Incontinence and the Overactive Bladder

Urinary incontinence is a common medical condition that effects both men and women of all ages. A related but separate condition is the overactive bladder, also known as bladder urgency. Urinary incontinence is the involuntary loss of urine. The overactive bladder is a disorder of excessively frequent urination, often described as the need to urinate greater than eight times a day. Patients who suffer from these conditions are often embarrassed and reluctant to discuss them with their doctor, however, they are very treatable conditions that can be controlled and often cured.

There are many different types of incontinence: stress, urge, overflow, and mixed. Stress incontinence is the involuntary loss of urine which occurs when stress (pressure) is applied to the bladder, which may occur when a patient coughs or sneezes. Urge incontinence is the extreme instance of an overactive bladder. This occurs when a patient feels a strong urge to urinate and loses control if they can not reach the bathroom soon enough. Overflow incontinence occurs when the bladder does not empty completely. As a result the bladder fills beyond its capacity and dribbles out like water over a dam. Mixed incontinence is a combination of two or more of the above types of incontinence.

To understand why a patient leaks urine it is helpful to understand how the urinary system works. The kidneys process the urine, the body’s liquid waste, which then flows through the ureters to the bladder for storage. The bladder holds the urine until it is convenient to be released. The bladder neck, and urethra sphincter are circular muscles which hold the urine in the bladder and are normally in the closed state. When a person wants to urinate, the bladder neck and sphincter relax, the bladder muscle contracts, and the urine flows out of the body through the urethra. An incontinent patient suffers from an abnormality when one or more of these processes does not work correctly.

Stress incontinence occurs when pressure is applied to the bladder (i.e. exercise or heavy lifting) and the bladder neck or external sphincter are not strong enough to keep the urethra closed, thus, urine leaks. This often occurs as a result of pregnancy and childbirth, hormonal changes, pelvic surgery, or being overweight.

Urgency (the overactive bladder) and urge incontinence occur when the bladder muscle contracts at an inconvenient or inappropriate time. Despite a persons attempt to stop the flow of urine, the pressure of the bladder muscle overcomes the urethra sphincter and urine leaks out. Urge incontinence often occurs as a result of a bladder infection, damage to bladder nerves, damage to the brain (such as a stroke), or even medications.

Overflow incontinence occurs when the bladder fills beyond its capacity due to the inability to empty correctly. The full bladder continues to receive urine from the kidneys, and when there is no more room to hold the urine it flows out the urethra causing dribbling and leaking. Causes of overflow incontinence include, stroke, diabetes, neuralogic disorders, medications, pelvic surgery or pelvic radiation.

Like any other disease process, the key to proper treatment is a proper diagnosis. The first step in the diagnosis is a complete and accurate history and physical exam. In addition, there are a number of tests which aid in the diagnosis of incontinence or the overactive bladder. These tests may include a urinalysis and culture, a look inside the bladder known as a cystoscopy, x-rays of the urinary system, a voiding diary documenting the time and volume of urination and incontinent episodes, measurement of the urine left in the bladder after emptying, or a urodynamic study. The types of tests ordered will depend upon the symptoms the patient presents with.

Once a diagnosis is made a treatment plan is chosen. The treatment of the various causes of incontinence is different and thus the proper diagnosis is imperative. Various possible treatment options include medication, muscle strengthening exercises, timed voiding, behavioral modification, collagen injections, or minor surgery. All of the treatment options involve potential risks and benefits. There is often more than one possible choice for treatment, and it is important that the patient and physician discuss these options so as to decide upon the proper treatment for each individual.

To summarize, urinary incontinence and the overactive bladder are common conditions that affect people of all ages, both male and female. Urinary incontinence is never a “normal” process of aging. The nature of incontinence is often quite embarrassing which leads to a delay in patient seeking treatment. The cause of incontinence is variable, so it is important to identify the specific type to ensure effective proper treatment. There are numerous effective treatments for incontinence and the overactive bladder. These range from simple behavioral modification to minor surgery. The patient often has a choice of more than one therapy and should discuss these options with their physician to find the right choice for each individual.

Sean Manion, M.D., is a board certified urologist. He joined Longmont Clinic in September 2000.