis that collects urine from the kidneys, and functions to store and empty urine. It’s function is in large part coordinated by the brain, spinal cord, and nerves in the pelvis. The pelvic floor is a muscular bowl, and these muscles help hold urine in the bladder. In men, the prostate, which lies directly below the bladder, also helps to hold urine in the bladder. Dysfunction of any part of this system can lead to incontinence.
Stress Incontinence refers to leakage of urine in response to increases in pressure within the abdomen/pelvis. placement of aLaughing, sneezing, coughing, jumping, and lifting are all activities that increase pressure in the abdomen/pelvis and can lead to urine leakage. Stress incontinence is usually caused by damage or weakness of the pelvic floor muscles. In men, removal of the prostate (usually for prostate cancer) can also lead to stress incontinence.
Treatment for stress incontinence can include pelvic floor strengthening, pelvic floor physical therapy, surgical placement of a mesh sling, or placement of an artificial urethral sphincter.
Urge Incontinence refers to leakage of urine that follows the urge to urinate. It can be caused by dysfunction of the either the nervous system components that coordinate bladder function (brain, spinal cord, or pelvic nerves), or dysfunction of the bladder muscle itself. There are many different ways to manage urge incontinence
Treatment of urge incontinence starts with avoiding bladder irritants. Common irritants carbonated beverages, caffeinated beverages (sodas, tea, coffee, energy drinks), chocolate, alcohol, acidic foods (citrus, tomatoes and tomato based foods), spicy foods, and artificial dyes/flavorings/preservatives. Bladder training can also be used to help reduce urgency and incontinence episodes. If these behavioral strategies are not effective, medications can be used. When medication is not effective, there are surgical options that can be considered including botox injected into the bladder, in-office percutaneous tibial nerve stimulation, and placement of a sacral neuromodulator.
Overflow incontinence refers to leakage of urine that occurs when the bladder is too full. A normal healthy bladder is able to stretch and hold ~ 360 mL of urine (around 12 oz). If there is an issue with emptying of the bladder, then as more urine enters the bladder from the kidneys, it simply leaks out once the bladder is at full capacity. Addressing this, involves identifying why the bladder is not emptying and correcting that issue.
