Urinary Incontinence โ Diagnosis and Treatment
Diagnosis
Doctors begin by asking detailed questions about symptoms and medical history. This helps them identify the type of incontinence, such as stress, urge, overactive bladder, overflow, or mixed incontinence.
Understanding the pattern of urine leakage helps doctors choose the right treatment. Next, doctors perform a physical exam and may ask the patient to cough to check for urine loss.
Doctors usually check a urine sample for infection, blood, or other changes. They call this test a urinalysis and use it to rule out urinary tract infections or other problems.
Doctors often ask people to keep a bladder diary for a few days. The diary tracks:
- Amount and type of fluids consumed
- Times and amounts of urination
- Urgency or urge episodes
- Leakage events
Doctors measure postvoid residual to see how much urine remains in the bladder after urination. They perform this test with a catheter or an ultrasound.
If a lot of urine remains, it may suggest overflow incontinence or issues with bladder muscles or nerves.
Doctors may also order additional tests:
| Test | What it checks |
|---|---|
| Urodynamic testing | Bladder and urethra function |
| Pelvic ultrasound | Physical changes and any blockages |
| Pad test | Measures amount of urine leaked during activities |
These tests help providers find the cause, such as detrusor overactivity, functional incontinence, or transient incontinence. The results guide further care.
Treatment
Lifestyle and Bladder Control Methods
People can manage urinary incontinence by making behavior changes. These methods include:
- Bladder Retraining: Delaying urination after feeling the urge and slowly increasing the time between bathroom trips. The goal is to urinate every 2.5 to 3.5 hours.
- Double Voiding: Trying to urinate, waiting several minutes, then trying again to fully empty the bladder.
Other methods include scheduled bathroom visits every two to four hours. Adjusting fluids and diet can help, such as reducing alcohol, caffeine, or citrus juices that irritate the bladder.
Limiting the amount of liquids and working on weight loss or increasing activity, if advised, can also help.
Exercises to Strengthen Pelvic Muscles
Pelvic floor muscle training, or Kegel exercises, builds stronger muscles that support bladder control. Both women and men with incontinence can benefit.
- How to do Kegels: Squeeze the muscles used to stop urine flow. Hold for five seconds, then relax for five seconds.
- Repetitions: Work up to ten-second holds and aim for at least three sets of ten repetitions daily.
Some people benefit from guidance by a pelvic floor therapist or biofeedback to ensure correct technique.
Drug Treatment Options
Doctors prescribe medications to reduce leakage and manage bladder problems.
| Medication Type | Main Uses | Typical Users |
|---|---|---|
| Anticholinergics | Urge incontinence | Most adults |
| Beta-3 agonists | Urge incontinence | Most adults |
| Alpha-blockers | Overflow/urge (mainly in men) | Men |
| Topical estrogen | Tissue support in women | Postmenopausal women |
- Anticholinergic Drugs: These medications relax the bladder and are often used for urge incontinence.
- Beta-3 Adrenergic Agonist: This medication relaxes bladder muscles and helps the bladder hold more urine and empty better.
- Alpha-Blockers: Tamsulosin, alfuzosin, silodosin, and doxazosin help men with symptoms from an enlarged prostate or trouble emptying the bladder.
- Topical Estrogen: Low-dose estrogen creams, rings, or patches may improve tissues around the urethra and vagina in women, possibly easing symptoms.
Electrical Impulse Treatments
Doctors use mild electrical currents to activate and strengthen pelvic muscles.
- Method: They place electrodes in the vagina or rectum to stimulate muscle contractions.
- Duration: Treatments occur over several months.
This approach can help with both stress and urge incontinence, but doctors usually try other methods first.
Devices to Support Bladder Control
Some people benefit from simple medical devices that stop leaks.
| Device Type | Who Uses It? | How It Works | When Used |
|---|---|---|---|
| Urethral insert | Mainly women | Plugs urethra temporarily | Physical activity |
| Pessary | Mainly women | Supports pelvic organs | Daily, with prolapse |
- Urethral Inserts: Small, disposable plugs for the urethra, used during activities that may cause leaks. Remove them before urinating.
- Pessaries: Soft, flexible devices placed in the vagina to support the urethra, especially helpful for women with prolapsed pelvic organs.
Minimally Invasive Procedures and Injections
Doctors may offer interventional approaches if other methods do not help enough.
