Urinary Incontinence

Types of Urinary Incontinence

Normally, the brain and bladder work together to control lower pelvic, bladder, and sphincter muscles. Urination occurs through a series of bladder muscle contractions that send urine through a tube that exits the body called the urethra. If anything disrupts this process, urine leakage may occur. Other people with UI have a strong urge to urinate that results in accidents. There are several different types of urinary incontinence that may be experienced:

• Stress urinary incontinence (SUI): Urine leaks occur from bladder pressure due to actions such as laughing, coughing, or strenuous abdominal movements.
• Urge incontinence: Sometimes caused by infections or underlying neurological disorders, this type of UI is characterized by a sudden urge to go. It’s also referred to as over-active bladder (OAB).
• Functional incontinence: UI caused by a mental or physical impairment, such as arthritis, that makes it difficult to get to the bathroom on time.
• Overflow incontinence: With this type of UI, the bladder doesn’t completely empty because the body produces more urine than what the bladder can hold, which results in leakage after urination.
• Mixed UI: A combination of different types of urinary incontinence.

Recurring Urinary Incontinence

Age-related changes and prostate cancer are some of the factors that may contribute to UI becoming a recurring issue. Some individuals have urine control issues because of a tumor or some other type of urinary tract obstruction.

Diagnosis and Treatment

Making a positive diagnosis of UI typically starts with a physical exam and a review of your medical history. Recommended testing may include a urinalysis to rule out infections and a post-void residual measurement to determine how much urine is left in your bladder with an ultrasound or catheter. You might be asked to keep a bladder diary to document your urination habits and patterns.

The way UI is treated will depend on the severity of your symptoms. If urinary incontinence symptoms are mild or moderate, for instance, you may benefit from bladder training, scheduled bathroom trips, or pelvic floor exercises that may help improve bladder control.

If symptoms are severe or not easy to control, gentle electrical stimulation may be recommended to stimulate pelvic floor muscles. If you prefer to avoid surgery, pads and protective garments or self-catheterization may be helpful. UI treatment might also involve:

• Anticholinergics, alpha blockers, and other medications
• Urethral or vaginal inserts
• Injections with bulking agents or Botox
• Nerve stimulators
• Surgery to insert an artificial urinary sphincter
• Sling procedures for stress incontinence

Artificial Urinary Sphincter

Leakage often occurs at the place where the bladder connects with the urethra that carries urine out of the body. If there aren’t other structural problems involved, the problem may be correctable by creating a tighter seal around the bladder neck to keep urine from leaking when it’s stored in the bladder.

An artificial urinary sphincter is a prosthetic device that includes a balloon and a control pump that’s inserted in the scrotum. A fluid-filled ring (urethral cuff) made of silicone is inserted around the bladder neck to keep the sphincter firmly closed until it’s time to urinate. A valve placed under the skin deflates the urethral cuff. During surgery, an incision is made in the area between the rectum and scrotum to insert the pump. Another incision is made in the abdomen for the artificial urinary sphincter and balloon.

A common reason for an AUS is urinary control issues related to an enlarged prostate. If this gland needs to be removed, an artificial sphincter may be inserted after the prostate is taken out. There may be some urine leakage following the insertion of an AUS, although this usually stops within a few months after the device is activated.

Results after a penile implant or an artificial urinary sphincter to correct urinary incontinence problems is inserted will depend on factors such as a man’s overall health and whether or not there are underlying health issues to consider. Because of the increased use of minimally invasive techniques by surgeons and specialists, patients often experience fewer risks when prosthetic devices are inserted and enjoy shorter recovery periods.

Urinary incontinence isn’t hereditary, nor is it considered a disease. It’s usually a symptom of an underlying issue, although it’s not always preventable. However, you may notice improvements with some urine control problems by making some positive lifestyle changes. For instance, losing weight may decrease pressure on the bladder. Avoiding excessively acidic or spicy foods, eating more fiber-rich foods, and quitting smoking are additional steps that may make UI symptoms less of a distraction.