Ask a Nurse - Urinary Incontinence
by Cathy Parkes January 22, 2023 Updated: April 27, 2023 4 min read
- 0:00 What to expect in this episode of Ask A Nurse
- 0:17 What are the types of urinary incontinence?
- 0:49 What causes stress urinary incontinence?
- 2:31 How is stress urinary incontinence treated?
- 4:10 What causes urge urinary incontinence?
- 5:20 How is urge urinary incontinence treated?
Hi. I'm Cathy with Level Up RN. In this episode of Ask a Nurse, I'll be answering your questions about urinary incontinence, such as what are the types of urinary incontinence and what causes urinary incontinence and how is urinary incontinence treated? Urinary incontinence is the involuntary leakage of urine. The most common types of urinary incontinence include stress urinary incontinence, urge urinary incontinence, and mixed urinary incontinence. So mixed urinary incontinence is a combination of both stress and urge incontinence. In this video, I'll be covering the causes and treatment of both stress and urge urinary incontinence.
With stress urinary incontinence, increased abdominal pressure from laughing, coughing, sneezing, or exercise causes the leakage of urine. This is due to a weakened pelvic floor or weakened urinary sphincter muscles. So the pelvic floor is like a hammock that runs from your pubic bone to your tailbone and supports your bladder, your reproductive organs, and your large intestine. So the urethra passes through the pelvic floor muscles, and the muscles of the pelvic floor wrap tightly around the urethra to help keep urine inside the bladder. If the pelvic floor muscles are weakened and pressure is exerted against the bladder, such as when you cough or sneeze, this can allow urine to leak out of the bladder. Urinary sphincter muscles are the muscles that control the flow of urine from the bladder into the urethra. And if these muscles are weakened or damaged, then that can lead to stress urinary incontinence. So stress urinary incontinence is much more common in women than it is in men. In women, a weakened pelvic floor can occur due to pregnancy, childbirth, menopause, as well as previous pelvic surgeries. In men, a prostate surgery can cause damage or weaken the urinary sphincter muscles, which can lead to stress urinary incontinence. Other risk factors include chronic coughing or straining as well as obesity and smoking.
Treatment of stress urinary incontinence includes pelvic floor exercises that are referred to as Kegel exercises. This is where you contract and relax the pelvic floor muscles that surround the urethra, vagina, and rectum, and this helps to strengthen those muscles. Losing weight can also significantly improve incontinence symptoms because it decreases the amount of pressure that is exerted against the bladder and the pelvic floor. After menopause, vaginal creams that contain estrogen can help strengthen the tissue in the urethral and vaginal area, and this, in turn, can help with bladder control. Vaginal pessaries can also be used. These are small silicone or plastic devices that are placed in the vagina, and they help to support the urethra and bladder and provide gentle compression of the urethra against the pubic bone, which prevents the leakage of urine. Collagen, which is a bulking agent, can also be injected around the urethra, and this makes it thicker and better able to control urine leakage. And then there are surgical options, including the insertion of a sling, which helps to support the urethra and hold the bladder in place. This surgery does have the potential for serious complications, so you'll definitely want to better understand the benefits and risks of this surgical intervention before making the decision to have surgery.
Let's now talk about urge incontinence. So urge incontinence is sometimes referred to as an overactive bladder. So with this type of incontinence, you will have a sudden and strong need to urinate, and you may not make it to the bathroom on time. So urge urinary incontinence is associated with an overactive detrusor muscle. This is the smooth muscle in the wall of the bladder, so this muscle will contract at the wrong times and no matter how much urine is in your bladder. Urge urinary incontinence can be caused due to damage to the nerves in the bladder, which can occur with diabetes as well as nervous system disorders such as multiple sclerosis, spinal cord injury, and a stroke. It can also be caused by bladder irritation due to a urinary tract infection, caffeine, or certain medications. In men, urge incontinence can be associated with an enlarged prostate due to benign prostatic hyperplasia.
Conservative treatment of urge urinary incontinence may include something called bladder training. So bladder training typically involves maintaining a set toileting schedule and gradually increasing the amount of time between voiding. It also usually includes urge suppression techniques that allow you to control the urge to urinate and make it to the bathroom on time, so this may include staying still, taking deep breaths, and squeezing the pelvic floor muscles. With urge incontinence, it is also important to avoid bladder irritants such as caffeine and alcohol. Medications such as oxybutynin can help to relax the muscles of the bladder and increase the amount of urine that your bladder can hold. Another treatment option is nerve stimulation, which uses mild electrical pulses to stimulate the nerves in the bladder. This helps to improve blood flow to the bladder and strengthens the muscles that control the bladder. Botox injections are another option that help to reduce urgency symptoms and help to increase the amount of urine that the bladder can hold. And then surgical options are available as well to enlarge the bladder or remove the bladder altogether, but these options definitely come with complications and risks.
If you have urinary incontinence issues, rest assured that you are not alone. It is extremely common. People are often reluctant to tell their healthcare providers about their symptoms, but we need to know what's going on so that we can help you. Urinary incontinence is associated with depression, social isolation, skin breakdown, as well as financial hardship due to the cost of incontinence pads. So it is so, so important that you let your provider know about your symptoms so you can get help and improve your quality of life. I hope this episode of Ask a Nurse has been helpful. And if you have a medical question or topic you'd like me to cover in a future episode, then definitely let me know in the comments. Stay informed and stay well.
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