- Bulking Agent Injections: Doctors inject a substance near the urethra to make leakage less likely. Repeat injections are possible.
- Botox Injections: Doctors inject botulinum toxin into the bladder muscle to calm it for people with overactive bladder symptoms if other treatments fail.
- Nerve Stimulators: Devices implanted under the skin or inserted as a vaginal plug send painless electrical pulses to nerves that control the bladder.
Surgical Solutions for Incontinence
Doctors consider surgery when other methods are not effective.
- Sling Procedures: Doctors place a sling made from synthetic material or a personโs tissue under the urethra to support it and prevent leakage during actions like coughing or sneezing.
- Bladder Neck Suspension: This surgery lifts and supports the bladder neck and urethra, usually through an abdominal incision.
- Prolapse Repairs: Women with both prolapse and incontinence can have both problems addressed with one surgery.
- Artificial Urinary Sphincter: Doctors place a small ring around the bladder neck to keep it closed until urination. The person presses a valve under the skin to open the ring and urinate.
Pads, Collectors, and Catheters for Urine Management
When controlling symptoms is not possible, people use special products for comfort.
- Absorbent Pads: Thin, discreet pads and protective garments work like regular underwear. Men may use a drip collector, a small pad worn over the penis under tight underwear.
- Urinary Catheters: People who cannot empty their bladders may use a catheter, a thin tube, to drain urine several times a day. They must clean these tubes regularly to prevent infections.
Ways to Manage Daily Life and Home Care
People can make simple changes at home to help decrease urine leakage and avoid skin problems. Keeping clean by wiping with a washcloth and letting the skin dry naturally is important.
Using barrier creams like petroleum jelly or cocoa butter may protect the skin from irritation. Special skin cleansers made to remove urine can also help and may be less drying.
Bladder training and pelvic floor exercises, such as Kegels, strengthen muscles that help stop leaks. Setting up a routine to use the bathroom, or bladder retraining, can improve bladder control.
Making the toilet easier to reach can help, especially at night. Clearing walkways, adding night lights, or placing a commode close to the bed makes getting to the toilet safer.
Alternative medicine
No alternative medicine methods completely cure urinary incontinence. Early research suggests that acupuncture and yoga may help some people manage symptoms.
More studies are needed to confirm these effects.
Managing and Adjusting
Many people feel self-conscious about bladder control issues, so they might use absorbent products, pack extra clothes, or limit activities outside the home. These actions help them feel more prepared and avoid accidents.
Helpful tips include:
- Using absorbent pads or briefs
- Carrying spare clothing
- Choosing clothes that are easy to change
- Planning trips with restroom stops in mind
Seeking treatment from a healthcare provider can improve symptom control and quality of life.
Getting Ready for Your Visit
How to Prepare Before Seeing the Doctor
To make the most of your appointment, get organized ahead of time. Here are some helpful steps:
- Check for pre-visit instructions. There may be food or drink restrictions.
- Keep a symptom diary. Write down when symptoms happen, how often you urinate, and any nighttime bathroom trips.
- Record your medications. Bring a list of all medicines, vitamins, and supplements, including dosages.
- Gather medical history. Note any other health issues, surgeries, or diagnoses.
- Bring support if needed. Ask a family member or friend to come along to help remember what is discussed.
- Take notes. Bring a notebook or use your phone to write down key points during the visit.
- Prepare questions. Some possible things to ask:
| Question Ideas |
|---|
| What could be causing my symptoms? |
| Will I need tests? What kind? |
| Are my symptoms temporary? |
| What treatments are available? |
| What side effects might I expect? |
| Are there generic medicine options? |
| How should I manage this with my other conditions? |
Writing down these questions can help you have a smoother and more helpful conversation with your family physician, urologist, or urogynecologist.
What Your Doctor May Ask You
During the visit, doctors often ask questions to understand your symptoms and health history.
They may ask when your symptoms began and how severe they are. Doctors might ask if your problems are constant or come and go.
They may want to know what makes your symptoms better or worse.Your doctor could ask how often you go to the bathroom. They might ask if you have trouble starting to urinate or emptying your bladder.
Doctors may ask if you have seen any blood when you go. They might also ask if you smoke, drink alcohol, consume caffeine, or eat foods that could affect your bladder.
Your doctor may discuss next steps, such as exams or tests. If you share clear and honest answers, your healthcare provider can develop a care plan that fits your needs.
