It’s important to determine the type of urinary incontinence that you have. That information will guide treatment decisions.
By asking questions, a physician can better understand a patient’s particular situation and type of incontinence. Questions focus on:
- bowel habits,
- patterns of urination and leakage,
- pain, discomfort, or straining when voiding
- Medical and Surgical History: illnesses, pelvic surgeries, and pregnancies
- medications he or she is currently taking
The cough stress test, in which the patient coughs forcefully while the physician observes the urethra, allows observation of urine loss. Instantaneous leakage with coughing suggests a diagnosis of stress incontinence. Leakage that is delayed or persistent after the cough suggests urge incontinence. The physical examination also helps the physician identify medical conditions that may be the cause of incontinence. For instance, poor reflexes or sensory responses may indicate a neurological disorder.
The physician may ask the patient to keep a record of his or her bladder activity. In the voiding diary, the patient records fluid intake, fluid output, and any episodes of incontinence. This contributes valuable information to help the physician understand the patient’s situation.
The pad test is an objective test that determines whether the fluid loss is in fact urine. The patient may be asked to take a medication that colors the urine. As fluid leaks onto the pad, it changes color indicating that the fluid lost is urine. The pad test may be performed during a one-hour period or a 24-hour period. The pads may be weighed before and after use to assess the severity of urine loss (1 gram of increased weight = 1 mL of urine lost).
Because bladder infection, or urinary tract infection, can cause symptoms similar to urge incontinence, the doctor may obtain a sample of urine for urinalysis and urine culture to see if any bacteria are present.
Bladder cancer such as carcinoma in situ of the urinary bladder (cancer that is confined to the bladder lining cells in which it originated and has not spread to other tissues) can cause symptoms of urinary frequency and urgency, so a urine sample may be examined for cancer cells (cytology).
- A study of the urine called a chemistry 7 profile may be performed to test for poor kidney (renal) function.
Post-Void Residual Volume
The measurement of post-void residual (PVR) volume is a part of the basic evaluation for urinary incontinence.
To determine the PVR urine volume, either a bladder ultrasound or a urethral catheter may be used. The initial attempt to urinate should be evaluated for hesitancy, straining, or interrupted flow. A PVR volume less than 50 mL indicates adequate bladder emptying. Measurements of 100 mL to 200 mL or higher, on more than one occasion, represent inadequate bladder emptying.
This test is performed by inserting a sterile lubricated cotton swab (Q-tip) into the female urethra.
The cotton swab is gently passed into the bladder and then slowly pulled back until the neck of the cotton swab is fit snugly against the outflow tract of the bladder (the bladder neck). The patient is then asked to bear down (Valsalva maneuver) or to simply contract the abdominal muscles. Excessive motion of the urethra and bladder neck (hypermobility) with straining is noted as movement of the Q-tip and may correlate with stress incontinence.
Treatment for urinary incontinence depends on the type of incontinence, its severity and the underlying cause. A combination of treatments may be needed.
Your doctor may recommend:
- Bladder training
- Double voiding
- Scheduled toilet trips
- Fluid and diet management
- Pelvic floor muscle exercises or Kegel exercises
Electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months.
Medications commonly used to treat incontinence include:
- Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura).
- Mirabegron (Myrbetriq). Used to treat urge incontinence, this medication relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.
- Alpha blockers. In men with urge or overflow incontinence, these medications relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), terazosin (Hytrin) and doxazosin (Cardura).
- Topical estrogen. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate tissues in the urethra and vaginal areas. This may reduce some of the symptoms of incontinence.
Devices designed to treat women with incontinence include:
Interventional therapies that may help with incontinence include:
- Bulking material injections.
- Botulinum toxin type A (Botox)
- Nerve stimulators
If other treatments aren’t working, several surgical procedures can treat the problems that cause urinary incontinence:
- Sling procedures
- Bladder neck suspension
- Prolapse surgery
- Artificial urinary sphincter
Absorbent pads and catheters
If medical treatments can’t completely eliminate your incontinence, you can try products that help ease the discomfort and inconvenience of leaking urine:
- Pads and protective garments