Incontinence

When leaking becomes frequent or severe enough to become a social or hygiene problem, it is called urinary incontinence. It is estimated that over 25% of women over age 60 and 15-25% of women under age 60 have urinary incontinence, though only 20% of people seek help for their problem.

My Daily Bladder Diary
Help your doctor by tracking your urinary incontinence symptoms. Make enough copies to last until your Doctors appointment. Take your diaries to your appointment to help your healthcare team diagnose and treat your problem.

- Download and print your Daily Bladder Diary

There are many types of urinary incontinence and it can result from a variety of causes. Some common examples include:

• Medications (including diuretics ('water pills'), narcotic pain medications,
  medications used for Parkinson's disease, and some antidepressants)
• Alcohol
• Caffeine
• Vaginal and/or bladder infections
• Chronic cough from smoking and/or lung disease
• Menopause with thinning of vaginal/bladder tissues, sometimes called 'urogenital atrophy'
• Pelvic relaxation ('dropped bladder')
• Prior bladder or pelvic surgery

Urinary Incontinence can be divided into different categories, including the overactive bladder (OAB), stress urinary incontinence (SUI), overflow incontinence and mixed incontinence.

This page will explain the OAB, with emphasis on causes, diagnosis and treatment. Normally, the bladder fills with urine from the kidneys. As the bladder becomes full, a signal is sent to the brain resulting in the desire to empty the bladder. With urination, the bladder muscle (called the detrussor muscle) contracts and the muscles around the urethra (the small, tube like structure which carries urine from the bladder to the outside of the body) relax allowing a normal urine flow. When complete emptying occurs, the bladder relaxes and urethral muscles tighten to stop the flow of urine.

The overactive bladder (OAB) occurs when the detrussor muscle becomes overactive. As the bladder fills with urine, the detrussor muscle spasms and causes an overwhelming urge to urinate, even if the bladder isn't full. This results in a sudden simultaneous and uncontrollable urge to urinate with subsequent leaking. This condition is known by a variety of names, including the overactive bladder, unstable bladder, detrussor instability, and urge incontinence.

Could you have an OAB?
The following symptoms can occur with the OAB:

• Urinating more than eight times in 24 hours.
• Sudden, strong urge to urinate.
• Accidents that occur prior to getting to the bathroom.
• Awakening more than twice to urinate at night.
• Wearing pads to protect clothes from getting wet.
• Avoiding sexual relations because of anxiety about urine leaking during lovemaking.

What causes the OAB?
A number of conditions can be associated with OAB, although a distinct reason cannot be found in a number of patients. Common causes of OAB include inflammation from a bladder infection, some neuromuscular disorders (such as multiple sclerosis and spinal cord accidents), side effects from medications, pelvic support problems and thinning of genital tissues (provide link to urogenital atrophy page) associated with menopause and lack of estrogen. Occasionally, the bladder can be irritated from certain ingested foods including caffeine, alcohol and spicy / acidic foods.

How can the OAB be diagnosed?
The most important step is the diagnosis of the OAB is discussing your problem with your physician. Many patients are reluctant to discuss their problem with their doctor. However, this condition can be easily treated through proper diagnosis and education about treatment options. Family doctors, gynecologists, and urologists are generally able to diagnose and treat the OAB. A detailed history is often necessary for proper evaluation. This may include a 'urine log', where recording the number and times of urinating occur over a 3 day interval. The number and timing of accidents will be evaluated. Your complete medical history, including medications and pregnancy should be discussed. Finally, certain tests may be necessary to document the type of incontinence. These tests may include checking your urine for infection (urinalysis and/or culture) and physical exam (including detailed pelvic exam). Occasionally, detailed urinary system testing may be necessary to figure out the exact type of incontinence that is present.

How is OAB treated?
After your evaluation, your doctor may diagnose the OAB and recommend a treatment. The current treatments are very effective. The use of conservative 'behavioral treatments' are effective and can be combined with medical treatments. Retraining the bladder and pelvic muscles will allow better control of urine flow and control. Urinating on a regular basis and not allowing your bladder to become extremely full are important techniques associated with bladder training. Typically, emptying your bladder approximately every four hours is prudent. Your doctor may recommend a 'voiding diary' to help with regular bladder emptying. Strengthening the pelvic floor by exercises (called Kegel exercises) is associated with a 40-60% improvement in bladder control. In fact, a study using behavioral therapy (including biofeedback and pelvic exercises) showed an 80.7% reduction in incontinence episodes for patients with the OAB.(1)

Medications can be used to effectively treat the OAB. The primary objective of medical treatment for the OAB is to relax the detrussor muscle, thereby decreasing the overwhelming urge to urinate and stopping the accidents that may occur. By combining medications with bladder training, most patients will notice a significant improvement in accidents and symptoms.

If your doctor has noted a thinning of the genital tissues (called urogenital atrophy) associated with the menopause, then treatment with estrogen products may be recommended. Estrogen creams, tablets and long release rings can be used in the vagina to treat urogenital atrophy. By improving the genital tissues with estrogen, a reduction in urine urgency and leaking may be seen.

The two most commonly prescribed medications are oxybutynin (Ditropan®) and tolterodine (Detrol®). Other, newer medications include darifenacine (Enablex), solifenacin (Vesicare), and trospium (Sanctura). These medications belong to a group of drugs called 'anticholinergics', and are well tolerated. Fortunately, most medications are available in once a day tablets and are better tolerated than older formulations.

Overall, urinary incontinence due to the overactive bladder is a very common disorder. Fortunately, there are effective treatments available. The first step in treating this often debilitating problem is initiating a discussion with your physician or health care provider. They will then be able to adequately evaluate your symptoms and initiate therapy to help decrease or stop the involuntary leak of urine.

*Please print this page to discuss urinary incontinence with your physician.

Reference:
1 - Burgio KL, et al. Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women. JAMA.
1998;280:1995-2000.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.