Urinary incontinence

Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the toilet but can't get there in time. These problems are very common, especially among older adults. They usually don't cause major health problems.

The main symptom of urinary incontinence is the accidental release of urine. Symptoms depend on the type of incontinence. You may leak urine when you sneeze or cough, or you may always leak urine. Or you may feel a strong urge to urinate, but urine leaks because you can't reach the toilet in time.

To diagnose urinary incontinence, your doctor will ask about your past health. You'll have a physical exam and be asked about any symptoms. Depending on your symptoms, you may have a pelvic exam. Or if your symptoms could be caused by prostate problems, you may have a rectal exam.

Your doctor will ask about what and how much you drink. You will also be asked how much and how often you urinate and leak urine. It may be easier for you to answer questions if you keep track of these things using a bladder diary for 3 or 4 days before you see your doctor.

You'll also be asked about any medicines you take.

Your doctor will check a sample of your urine. Depending on your results, or if your doctor thinks that your problem may have more than one cause, you may have more tests.

Other tests may include:

• A urine culture. It finds bacteria that can cause urinary tract infections or prostatitis.
• A bladder stress test. It simulates the accidental release of urine that may occur when you cough, sneeze, laugh, or exercise.
• A post-void residual volume test. It measures the amount of urine left after you empty your bladder.
• Urodynamic testing. It is a group of tests to check how well the urinary tract stores and releases urine.

Treatment for urinary incontinence depends on the type you have and how much it affects your life.

Treatments may include:

• Bladder training. This can help you better control when you have to urinate.
• Pelvic floor exercises (Kegels). These help strengthen the muscles that control the flow of urine.
• Medicines. An antidepressant medicine or other medicines may help with bladder control. Estrogen cream used in the vagina may also help.
• Changes in your diet and lifestyle. One example is to limit caffeine, carbonated drinks, and alcohol. These can make you urinate more.
• Medical devices.
  • Urinary catheter. This includes condom catheters.
  • Penile clamp. This may work for short-term use.
  • Incontinence pessary. This fits into the vagina and compresses the urethra.
• Surgery. When other treatments aren't helping enough, you may need surgery. Types of surgery include urethral bulking, surgery to treat an enlarged prostate, and perineal or urethral sling surgery.

Several types of behavioral methods are used for treating urinary incontinence: bladder training, pelvic muscle exercises (Kegels), and biofeedback. People who have incontinence due to physical or mental limitations (functional incontinence) also have options. They can plan to use the toilet before they feel like they need to go. Or they can schedule regular times to use the toilet.

Bladder training

Bladder training helps to increase how long you can wait before having to urinate. You can start by keeping a voiding diary for 24 hours. This will help you track the shortest time you have before you need to urinate again.

Using your shortest time, make a schedule to go to the toilet at this interval all day long. Go to the toilet at these times whether or not you feel the need. Once you can avoid leaking for a full day, increase your scheduled time by 15 minutes. Do this until you are able to be comfortable urinating every three to four hours.

Biofeedback

Biofeedback can be helpful if you are having difficulty doing pelvic floor exercises. During biofeedback, you'll get information on how well you are contracting your pelvic floor muscles.

Learning biofeedback requires practice in a lab or other setting with the guidance of a trained therapist. Home biofeedback units also are available.

Pelvic floor muscle training

Pelvic floor (Kegel) exercises can help strengthen some of the muscles that control the flow of urine. These exercises are used to treat urge or stress incontinence. To do Kegel exercises:

• Squeeze your muscles as if you were trying not to pass gas. Or squeeze your muscles as if you were stopping the flow of urine. Your belly, legs, and buttocks shouldn't move.
• Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
• Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
• Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.

If you are having trouble finding out what muscles to squeeze, you can try stopping the flow of urine a few times. But don't make it a practice to do Kegels while urinating.

If doing these exercises causes pain, stop doing them and talk with your doctor. Sometimes people have pelvic floor muscles that are too tight. In these cases, doing Kegel exercises may cause more problems.

If you aren't sure how to do these exercises, talk to your doctor about getting a referral to a pelvic floor physical therapist.

Kegel exercises are often combined with biofeedback techniques to teach the proper exercise methods and to make sure the exercise is working.