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Urinary Incontinence: What Should You Do If You Think You Have It?

How is urinary incontinence diagnosed?

Medical conditions should never be self-diagnosed. If you think you have urinary incontinence, please review the symptoms and then consult a medical professional. Your medical provider will ask you about your medical history and symptoms, including:

● How frequently you empty your bladder

● When and how you leak urine

● The amount of urine you leak

● When your symptoms began

● What kinds of medicines you take

● If you have ever given birth and, if so, what your experience was like

● Your medical practitioner will do a physical exam to look for signs of health problems that may cause incontinence.

Your medical practitioner may also do other tests such as:

● Urine test. They will have you urinate into a cup, they will send your urine to a lab and your urine will be checked for causes of incontinence like an infection.

● Ultrasound. Your doctor will use an ultrasound to take pictures of the bladder, kidneys and urethra. Your doctor will look for anything abnormal that may be causing urinary incontinence.

● Bladder stress test. During this test, you will cough or imitate pushing during childbirth.

● Cystoscopy. Your healthcare provider places a thin tube with a minuscule camera into your bladder and urethra to examine for damaged tissue. Depending on the type of cystoscopy, your doctor may use medicine to numb you, or you may be fully sedated.

● Urodynamics. Your healthcare provider places a thin tube into your bladder and fills your bladder with water. This allows them to measure the pressure in your bladder to see how much fluid your bladder can hold.

Your healthcare practitioner may ask you to keep a symptom journal for a few days to track when you leak urine or empty your bladder. This can help us see patterns that give us clues about the cause of your incontinence and the types of treatments that may work for you.

How is urinary incontinence treated?

You and your healthcare practitioner will work together to create a treatment plan. You can start with steps you can take at home and if these steps do not improve your symptoms, your healthcare practitioner may recommend other treatments.

Be patient with yourself and your treatment plan, it can take a month or longer for different treatments to begin working.

Should I drink fewer fluids if I have urinary incontinence?

No, many people with urinary incontinence think they need to drink fewer fluids to reduce their urinary incontinence symptoms. However, you need fluids, especially water, for good health. This excludes alcohol and caffeine which can stress or irritate the bladder and make urinary incontinence worse.

According to the Institute of Medicine, women need about 11 cups (91 ounces) of fluids a day from food and beverages. Getting an ample amount of fluids helps keep your kidneys and bladder healthy. It also prevents things like urinary tract infections or constipation, which may make urinary incontinence worse.

After the age of 60, people are less likely to get enough fluids which put them at risk for dehydration, as well as, other conditions that make urinary incontinence worse.

What are some medical treatments for stress incontinence?

If the steps you take at home don’t improve your stress incontinence, your doctor may talk to you about other options like:

● Medicine. After menopause, hormone therapy can help strengthen the muscles and tissues in the vaginal areas. It can also help strengthen your urethra and a strong urethra will help with bladder control. 

● Vaginal pessary. 

○ A reusable vaginal pessary is a small silicone or plastic device that you insert into your vagina. The pessary pushes up against the urethra and vaginal walls to support the pelvic floor muscles, which can help reduce stress incontinence. Pessaries come in different sizes, so your healthcare practitioner must write a prescription for your specific size. 

○ Another kind of pessary resembles a tampon, it is used once and then thrown away. You can get this kind of pessary at most stores that sell feminine hygiene products.

Bulking agents. Your healthcare provider can inject a bulking agent into the tissues surrounding the urethra and bladder to cause them to thicken. This reduces the amount of urine that can leak out by keeping the bladder opening closed.

Surgery. Surgery for urinary incontinence is not advised for women who plan on getting pregnant in the future because this can cause leakage to happen again. According to the American College of Obstetricians and Gynecologists, the two most common types of surgery for urinary incontinence are:

Sling procedures. Specifically, the mid-urethral sling is the most common type of surgery to treat stress incontinence. The sling is either a piece of tissue from your own body or a narrow piece of man-made (synthetic) mesh that your doctor places underneath your urethra. The sling functions like a hammock to hold the bladder in place and support the urethra.

Colposuspension. This surgery, often referred to as a Burch procedure, helps hold the bladder in place with stitches on either side of the urethra.

What are some nonsurgical treatments for urge incontinence?

