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Bladder Control and Urinary Incontinence

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Updated June 12, 2014

A friend confided that she could not make it to the bathroom in time when she felt a sudden urge to urinate. It happened to her at home, and fortunately, she was able to clean her wet pants and floor, and change. But she felt embarrassed and ashamed.

This is not the kind of thing women or men talk about except in the confines of a 1 on 1 relationship, with a close friend. If it is happening to you often, you should bring it to the attention of your doctor. They can help you figure out why you are having episodes like these, and in many cases, they can work with you on treatments that will help you gain better bladder control.

What Could Cause Me To Lose Urinary Control?

A variety of physical problems can contribute to loss of bladder control:

Infections

  • Urinary tract infections
  • Vaginal infections

Sphincter Problems

The lower urinary tract is surrounded by muscles. When those muscles are weak, it becomes difficult to control the opening and closing of the urethra, which carries your urine from your bladder. Overactive bladder muscles can also be an issue.

Functional Problems

  • Neurologic disorders, including a spinal cord injury, cervical spondylosis, or degenerative multiple sclerosis.
  • Diabetic neuropathy
  • Mobility impairment may make it difficult to get to the bathroom quickly.
  • Psychological issues, such as depression may interfere with normal urination/li>

Types of Urinary Incontinence

  • Urge incontinence.

    Urge incontinence is a sudden and intense urge to urinate that you cannot stop. Without warning, you might suddenly feel like you burst your bladder, and urine comes rushing out. If it happens in a social setting, it might deter you from social situations. With urge incontinence, you can lose a lot or just a little urine with each episode. It is a distressing form of incontinence because you may have to rush to the toilet and not get there in time. You could have to urinate more frequently without warning. You might need to get up at night to urinate suddenly. and you might wet the bed.

    Overactive bladder, also referred to as OAB, is a sudden urge to urinate that cannot be suppressed. Sometimes, it is viewed as a subcategory of urge incontinence.

  • Stress Incontinence

    If you leak small amounts of urine with minimal motion, for example, when you cough, laugh, or sneeze, you may have stress incontinence. Typically, the amount of urine that you leak is low to moderate.

  • Overflow Incontinence

    This occurs when you feel like your bladder is full, but you can only release small amounts of urine each time that you go to the toilet.

  • Mixed Incontinence

    This type of incontinence is just what it sounds like: you may have a combination of any of the three types of incontinence (urge, stress, or overflow) incontinence.

How Will My Doctor Evaluate My Problem?

A comprehensive examination will include a full health history, a voiding (urination) diary, which will document hour-by-hour, for 48-72 hours, the type of urinary leakage that you are experiencing, a physical exam, laboratory tests, and urodynamic tests. Urodynamic tests, which show how well your bladder and lower urinary tract are functioning, will be performed. They will show problems with storage capacity

What Type Of Treatments Can Help?

Behavioral Changes

Behavioral changes, including diet and exercise, done consistently and regularly, will help many people regain bladder control. In some cases, drugs will need to supplement these strategies.

Bladder training involves setting a schedule that you follow-every two to 3 hours during the day- documenting when you urinate. You urinate only then. And you should drink much three-four hours before you go to bed because it may make your bladder full at night, when you are sleeping. This helps you learn when to sense a full bladder and only go then. It also helps eliminate excess trips to the toilet when your bladder just isn't full.

  • Pelvic muscle training.

    The pelvic muscles are very important in squeezing and releasing the bladder and allowing you to urinate. Some people have weak pelvic muscles, possibly due to having been pregnant, or being obese. Kegel exercises are a common form of pelvic muscle training. Kegel exercises teach people how to isolate the pelvic muscles and improve contraction of the bladder muscles.

  • Modifying Fluid Intake

    Drinking too many caffeinated beverages, such as coffee, tea, and coke, can irritate the bladder. Restricting your intake to 1-2 cups per day is best. Also, if increased urinary frequency is a problem, try eliminating your drinking before attending social situations.

  • Medical Intervention

    • Medication is often recommended as a supplement to, and not a replacement for lifestyle changes.
    • Pessary insertion. If you are in your postmenopausal years and your doctor determines that your pelvic muscles are weak and cannot support your bladder, s/he may insert a pessary to support them.
    • Surgery is sometimes needed. If you are an older women with a collapsed urethra or bladder, you may benefit from a retropubic suspension, suburethral sling, or bulking agents. For men who have failed medical therapy, an artificial sphincter, male sling, or urinary diversion may help contain your urine.

    Sources:

    Serels SR, Appell RA. Contemporary diagnosis and management of bladder control problems. 2nd ed. Handbooks in Healthcare Co.: Newtown, PA, 2005.

    Vasavada SP, Appell RA, Sand PK, and Raz S. Female urology, urogynecology, and voiding dysfunction. 1st ed.Informa HealthCare: New York, NY, 2004.

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