Incontinence and Over Active Bladder

Urinary incontinence affects about 12 million Americans -- more women than
men. It happens when you lose urine by accident. There are several different
types of urinary incontinence.

Types of Urinary Incontinence: Stress Incontinence

This may happen when there is an increase in abdominal pressure -- such as
when you exercise, laugh, sneeze, or cough. Urine leaks due to weakened pelvic
floor muscles and tissues.

Causes of this type of urinary incontinence include:

• Multiple pregnancies and childbirths, which cause stretching and damage
  
• Being overweight
  
• Genetic weaknesses
  
• Radiation therapy
  
• Other chronic conditions

Types of Urinary Incontinence: Urge Incontinence

This type is often called "overactive bladder": You have an urgent need to go
to the bathroom, and may not get there in time, leaking urine.

Causes of this type of urinary incontinence include:

• Damage to the bladder’s nerves
  
• Damage to the nervous system
  
• Damage to muscles
  

Conditions such as multiple sclerosis, Parkinson’s disease, Alzheimer’s
disease, and stroke can harm muscles or nerves, leading to this type of urinary
incontinence.

Some women have both of these types of urinary incontinence -- "stress" and
"urge." Doctors call this mixed urinary incontinence.

Types of Urinary Incontinence: Overflow Incontinence

You may have this type if you are not able to empty your bladder when you
urinate. As a result, you have a constant or frequent dribble of urine. This is
the type of urinary incontinence that most often strikes men.

Causes of this type of urinary incontinence include:

• Weak bladder muscles
  
• Blockage of the urethra
  
• Medical conditions such as tumors

Types of Urinary Incontinence: Functional Incontinence

With this type of incontinence, physical problems such as arthritis or
cognitive problems such as dementia prevent you from getting to the bathroom in
time.

Treatment for Different Types of Urinary Incontinence

To improve or eliminate the problem, you can make lifestyle changes and get
treatment for each of the types of urinary incontinence.

For stress incontinence, treatment options include:

• Pelvic floor exercises. If you've had a baby, chances are you've been
  told to do Kegel exercises. These help to strengthen the pelvic floor after
  childbirth. It is wise to keep doing the Kegels to keep your pelvic muscles and
  tissues strong, which can help prevent stress incontinence.

To do Kegels:

• 
  
  
  
  • Pretend you are trying to stop the flow of urine.
    
  • Hold the squeeze for 10 seconds, then rest for 10 seconds.
    
  • Do 3 or 4 sets daily.
    
    
  
  
• Biofeedback. Using monitors, the biofeedback instructor feeds you
  information about bodily processes, including when your bladder and urethral
  muscles contract. This helps you gain control. It's also often used in
  combination with Kegel exercises.
  
  
• Medications or surgery. Medications can help tighten muscles at the
  bladder neck, preventing leakage. Or, in more extreme cases, surgery can help.
  One procedure pulls the bladder back up to a more normal position, relieving the
  pressure and leakage. Another surgery involves securing the bladder with a
  "sling," a piece of tissue or other material that holds up the bladder to
  prevent leakage.

For urge incontinence, treatment options include:

• Timed voiding and bladder training. First, you complete a chart of
  the times you urinate and the times you leak. You observe patterns and then plan
  to empty your bladder before an "accident" would likely occur. You can also
  "retrain" your bladder, gradually increasing the time between bathroom
  visits.
  
  
• Medications or surgery. Doctors sometimes prescribe medicinesdesigned
  to inhibit the contractions of an overactive bladder. Surgery is reserved for
  severe cases. It aims to increase the storage capacity of the bladder.
  

Bringing up the Topic

All types of urinary incontinence can be embarrassing to talk about, but
overcoming your reluctance is worth it. Treatment can reduce or eliminate the
problem.

Here are some tips that may help you overcome your embarrassment:

• Be straightforward. Just tell the physician or the nurse you are having
  problems. Keep it simple: "I'm having bladder problems."
  
• Expect your doctor to ask many questions about your situation: how long the
  leakage has been happening, how bad it is, how much it upsets your life. If this
  doesn’t happen, it may be time to switch doctors or at least to ask for a
  referral to another doctor with expertise in this kind of problem.