The NIDDK lists several types of incontinence:

• Stress incontinence occurs when urine leaks during such activities as laughing, sneezing, coughing, and bending. These acts increase pressure on the abdomen, which pushes on the bladder. This is the most common type of incontinence in women. It is usually caused by a weakening of the muscles that control the bladder, which often occurs after pregnancy, childbirth, or menopause.
• Urge incontinence, also called overactive bladder, is characterized by frequent urination; a strong, sudden need to urinate; and inability to get to the bathroom in time after the urge. Nerve damage that results from certain diseases or surgeries often causes overactive bladder. The NAFC estimates that 1 in 5 adults over age 40 has symptoms of overactive bladder.
• Mixed incontinence is a combination of several types of incontinence, usually stress and urge.
• Overflow incontinence occurs when the bladder never empties completely. It becomes so full that it just overflows. This type of incontinence is more common in men, often because of an obstruction such as an enlarged prostate, the male gland that sits just below the bladder.
• Functional incontinence is leakage in a person who has difficulty reaching a bathroom in time because of a physical disability, such as arthritis, or a mental disorder, such as Alzheimer's disease.

Diagnosis and Treatment

Successful treatment starts with a doctor's evaluation to determine the type of incontinence and the cause. The patient may be referred to a urologist, a doctor who specializes in treating problems of the urinary tract and bladder in both women and men, or to a urogynecologist, a gynecologist by training who focuses on women's urinary problems.

The evaluation usually includes a medical history, a physical examination, and a test to check the bladder storage and emptying functions (urodynamic testing).

Leng stresses the importance of a thorough evaluation and discussion of treatments so that "the patient and I are on the same page, and so we have the same expectations. Treatment should be very much custom-tailored to the individual patient."

"There are varying degrees of treatments," says Janine Morris, Chief of the FDA's Urology and Lithotripsy Devices Branch. "They go from conservative therapy to surgery. All are for managing symptoms, and all have benefits and drawbacks."

Treatment options fall into four broad categories: behavioral, medications, devices, and surgery.

Behavioral Therapy

Behavioral therapies are noninvasive, free of side effects, and don't limit further treatment options. These therapies include "retraining" the bladder and doing exercises called Kegels.

Bladder retraining helps the bladder to hold urine for longer periods of time. The individual is instructed to empty the bladder at scheduled times during the day, and then to gradually extend the time between bathroom trips.

For stress incontinence, a doctor may recommend Kegel exercises to strengthen the muscles below the bladder (pelvic floor muscles) that hold in urine. These exercises for women and men involve repeatedly tightening, holding, and then relaxing the pelvic floor muscles.

Leng advocates Kegels for patients with mild incontinence. "And like any exercise, it's only effective as long as you continue doing it."

Some people can't tell whether they are doing the exercises correctly. "A lot of women try to do the exercises on their own and give up," says Leng, who refers patients to a physical therapist to teach them to use the proper muscles. Specialists may use biofeedback devices that indicate a muscle contraction when the correct muscle is exercised. Some biofeedback devices are sold over-the-counter for home use.

<< Previous    1  [2]  3  4  5    Next >>