Urinary Incontinence: Frequently Asked Questions

Incontinence is certainly a common problem that we see in urology. It tends to be somewhat more common as patients age, but certainly it cuts across all age groups and sexes. The good news is that incontinence is generally a very treatable problem. However, it is important to have a good and complete evaluation prior to treatment.

Patients should not feel embarrassed or apprehensive about talking to their physicians about this condition. The majority of patients can be successfully treated using either conservative or surgical therapy. Incontinence should not be considered an inevitable part of getting older. The best source of information for the patient with incontinence is their family physician. They will be able to either diagnose and treat the problems themselves or make an appropriate referral.

Is incontinence a problem seen mostly in the elderly?
Incontinence is certainly more common as patients age, but incontinence can be seen in children, adolescence and adults, both male and female.
Is incontinence a problem seen in diabetes?
Incontinence can certainly been seen in the diabetic patient. Diabetics tend to have decreased bladder emptying and are somewhat prone to having overflow incontinence, but may also have stress or urge incontinence and therefore need a complete evaluation prior to treatment.
Does pregnancy leave a lasting problem with urinary incontinence?
Certainly not all pregnant patients have incontinence following delivery. But pregnancy can certainly predispose to urinary incontinence especially in the case of a vaginal delivery.
How do you decide if you really have a problem? I certainly have some "laxness" after several childbirths, but my doctor hasn't indicated there is a problem.
Do you have incontinence or some dropping down of the bladder?
Can incontinence come & go? Some weeks I have no problems.
Yes, incontinence can come and go depending on its cause. For instance, some patients will complain of stress incontinence only when they have a severe cold with coughing or during periods of excessive activity. Patients with urge incontinence frequently report increased leakage during cold weather and sometimes related to dietary factors such as excessive fluid intake, particularly with products containing caffeine such as coffee.
Do you know of any home remedies for this problem?
No, I do not know of any home exercises for this problem except the Kegel exercises, but you need to be taught how to do them properly.
Do you have any advice about the embarrassing nature of this problem?
If this troubles you, you should visit your physician and undergo an evaluation and seek therapy.
What causes incontinence, is it lifestyle, or biological?
It is primarily biological in most cases. However, it can be made worse by lifestyle such as someone with urge incontinence that drinks excessive amounts of fluids.
What is the most effective treatment for incontinence in older women? My mother is 77 and has had this problem for some time. She has had some relief with pills but still experiences problems.
The evaluation for an older woman should be similar to that for a woman of any age. Once the cause of the incontinence is identified, then your mother should have a discussions with her physician regarding the risk and benefits of the various therapeutic options which are available.
What are some newer treatments that we can look to for help with incontinence?
Neuromodulation or electrical stimulation of the nerves to the bladder is a newer treatment which holds some promise especially for those patients with urge incontinence which does not respond to more conservative forms of management. There are also injectable agents, which may be useful in some forms of stress incontinence. These injectables are placed around the urethra to help it coat.
What is overflow incontinence, and how does it occur and get treated?
Overflow incontinence occurs because the bladder does not empty properly. It can occur for a variety of reasons including problems with the nerves, which innervate the bladder, or long standing obstruction of the bladder among others. It can be treated in a variety of ways depending on its severity which include frequent voiding or voiding by the clock, double voiding, intermittent catherization and indwelling catheter; in some cases, neuromodulation or by diverting the urine from the bladder completely.
How are incontinence cases diagnosed?
Taking a history and performing a physical examination diagnose patients with urinary incontinence. Usually a urinalysis is performed and depending on the findings of the history and physical, further testing with either x-ray studies or an urodynamics study may be appropriate. Get a full evaluation prior to any treatment because the treatments are different because of the etiology or cause of the incontinence.
Any new techniques for control of urinary incontinence following radical prostatectomy?
Following radical prostatectomy patients may be incontinent because of weakness in the valve mechanism or problems associated with the bladder such as decreased capacity. The treatments for incontinence will obviously depend on which of these is the primary cause. Generally, the treatments for sphincteric weakness include pelvic floor exercises, injections of a bulking agent, or an artificial urinary sphincter.
How can recurring bladder infections impact on incontinence?
Recurrent bladder infections can in and of themselves cause enough bladder irritation to cause incontinence. They will also make any underlying condition which causes incontinence worse.
I have a problem not making it to the bathroom without drizzling so to speak. Is this incontinence, or what do you think it might be?
Any leakage of urine would be considered to be incontinence.
What is the normal amount of time between voiding?
