Urinary control relies on the finely coordinated activities of the smooth muscle tissue of the urethra and bladder, skeletal muscle, voluntary inhibition, and the autonomic nervous system. Urinary incontinence can result from anatomic, physiologic, or pathologic (disease) factors. Congenital and acquired disorders of muscle innervation (e.g., ALS, spina bifida, multiple sclerosis) eventually cause inadequate urinary storage or control.
Acute and temporary incontinence are commonly caused by the following:
- Limited mobility
- Medication side effect
- Urinary tract infection
Chronic incontinence is commonly caused by these factors:
- Birth defects
- Bladder muscle weakness
- Blocked urethra (due to benign prostate hyperplasia, tumor, etc.)
- Brain or spinal cord injury
- Nerve disorders
- Pelvic floor muscle weakness
Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of cases. Overflow incontinence is more common in people with disorders that affect the nerve supply originating in the upper portion of the spinal cord and older men with benign prostate hyperplasia (BPH). The primary characteristics of these types are as follows:
Stress: urine loss during physical activity that increases abdominal pressure (e.g., coughing, sneezing, laughing)
Urge: urine loss with urgent need to void and involuntary bladder contraction (also called detrusor instability)
Mixed: both stress and urge incontinence: constant dribbling of urine; bladder never completely empties
Incidence and Prevalence
The U.S. Department of Health and Human Services reported in 1996 that approximately 13 million people in the United States suffer from urinary incontinence. The condition is far more prevalent in women than men. In the general population aged 15 to 64 years old, 10-30% of women versus 1.5-5% of men are affected. At least 50% of nursing home residents are affected. Of that number, 70% are women.
There are various treatments for urinary incontinence depending on the type and severity. Mild incontinence may be treated by Kegel exercises which help to strengthen the pelvic muscles. You can click on the patient form section which describes the Kegel exercises and how to perform these. In cases of urgency incontinence, medications are best suited. These include medicines like Ditropan, Ditropan XL, Detrol, and Sanctura as well as others. These medicines help to decrease the urgency of urination by decreasing bladder contractions allowing the bladder to hold more urine comfortably. These medications may cause dry mouth, constipation, dizziness, and blurred vision. They are generally contraindicated in patients with glaucoma so you must check with your ophthalmologist before taking these medicines.
In the case of patients with stress incontinence which is not mild, you may try collagen injections. These involve the injection of collagen (contigen) into the periurethral area which provides bulk to prevent leakage of urine. If you wish to read more on this, you can visit www.bard.com and under products section select collagen implants. These injections are helpful in controlling leakage however they don't last forever as the material is reabsorbed and with time patients will require re-injection.
Patients who wish a more permanent procedure for control of their leakage can select to have a trans-vaginal tape or sling procedure. There are many companies that make the sling materials that are used by MCSO urology doctors. The different slings are very similar and you can ask your individual doctor about the specific differences between this one and the one he might recommend.
Slings are much more successful than collagen in controlling leakage. They have a 90% success rate. After many years some patients with sling may again notice that their leakage may recur slowly but in general these are the most successful and long lasting treatments available at this time. The main risk with the sling procedures is the possibility of injury during the procedure of the urethra, bladder or other organs depending on the type of sling used. The other possibility is that of sling erosion. This occurs when the sling material doesn't take and begins to erode through the tissues until it becomes exposed into the vagina or the urethra requiring removal. If you need more information you can also access www.urologyhealth.org.