Treatments for Urinary Incontinence

By Lisa Moore –

Men and women of all ages can suffer from urinary incontinence (UI), but it is particularly prevalent in the elderly, and women experience it almost twice as often as men. It is defined as the involuntary leaking of urine. Estimates suggest that about 13 million Americans suffer from UI: about 20% of adults over the age of 40 suffer from this condition; while in the nursing home population, at least 50% of patients have some form of UI. Fortunately, there are many treatment options available, and most cases of UI are treatable.

Urinary incontinence has many different causes, and it can take many forms, ranging from small amounts of leakage to a complete lack of bladder control. The main types of UI are as follows:

• Stress incontinence occurs when the pressure in the abdomen increases, overcoming the pressure in the bladder. Movements such as sneezing, coughing, carrying heavy objects, or laughing can increase abdominal pressure, leading to stress incontinence. It is common in women after childbirth, men who have enlarged prostates or have undergone prostate cancer treatments, and postmenopausal women whose low estrogen levels can lead to muscle atrophy. Elderly patients may experience stress incontinence because their bladder muscles are weaker, and small efforts such as standing up from a chair can cause leakage.
• The diagnosis of urge incontinence is given to those who suffer from strong, sudden urges to urinate, often accompanied by loss of urine before reaching a toilet. It accounts for 40-70% the elderly who present UI complaints to a physician. Urge incontinence is a symptom of an overactive bladder, when the bladder muscles contract at inappropriate times, possibly due to abnormal nerve signals. Impaired nerve function has many causes, such as stroke, Alzheimer´s disease, and multiple sclerosis.
• Overflow incontinence occurs when the bladder does not empty properly due to either an obstruction or dysfunctional bladder muscle contractions. Nerve damage can lead to weak bladder muscle contractions, and tumors and bladder stones can block the urethra.
• Functional incontinence refers to cognitive and physical mobility problems which impede the ability to reach the toilet on time. Arthritis and Alzheimer’s disease can cause functional incontinence.
• Mixed incontinence refers to the presence of more than one type of UI, most often stress and urge incontinence. Transient incontinence refers to UI caused by a condition that will pass, like a common cold or an infection.

Treatment of UI depends upon the cause. Here are some of the treatment options used against UI:

• Behavioral therapy involves altering food and liquid intake, scheduling trips to the bathroom, bladder training, and pelvic floor muscle exercises (Kegel exercises). Medications are often used in conjunction with behavioral therapy.
• Anticholinergic medications relax bladder muscles to help prevent spasms in patients who suffer from an overactive bladder.
• Botox, newly approved by the FDA to treat people with UI who have been affected by neurologic conditions like stroke or multiple sclerosis, can also be injected directly into the bladder, where it relaxes the muscles and blocks the chemicals which cause muscle spasms. The price of botox varies from area to area and from state to state.
• Estrogen therapy helps reverse atrophy of the urethra and vagina in elderly women with stress incontinence.

If UI is caused by an enlarged prostate or an infection, antibiotics should be prescribed. Medications like Flomax can also be prescribed to shrink the prostate and relax the urinary tract muscles in men.

Some medications taken for other conditions, like high blood pressure, may cause UI. Changing to an alternative medication may relieve symptoms. Devices may also be used to treat UI. A pessary, for example, is a rigid ring inserted into the vagina, where it exerts pressure on the vaginal walls and the urethra. The added pressure may help to reposition the urethra and reduce leakage. Other devices include the bladder neck support device, urethral insert, and the artificial urinary sphincter. Surgical interventions are used when all other treatment options fail. Surgery can be effective in eliminating urinary tract blockages, supporting weakened muscles, adding bulk, and changing the position of the bladder. More than 150 surgical procedures exist today.

References:
Nursing Homes.APlaceForMoms.com – “Elderly Urinary Incontinence”
NCBI.NLM.NIH.gov – “Urinary Incontinence in the Elderly” Joseph G. Ouslander, MD
Plasticsurgeryguide.com – BOTOX ® Injection Treatments
Kidney.NIDKK.NIH.gov – “National Kidney & Urologic Diseases: Information Clearinghouse (NKUDIC)”
WebMD – “Type of Urinary Incontinence”