Urinary Incontinence: The Urge to Go

Urinary incontinence, or lack of bladder control, is a common issue that can happen to anyone at any age. We understand that this problem can have serious personal ramifications, such as preventing you from leaving your home, inconveniencing your life, and causing depression.

For the urinary system to do its job properly, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Urinary incontinence (UI) is loss of bladder control and the accidental loss of urine. There are varying degrees of severity, while some people may experience mild leaking, others may have uncontrollable wetting.

In men, this problem is frequently due to prostate issues. Fortunately, urinary incontinence is easy to diagnose, and treat and there are a number of treatment options depending on the type and severity of your problem, your lifestyle, and your preference.

The experts at Western Michigan Urological Associates have the knowledge and compassionate care you need. We provide world-class care and will help you treat this common issue, and we will find the option that works best for you.

Types of Urinary Incontinence:

There are several types of urinary incontinence based on what symptoms you may be experiencing, including:

Stress Incontinence – Loss of urine happens when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Stress incontinence occurs when the bladder’s sphincter muscle weakens. In men, removing the prostate can lead to this type of incontinence.

Urge Incontinence – A sudden, intense urge to urinate, followed by an involuntary urine loss. Your bladder muscle contracts, which acts as an alert that may last several seconds to one minute. You may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson’s disease, Alzheimer’s disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there’s no known cause, urge incontinence is also called overactive bladder.

Overflow Incontinence – The inability to empty your bladder, resulting in frequently or constantly dribbling urine. You may produce only a weak urine stream when trying to urinate. This incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes and in men with prostate problems.

Mixed Incontinence – Symptoms of more than one type of incontinence may be diagnosed as mixed incontinence.

Factors That Put You at Higher Risk for Urinary Incontinence Include:

At different ages and throughout various stages of life, there are different risk factors for urinary incontinence, including:

  • Prostate Problems – As the prostate enlarges, it may squeeze the urethra and affect urine flow. The lower urinary tract symptoms (LUTS) associated with an enlarged prostate involve changes or problems with urination, such as a hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence
  • Radical Prostatectomy – The surgical removal of the entire prostate gland, called radical prostatectomy, for prostate cancer may lead to erection problems and UI
  • External Beam Radiation – This prostate cancer treatment may result in either temporary or permanent bladder problems

Causes for Urinary Incontinence Include:

  • Blocked urethra due to an enlarged prostate
  • Urinary tract infections
  • Effects of certain medications
  • Constipation
  • Diseases and disorders involving the nervous system muscles (such as multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke)
  • Diabetes
  • Delirium
  • Dehydration
  • Overactive bladder
  • Weak muscles that hold the bladder in place
  • Weak sphincter muscles surrounding the urethra
  • Birth defects
  • Some surgeries

Tests Used for Diagnosing Urinary Incontinence Include:

Testing for urinary incontinence in men usually involves different types of testing to determine the best course of action for your treatment, including:

  • Keeping a Bladder diary – Your provider may ask you to keep a bladder diary for several days. For this, you would record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate, and the number of incontinence episodes.
  • Urinalysis (urine test) — A urine sample is collected and examined for signs of infection and traces of blood or other abnormalities.
  • Blood test – A blood sample is collected and checked for various chemicals and substances related to incontinence causes.
  • Post void residual (PVR) measurement – For this test, you would urinate (void) into a container that measures urine output. Your provider will then check the amount of leftover (residual) urine in your bladder using a catheter or ultrasound. A large amount of leftover urine may mean a blockage in your urinary tract or a problem with your bladder nerves or muscles.
  • Pelvic ultrasound — An ultrasound used to view other areas of your urinary tract or genitals and examine for abnormalities.
  • Stress test – For this test, you would be asked to cough vigorously or bear down so your provider can watch for urine loss.
  • Urodynamic testing — Measures pressure in your bladder when resting and filling. A catheter is inserted into your urethra and bladder to fill your bladder with water. A pressure monitor measures and records the pressure within your bladder.
  • Cystogram — In this X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, a special dyed fluid is injected. As you urinate, the X-ray images help to show possible problems with your urinary tract.
  • Cystoscopy — A thin tube with a tiny lens (cystoscope) is inserted into your urethra to check for — and possibly remove — abnormalities in your urinary tract.

Treatment Options for Urinary Incontinence:

The good news is many men typically regain urinary control by changing some small daily habits. Treatment depends on the type of problem and what best fits your lifestyle. It may include simple exercises, medicines, special devices or procedures. If behavioral treatments fail, your provider may consider medicines. For some patients, surgery is the best choice, however treatment will start with the least invasive options first.

What can you expect with the different treatment options?

  • Behavioral Treatment – For some, avoiding urinary incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom — a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips.
  • Medication– Medication can affect bladder control in different ways, depending on your individual needs. Some medication helps to prevent incontinence by blocking abnormal nerve signals that make the bladder contract at the wrong time. Others slow urine production or relax the bladder.
  • Note that before prescribing a medicine to treat incontinence, your provider may look at changing a prescription you already take. For instance, diuretics are often prescribed to treat high blood pressure because they reduce fluid in the body by increasing urine production. Some people may find that switching from a diuretic to another blood pressure medicine alleviates their issues with incontinence.
  • Biofeedback – This option uses measuring devices to help you become aware of how your body is functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can supplement pelvic muscle exercises and electrical stimulation to relieve stress and urge incontinence.
  • Neuromodulation – For urge incontinence that does not respond to behavioral treatments or drugs, stimulating certain nerves to the bladder can be effective in some patients. You would need to have testing done, in order to determine if this device would be helpful to you.
  • Catheterization – If you are incontinent because your bladder never empties completely, such as in overflow incontinence. Or your bladder cannot empty because of other reasons such as: poor muscle tone, past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube you insert through the urethra into the bladder to drain urine.
  • Male sling – In a sling procedure, we create a support for the urethra by placing a strip of material under the urethra and attaching the strip ends near the pelvic bone. The sling keeps constant pressure on the urethra so it does not open until you consciously release the urine.
  • Artificial Urinary Sphincter – a device placed completely inside the patient’s body to provide simple and discreet urinary control.

While urinary incontinence may be frustrating, we are here to help you every step of the way to make this process more manageable. It is important that your doctor work with you to accurately diagnose your symptoms and tailor a unique treatment plan to fit your specific needs. We at Western Michigan Urological Associates want to work with you to find the best option for you and your family. You can use our CONTACT FORM or call us at (616) 392-1816 to request an appointment with one of our doctors.

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