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Urinary Incontinence

Urinary incontinence is the loss of voluntary bladder control, causing a leakage of urine. The severity ranges from occasionally leaking when one coughs or sneezes to an urge so sudden and strong that one cannot get to a bathroom in time. Urinary incontinence is especially common in older men and women, nursing home residents, and people who are obese.

There are different types of urinary incontinence:

Stress Incontinence - the loss of urine when exerting pressure, or stress, on the bladder by coughing, sneezing, laughing or with exercise. This occurs when the sphincter muscle, a valve at the outlet of the bladder, is weakened. Pregnancy, childbirth and menopause are the leading causes of stress incontinence in women. Removal of the prostate gland is the primary cause in men.

Urge Incontinence - a sudden, intense urge followed by an involuntary loss of urine, as well as a frequent need to urinate at night. This type of incontinence can be caused by a urinary tract infection, bladder irritants, neurological diseases like Parkinson's, Alzheimer's and stroke, and nervous system damage from multiple sclerosis.

Overflow Incontinence - a frequent, constant dribble of urine accompanied by an inability to completely empty the bladder. Overflow incontinence may be caused by bladder damage, a blocked urethra (the tube that carries urine out of the body), nerve damage from diabetes, multiple sclerosis or spinal cord injury, and, in men, prostate problems.

Mixed Incontinence - a combination of more than one of the above.

Treatment

The treatment of urinary incontinence depends on the type and severity. Doctors, however, like to try the least invasive treatment first, including:

  • Bladder training - learning to delay urination and lengthen the time between bathroom trips
  • Scheduled toilet trips - timed urination
  • Fluid/diet management - modification of eating and drinking habits to regain control of the bladder
  • Pelvic floor exercises -- to strengthen the urinary sphincter and pelvic floor muscles; these Kegel exercises include squeezing the muscles used to stop urination
  • Medications - anti-cholinergic drugs to calm an overactive bladder; low-dose topical estrogen to rejuvenate the urethra and vaginal area; and certain antidepressant drugs to treat stress and mixed incontinence
  • Sacral neuromodulation - a technique to improve nerve function related to urination
  • Surgery - when other treatments are not enough, surgery may be an option; this may include minimally invasive injections of bulking agents to major surgical intervention
  • In many cases, simple lifestyle changes or medical treatment can stop urinary incontinence.

Contact Information

Beth Israel Deaconess Hospital-Needham
148 Chestnut Street
Needham, MA 02492
781-453-3000