If the steps you take at home don’t help to improve your urge incontinence symptoms, your healthcare practitioner may recommend one or more of the following treatments:

Medicines. Medicines to treat urge incontinence help increase the quantity of urine your bladder can hold and relax the bladder muscles. 

Botox. Botox injections in the bladder can help if other treatments don’t but you may need to get Botox treatments once every three months to make it work for you. Botox can also help increase the quantity of urine your bladder can hold and relax the bladder muscles.

Nerve stimulation. This is when a practitioner uses mild electric pulses to stimulate nerves in the bladder. These pulses can help to strengthen the muscles that help control the bladder and increase blood flow to the bladder. Talk to your healthcare practitioner about the different kinds of nerve stimulation.

Biofeedback. Biofeedback is when a therapist puts an electrical patch on the skin over your urethral muscles and bladder. The patch is connected to a wire and linked to a screen. You and your therapist will watch the screen to see when these muscles contract so they can help you learn to control them.

Surgery. If you have severe urge incontinence, your healthcare practitioner may recommend surgery to help increase the amount of urine your bladder can hold or to remove your bladder. Removing your bladder is a serious surgery and is only considered when no other treatments are effective and the quality of your life is seriously impacted.

How can I prevent urinary incontinence?

Although you can’t typically prevent urinary incontinence, you can take steps to lower your risk:

● Practice pelvic floor exercises daily, especially during pregnancy and after talking to your doctor, nurse, or midwife.

● Reach or stay at a healthy weight.

● Eat foods with fiber to help prevent constipation.

 

For more information about urinary incontinence or set an appointment, call us at 530-345-0064, extension 281.

 

 

Sources:
  1. Centers for Disease Control and Prevention. (2014). Prevalence of Incontinence Among Older Americans (PDF, 1.3 MB). National Center for Health Statistics. Vital Health Statistics; 3(36). 
  2. Reddy, J., & Paraiso, M.F.R. (2010). Primary Stress Urinary Incontinence: What to Do and Why. Reviews in Obstetrics & Gynecology; 3(4): 150–155.
  3. Stewart, W.F., et al. (2003). Prevalence and Burden of Overactive Bladder in the United States. World Journal of Urology; 20(6): 327–336.
  4. American College of Obstetricians and Gynecologists. (2016). Urinary Incontinence (PDF, 84 KB).
  5. Altman, D., Granath, F., Cnattingius, S., & Falconer, C. (2007). Hysterectomy and Risk of Stress-Urinary-Incontinence Surgery: Nationwide Cohort Study. Lancet; 370(9597): 1494–1499.
  6. Gleason, J.L., Richter, H.E., Redden, D.T., Goode, P.S., Burgio, K.L., & Markland, A.D. (2013). Caffeine and Urinary Incontinence in Women. International Urogynecology Journal; 24(2): 295–302.
  7. Sangsawang, B., & Sangsawang, N. (2013). Stress Urinary Incontinence in Pregnant Women: A Review of Prevalence, Pathophysiology, and Treatment. International Urogynecology Journal; 24(6): 901–912.
  8. Kim, D.K., & Chancellor, M.B. (2006). Is Estrogen for Urinary Incontinence Good or Bad? Reviews in Urology; 8(2): 91–92.
  9. Health Resources and Services Administration, Agency for Healthcare Research and Quality. (2012). Nonsurgical Treatments for Urinary Incontinence in Adult Women: Diagnosis and Comparative Effectiveness (PDF, 12.9 MB). Comparative Effectiveness Review; 36.
  10. U.S. National Library of Medicine. (2017). Kegel exercises – self-care.
  11. “Urinary Incontinence.” Womenshealth.gov, 31 Jan. 2019, www.womenshealth.gov/a-z-topics/urinary-incontinence.
  12. Institute of Medicine. (2004). Dietary References Intakes: Water, Potassium, Sodium, Chloride, and Sulfate
  13. Rosinger, A. and Herrick, K. (2016). Daily water intake among U.S. men and women, 2009–2012. National Center for Health Statistics Data Brief; 242.
  14. American College of Obstetricians and Gynecologists. (2017). Surgery for Stress Urinary Incontinence (PDF, 85 KB).
  15. Food and Drug Administration. (2018). Considerations about surgical mesh for SUI.
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