Bladder Control Problems In Women

Health Update – Dr. John Brizzolara

Urinary incontinence is the uncontrolled loss of urine. Under normal conditions, the bladder stores urine until it is voluntarily released. This involves a complex interaction between the brain, spinal cord, bladder and support structures in the pelvis. Anything that interferes with this interaction or causes damage to the support tissues can result in a person developing urinary incontinence.

This condition is much more common than most people think occurring in greater than 40% of American women. The condition should not be considered a normal part of the aging processes and occurs in all age groups. In fact, recent studies show that urinary incontinence is becoming quite prevalent among younger women.

Although not a life‐threatening problem, urinary incontinence does have negative social implications. You may be obsessed by the fear of urine loss, concerned about urine odor and worried about being excluded socially. You may feel you are no longer attractive and even lose your sense of sexuality. You may stop exercising or fail to start a weight loss program because of fear of losing urine while exercising.

Feeling alone and isolated, some women may distance themselves from their spouses, family members, and relatives. Some individuals may restrict or avoid excursions outside the home, social interaction with friends and family. Others will avoid sexual activity because of the fear of loss of urine.

If you suffer from bladder control issues, the following instructions will help inform you on the different types of urinary incontinence. This information will allow you to better understand the type of urinary incontinence you suffer from. Being better informed will help guide you in deciding what type of treatment would be best for you. In the great majority of situations, urinary incontinence can be corrected or significantly improved. Physicians that specialize in the diagnosis and treatment of urinary incontinence have the training and knowledge to help you with this condition.

Types of Urinary Incontinence

There are five types of urinary incontinence. Stress, Urge, and Mixed are the most common. Less common types are Overflow and functional.

Stress Incontinence – Loss of urine with coughing, sneezing, laughing, lifting, exercise or maybe just walking. The increased pressure created on the bladder by these activities overcomes the muscular support of the urethra allowing urine to escape.

Urge Incontinence – Sudden uncontrollable loss of urine usually associated with a strong urge to void. May be precipitated by hearing water running, arising from a sitting position, getting out of bed, seeing a bathroom, or starting to enter your house.

Mixed Incontinence – Combination of Stress Incontinence and Urge Incontinence

Overflow Incontinence – Usually a constant seepage of small amounts of urine associated with the occasional loss of large volumes of urine when the individual coughs, laughs or moves. May also have a significant urinary frequency, getting up frequently at night and wetting the bed while asleep.

Functional Incontinence – A person is aware of the need to urinate but is unable to get to the bathroom in time.

Diagnosing Urinary Incontinence

By paying particular attention to the activities, situations, and conditions that seem to bring on, or cause you to have difficulty controlling your bladder, you will be able to have some insight into the type of urinary incontinence you have. Should you decide to seek medical help with your incontinence the more detailed information that you furnish, your physician will aid him in making a more accurate diagnosis. The physician’s correct diagnosis as to the type of incontinence a patient has is the most critical step in recommending the appropriate treatment.

From your explanation of your condition and the urologic physical exam, your physician performs a determination will be made as to whether further diagnostic test is needed to better evaluate your situation. These might entail some or all of the following tests.

Types of diagnosis testing include:

Urinalysis – microscopic evaluation of your urine

Residual Urine – Measurement of how much urine is left in the bladder after a person voids

Cystoscopy – Looking in the bladder with a small flexible telescope.

Stress Test – Placing saline into the patient’s bladder and asking her to cough or strain to see if incontinence occurs.

Urodynamic Testing – A series of advanced test that gives the physician a detailed report on the function of the bladder, urethra and pelvic floor support structures.

Treatment Options

I have learned through the years that the patient history and the exam performed are the two most important aspects of  the evaluation. The type and severity of urinary incontinence will help guide the physician and the patient in discussing treatment options.

Non‐surgical treatments apply to all types of urinary incontinence. These options are more effective for lesser degrees of incontinence. These include medication, pelvic floor exercises, and lifestyle changes.

Surgical treatments for Urinary Incontinence are minimally invasive, performed on an outpatient basis and are very effective as long as the correct diagnosis is made.