July 20, 2021
Destigmatizing Urinary Incontinence
Though it may not be as openly discussed as some conditions, 17 million people in the U.S. are affected by it.
I wish I could eliminate shame and fear from the equation regarding the barriers people face in visiting a doctor. As a physician who has made the field of urology his life's work, it is heartbreaking to meet patients who have suffered years (decades in some cases) battling a urologic condition in relative silence, ashamed or afraid to address it. Especially when it comes to urinary incontinence, people who experience it can often feel embarrassed and alone. But they are not alone. In fact, 17 million people in the United States are affected by some form of urinary incontinence. My goal is to help people understand what these conditions are and to ensure they know that help is available. Suffering in silence should never be an option.
Urinary incontinence can be subdivided into stress incontinence, urgency incontinence, and mixed incontinence. So let's delve in and get a better understanding about these conditions, their common causes, and treatment options.
Stress incontinence means uncontrollable urine leakage when physical (not psychological) stress is placed on the bladder. Examples of stress incontinence include leaking urine with sneezing, coughing, laughing, lifting, jumping, or bending. Essentially, any activity that increases external pressure onto the bladder may cause the urine in the bladder to leak out.
Some groups of people are at higher risk of developing stress incontinence. For women, childbirth, vaginal delivery, and post-menopausal changes to the body can increase the risk of urinary incontinence. In these cases, the pelvic muscles that hold the bladder in place and wrap tightly around the urethra become weakened. When the pelvic floor muscles are weak, they cannot prevent urine from leaking out of the bladder during sneezing, coughing, laughing, and exercising. In men, those who undergo prostate surgery for prostate cancer can have an increased risk of developing urinary incontinence. In these men, the prostate is no longer available to act as a barrier to prevent urine from leaking out of the body. Therefore, these patients are at higher risk of urine leakage when they sneeze, cough, laugh, or exercise. Finally, both men and women are at risk of urinary incontinence conditions worsening as they get older.
Another type of incontinence is called urgency incontinence. This means there is a leakage of urine when a person has the urge to urinate. This urge causes the bladder to uncontrollably contract, pushing the urine out before the person reaches the bathroom. Patients who develop urge incontinence, usually have first developed symptoms of overactive bladder.
Bladder overactivity is a condition in which the bladder contracts or spasms without a person's brain controlling it or keeping it relaxed. Uncontrollable bladder contractions cause a person to have increased urges to urinate. If the uncontrollable contraction is strong enough, it can lead to urine leaking out before a person reaches the bathroom. Therefore, urgency incontinence is a more severe form, or the result, of an overactive bladder.
Overactive bladder and eventual urge incontinence can occur in three broad scenarios:
1. Psychological stress, and anxiety: Psychological stress or anxiety may decrease the brain's ability to keep the bladder relaxed as it fills with urine, leading to uncontrolled bladder contractions, overactive bladder (increased urgency to urinate), and possibly leading to urgency incontinence.
2. Intrinsic muscle disorder of the bladder: In these situations, there is something wrong with the function of the bladder muscles, leading to the muscle constantly contracting and not responding to stimuli from the brain that normally cause relaxation of the bladder muscles. Diseases or conditions that lead to intrinsic muscle disorder of the bladder include but are not limited to urinary tract infection (UTI), cystitis, pelvic prolapse, bladder cancer, an enlarged prostate leading to thickening of bladder muscle, and diabetes.
3. Nervous system-related disorders: The nervous system's function is to coordinate bladder muscle function. This means that as the bladder fills with urine, the nervous system acts to keep the muscle relaxed to allow the urine to stay inside the bladder until a person reaches the bathroom. Nervous system diseases or conditions that lead to overactive bladder and urgency incontinence include but are not limited to: post-menopausal state, spinal disc disease, spinal cord injury, multiple sclerosis, brain stroke, and brain tumors.
Mixed incontinence occurs in patients who suffer from both stress and urgency incontinence. It is relatively common in women who have had multiple pregnancies and have various degrees of pelvic prolapse may suffer from mixed incontinence.
Now for the good news. There are more treatment options available today for people who are affected by urinary incontinence than ever before.
For those who suffer from stress incontinence: While there are no known medications that can primarily tighten pelvic floor muscles, certain drugs have the side effect of causing increased pelvic muscle tone to help with stress incontinence. Imipramine (an old medication used to treat depression) has the positive side effect of tightening the pelvic floor muscles and reducing stress incontinence. Additionally, physical therapy for pelvic floor muscles may strengthen the muscles and help prevent future leakage. Finally, female sling surgery can treat certain types of urinary incontinence. In men, the placement of an artificial urinary sphincter can effectively treat stress incontinence.
For those who suffer from urge incontinence or overactive bladder without leakage, there are more than six different medications such as Oxybutynin, Tolterodine, and Mirabegron, for example, that may alleviate the symptoms. Furthermore, pelvic floor therapy, injection of Botox into the bladder's inner lining, peroneal nerve stimulation, or placement of a spinal pacemaker can treat overactive bladder and urgency incontinence. And for these many reasons, patients should not suffer in silence.
I suspect that one of the reasons people may not seek treatment for urinary incontinence sooner is that it doesn't "seem" like a life-threatening condition and is likely not causing pain. But I can also say that many people who have suffered from it for years have so altered their lives to "work around it" that they can become extremely depressed and unhappy. That's no way to live this one very precious life we've been given. So, if any of the above conditions sound like something you're going through, please do not let shame, embarrassment, or pride stand in the way of you scheduling an appointment with your doctor. I guarantee they've seen it before, and they can help steer you in the right direction so you can find lasting relief.