Urinary Leakage
What is urinary leakage?
Urinary leakage or urinary incontinence is the accidental loss of urine. More than 15 million American men and women suffer from this disease. Many of these people suffer in silence unnecessarily, and are prevented from doing activities and living the life they want to lead. Since incontinence can be managed or treated, the following information should help you discuss this condition and what treatments are available to you with your urologist. For millions of Americans, incontinence is not just a medical problem. It is a problem that also affects emotional, psychological and social well-being. Many people are afraid to participate in normal daily activities that might take them too far from a toilet, so it is particularly important to note that the great majority of incontinence causes can be treated successfully.
What causes urinary leakage?
Below are a list of conditions and diseases that contribute and/or cause urinary incontinence:
- urinary tract or vaginal infections
- effects of medications
- constipation
- weakness of certain muscles in the pelvis
- blocked urethra due to an enlarged prostate
- some types of surgery
- diabetes
- delirium
- dehydration
- pregnancy and childbirth
- overactive bladder
- weakness of the muscles holding the bladder in place
- weakness of the sphincter muscles surrounding the urethra
- birth defects
- enlarged prostate
- spinal cord injuries
- Diseases and disorders involving the nervous system muscles (e.g., multiple sclerosis, Parkinson’s disease, spinal cord injury and stroke).
Multiple factors have been found to be associated with urinary incontinence, yet the leading culprits of incontinence have been neurologic disease, prostatic disease, and obstetric factors.
Studies have found that pregnancy, mode of delivery and parity (the number of children a woman has had) are all factors that can increase the risk of incontinence. Women who delivered babies (via cesarean section or vaginal delivery) have much higher rates of stress incontinence than women who never delivered a baby. Women who developed incontinence during pregnancy or shortly after delivery have higher risk of sustained incontinence than those who did not. Increased parity (having more babies) also increases the risk.
Age is also known to be a factor. As the human body ages, muscle loss and weakness occur and the urinary tract is not spared. Menopausal women can also suffer from urine loss as a result of decreased estrogen levels. Interestingly, replacement estrogen has not been found to help the symptoms. Many medications have been associated with urinary incontinence. These include: diuretics, estrogen, benzodiazepines, tranquilizers, antidepressants, hypnotics, and laxatives. Poor overall general health has been associated with incontinence. Specifically, diabetes, stroke, high blood pressure, smoking history, Parkinson’s, back problems, obesity, Alzheimer’s, and pulmonary disease have all been associated with incontinence.
What are the different types of urinary leakage?
Stress urinary incontinence: Stress incontinence is leakage that occurs when there is an increase in abdominal pressure caused by physical activities like coughing, laughing, sneezing, lifting, straining, getting out of a chair or bending over. The major risk factor for stress incontinence is damage to pelvic muscles that may occur during pregnancy and childbirth.
Urgency incontinence: Also referred to as “overactive bladder,” this type of incontinence is usually accompanied by a sudden, strong urge to urinate and an inability to get to the toilet in time. Frequently, some patients with urge incontinence may leak urine with no warning. Risk factors for urge incontinence include aging, obstruction of urine flow, inconsistent emptying of the bladder and a diet high in bladder irritants (such as coffee, tea, colas, chocolate and acidic fruit juices).
Mixed urinary incontinence: Mixed incontinence is a combination of urge and stress incontinence.
Overflow urinary incontinence: Overflow incontinence occurs when the bladder does not empty properly and the amount of urine produced exceeds the capacity of the bladder. It is characterized by frequent urination and dribbling. Poor bladder emptying occurs if there is an obstruction to flow or if the bladder muscle cannot contract effectively.
How is urinary leakage diagnosed?
As with any medical problem, a good history and physical examination are critical. A urologist will first ask questions about the individual’s habits and fluid intake as well as their family, medical and surgical history. A thorough physical examination looking for correctable causes of leakage, including impacted stool, constipation, prostate disease and prolapse or hernias, will be conducted. Usually a urinalysis and cough stress test will be performed at the first evaluation. If findings suggest further evaluation is necessary, tests such as cystoscopy or urodynamics may be recommended.
Cystoscopy is performed by placing a small scope or camera through the urethra and into the bladder. Urodynamics is an outpatient test that is done with a tiny tube in the bladder inserted through the urethra and often with a second small tube in the rectum. The bladder is filled and the patient is asked to void while pressure measurements are recorded.
How is urinary leakage treated?
Treatment for incontinence depends not only on the type of incontinence a person has but also the gender of the patient. Certain treatment options are optimal for men while others are better suited for females. Below are the various treatment options for both men and women.
What are the treatment options for stress leakage in women?
In most cases of incontinence, conservative or minimally-invasive management is the first line of treatment. This may include fluid management, bladder training or pelvic floor exercises. However, when the symptoms are more severe, when conservative measures are not helpful or are unsatisfactory the next best treatment option is surgery.
Behavioral Modification: Mild to moderate stress incontinence in the female is initially treated with behavior modification. Decreasing the volume of fluid ingested as well as eliminating caffeine and other bladder irritants can help significantly. Timed voiding can be helpful in preventing accidents by scheduling frequent trips to the toilet before leakage occurs.
Pelvic Floor Muscle Training: Strengthening or Kegel exercises can fortify the pelvic floor and sphincter muscles and improve urinary control. These exercises include repeated contractions of isolated muscles several times a day. Sometimes techniques including biofeedback, electrical stimulation of the pelvic muscles, and weighted vaginal cones can be helpful in teaching the patient how to isolate these muscles.
