About Incontinence

Incontinence, or loss of bladder or bowel control, is a common condition among adult women. At least every fifth woman is suffering from it in some phase of one’s life. In addition, the prevalence of female urinary incontinence increases with elder women being 59 % at the age of 70.

Often incontinence is being shamed and because of that it usually takes many years before person suffering from the condition finds one’s way to treatment. However these days there are effective treatment options available for every type of urinary incontinence.

Four basic types of urinary incontinence

Stress incontinence is the most common type of urinary incontinence among women under the age of 60. Stress incontinence occurs when sudden pressure is being put on the bladder. Usually leakage of urine happens during physical activity such as laughing, sneezing coughing, or exercise. Amount of leaked urine is relatively small and leakage happens without feeling the urge of urinate.

Stress incontinence often occurs as a result of weakened pelvic floor muscles that support the bladder and urethra. The weakness may be caused by muscle injury, hormonal changes, childbirth or aging. Also smoking and overweight are being considered as risk factors for the stress incontinence.

Urge incontinence is the urgent need to pass urine. This is followed by bladder contraction, which results in leakage. The condition is caused by overactive bladder, which often occurs because of infection, bladder stones, neurological diseases or because of damaged nerves between the bladder and the brain.

Mixed incontinence is the most common type of urinary incontinence among women older than 70 years. The condition occurs when symptoms of both stress and urge types of incontinence are present.

Overflow incontinence is the continuous leakage of urine. The condition occurs when person never feels the urge to urinate. As a result, the bladder never empties and a small amount of urine is leaked constantly. This type of incontinence is prevalent in older men and rare in women. Overflow incontinence can be caused by tumors, urinary stones, enlarged prostate or under active bladder.

Treatment options for incontinence

Behavioral techniques are often the first and the least aggressive treatment option for incontinence. By changing your lifestyle it is possible to ease the symptoms of stress and urge incontinence.

Especially with overweight individuals it is essential to lose some weight. Already 5 to 10 percent loss of weight often eases the symptoms.

You can also prevent incontinence by stopping smoking and curing constipation.

Further, it is also important to use right sized diapers to avoid skin irritation. Even though diapers are necessary, they often lower one’s self esteem. In these cases it is vital to seek an actual cure for the condition.

Scheduled toileting is one way to retrain one’s bladder. Scheduled toileting means that caregiver prompts the incontinent patient to go to the bathroom every 2 to 4 hours. The method is suitable especially for elderly people in institutional care. It is also possible to retrain the bladder by slowly increasing the time between toilet trips.

Physical therapy is primarily being used to cure stress, urge and mixed incontinence. However, rehabilitation of pelvic floor muscles is an effective treatment option for all types of incontinence.

Women suffering from stress incontinence will benefit from structured physical exercise lasting at least three months. This is also an effective treatment option for women suffering from the stress incontinence after childbirth.

Pelvic muscle rehabilitation is the most recommended and effective way to treat stress incontinence. It is also possible to do pelvic muscle exercises independently. However, the effect of training increases significantly when using biofeedback device that guides you towards the proper training technique. It may also be helpful to use vaginal cones to treat symptoms of stress incontinence, even though the cones are less effective than structured training. Another problem with the vaginal cones is the inconvenience of use.

Electrical stimulation is mainly being used to treat urge incontinence. However, the effectiveness of electrical stimulation as a treatment option for stress, mixed and overflow incontinence is not unarguable. Also so called TNS-treatment, which stimulates the nerves, can be effective treatment option for urinary incontinence. Acupuncture is not being considered as an effective treatment for incontinence.

Pharmacologic therapy is one common treatment for urge incontinence. Some patients may also benefit from drugs developed for stress incontinence. However, the side effects with these drugs are often noticeable, especially with elderly people. Added to this the drugs don’t actually heal the incontinence, which means one must use them for good to avoid the symptoms of incontinence.

Surgical treatment can be used to treat stress and overflow incontinence. Rarely it is used for urge incontinence. It is recommended to try all appropriate nonsurgical treatment options before deciding on surgery. 

There are many different surgical methods that may be used to treat different types of urinary incontinence. The new surgical techniques for stress incontinence, for example tension-free vaginal tape (TVT), are very effective. However, there is little research information available about possible complications in the long run. Surgical treatment is also significantly more expensive compared to other treatment options.

Sources: 
The Finnish Medical Society Duodecim, Käypä Hoito-suositus.
Aukee. P. Biofeedback training in urinary incontinence.
Bo. et. al. Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women.
MedlinePlus: http://www.nlm.nih.gov/medlineplus/urinaryincontinence.html