The normal amount of time between voiding will depend on a number of factors but primarily fluid intake. Normally, with average fluid intake, approximately 8 voids per day are considered to be within the normal range.
What are main causes of urinary incontinence?
In men, prostate surgery is probably the most common reason we see patients for urinary incontinence. In women, pregnancy and vaginal delivery is probably the most common cause of urinary incontinence.
How does incontinence relate to age?
Incontinence should not be considered to be a normal condition of aging. Elderly patients should be evaluated in essentially the same way that patients of any age should be evaluated.
Can urinary incontinence be caused by decreased (improper) nerve function of the sacral nerve supply and if so can a chiropractor help by restoring the proper nerve function through the adjustment and restoring the normal parasympathetic response to this organ (bladder)?
Incontinence can be caused by problems with the sacral nerves.
What is the surgery where the bladder is shifted? Is it successful?
It is certainly one option, but it is not the only option. I think it is important to have a complete evaluation before one options for any therapy.
What percentage of incontinence is male and which is female?
I think it is safe to say that incontinence is more common in women.
I am a 43-year-old female; 3 full term pregnancies. I have urinary leakage. I wear a pad everyday. Do I need surgery, or is there something else available?
The first thing that you should have is an evaluation to see what type of incontinence you have. Generally speaking, incontinence falls into several categories. One can have overflow incontinence whereby the bladder fills, doesn't empty, and reaches its capacity and then the patient leaks urine more or less on a continuous basis. Another type of incontinence is stress incontinence. This is usually associated with activity, lifting, coughing, running. And then there is urge incontinence, which is caused by a bladder contraction that occurs when the patient is not trying to empty their bladder. Typically, patients will complain that they feel the need to empty their bladder but begin leaking before they can reach a bathroom. The treatments for these different types of incontinence generally fall into two categories: Conservative management with either medications, devices such as a pessary and sometimes biofeedback, and more invasive forms of therapy such as surgery. The type of incontinence, which is diagnosed during the evaluation, will dictate which type of treatment is appropriate.
What are common meds for incontinence?
Probably the most common medications used for the treatment of incontinence fall into the general category of anticholinergics or drugs designed to "relax" the bladder.
What is the difference between 'urge’ incontinence and 'stress' incontinence?
Stress incontinence is also known as activity related incontinence. It typically occurs when the patient is lifting, coughing, straining, or otherwise engaging in some form of physical activity. The bladder contracting when the patient doesn't want it to and is typically described by patients as "I feel I have to go to the bathroom, but I can't make it in time" urge incontinence.
Should a general care physician or specialist treat incontinence? What type of specialist if not a general care physician?
Incontinence may be successfully treated by a variety of physicians including general practice or family practice physicians, urologists, or gynecologists depending on the cause of complexity of the particular case.
If a person has an indwelling catheter in place long term because of incontinence, is irrigation indicated and if so, with what?
Generally, a long term indwelling catheter is only used as one of the last options for the treatment of incontinence. Irrigation is sometimes helpful in keeping the catheter functional and potentially decreasing the incidence of catheter associated infections. A number of irrigation solutions are available and the treating physician is the best one to decide what might be best for a particular patient.
I frequently have strong urges to go to the bathroom that soon pass. What can this be attributed to? Has happened to other males in my family and I'm 63.
Frequent strong urges to go to the bathroom in a 63 year old male can commonly be due to enlargement of the prostate. An evaluation by a physician would certainly be advisable.
Am I correct in saying that my first line of action to prevent incontinence is not to cut back on fluids, but specifically fluids with caffeine?
Well, it depends on how much fluid the patient is taking in. Cutting back too much on fluid can be detrimental. But assuming the patient is getting an adequate amount of fluids, it might be worthwhile to try limiting caffeine to see if this helps the incontinence.
Can a female patient be diagnosis with an ectopic ureter?
Yes.
What about Ditropan XL?
DitropanXL is an extended release anticholinergic medication. Your physician is the best one to decide if you are a candidate for this.
What are Kegel exercises and whom do they benefit?
Kegel exercises are also known as pelvic floor muscle strengthening exercises and are designed to strengthen the muscles that support the pelvic floor and maintain continence. Kegel exercises will benefit patients with stress or urge incontinence and are very worthwhile treatments as they have virtually no side effects and a relatively high degree of success.
Please instruct on PROPER way to do KEGEL exercises?
The best way to instruct a patient on how to do proper Kegel exercises is in the office while doing a physical exam to be sure they are using the proper muscles.
How can fistulas (urinary) cause involuntary urine loss?
Fistulas are abnormal connections from the urinary tract usually into the vagina in the case of female or into the skin in the case of males. They cause incontinence because they bypass the normal sphincter mechanism.

Karl Kreder, MD
Department of Urology
University of Iowa Hospitals and Clinics