What is the most effective treatment for bladder incontinence?

Bladder incontinence or urinary incontinence is the loss of bladder control movements that causes unintentional leakage of urine and is often an embarrassing problem for many people. It is commonly seen in older adults and women after delivery and menopause. Bladder incontinence is seen more in women as compared with men. Urinary tract infections, prostate enlargement, diabetes, medications, and pelvic floor disorders can also lead to bladder incontinence. 

The main symptom is the passing of urine when you don’t want to do it, especially while coughing or sneezing. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that is so sudden and strong you do not get to a toilet in time. Don’t hesitate to tell all these things to your doctor. 

Consult your healthcare provider if you experience bladder incontinence that affects negatively in performing your daily activities. Treatment depends upon the type of incontinence, patient’s age, general health and mental health status of the patient. Maintaining a healthy lifestyle, following a healthy diet, and certain medications help to manage the condition.

What is bladder incontinence?

Bladder incontinence is the unintentional leakage of urine when a person does not want to do it. This happens when a person’s control over the urinary sphincter muscle is lost or weakened. It affects millions of people in the world. The chances of getting bladder incontinence increase with age. It can also be due to stress factors such as coughing and sneezing, and it can happen during and after pregnancy. Obesity, smoking, urinary tract infections,  prostate enlargement etc will increase the chances of getting bladder incontinence. Bladder control and pelvic floor, or Kegel, exercises can help prevent or reduce it.

What are the different types of bladder incontinence:

There are different types of bladder incontinence and they have different causes, characteristics and triggers for urine leakage. They are:

• Stress incontinence: In this type, urine leaks out and times when your bladder is under pressure. For example, urine leaks when you laugh, cough, run, sneeze jump, or lift up things
• Urge incontinence: In this type, you will experience an intense urge to urinate right away. This may happen as a result of an overactive bladder(OAB). Various reasons such as weak pelvic muscles, infections, nerve damage, low levels of estrogen after menopause or a heavier body weight, medications, and excess intake of beverages like alcohol and caffeine will result in OAB.
• Overflow incontinence (chronic urinary retention): This type of incontinence happens when you do not empty the bladder completely each time while urinating. As a result of improper emptying, urine leaks frequently from the bladder. It is seen in men with large prostate and in people with diabetes, stroke, and multiple sclerosis.
• Mixed incontinence: you have mixed incontinence if you have both an overactive bladder and stress incontinence
• Total incontinence: This type of bladder incontinence happens when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leaking.

What are the symptoms of bladder incontinence:

The symptoms of bladder incontinence include:

• Leaking of urine during everyday activities such as exercising, lifting, laughing, coughing, sneezing, and bending
• Leaking urine without any warning or urge
• Difficulty in holding urine, after feeling a sudden urge to urinate
• Being unable to reach out toilet on time
• Wetting your bed while sleeping
• Leakage of urine during intercourse
• Nocturia (getting up often at night to urinate)

How is bladder incontinence diagnosed?

If you experience involuntary leaking of urine that impairs your daily activities, you should consult a doctor. After discussing your symptoms, your doctor will ask you some questions such as how often you feel leakage, how long have you been experiencing the symptoms, Do you leak urine between trips to the toilet, how often this happens and how much urine you leak each time etc to figure out the type of incontinence you are having. Also, they will ask you if you have any underlying medical histories such as diabetes, prostate diseases, etc. They will ask you to maintain a diary adding all the symptoms you are experiencing and how often you are experiencing it in a day.

After discussion, your doctor will do a physical examination. They will look for any physical reason that could be causing your incontinence. This could include doing a pelvic exam if you’re a woman or checking the size of a man’s prostate.

Other diagnostic procedures include:

• Urine samples: your doctor will ask you to do a routine urine analysis to check if you have any infections, or blood in the urine that may cause bladder incontinence
• Ultrasound: This helps the healthcare provider to visualize your bladder.
• Stress test: your doctor will ask you to cough, sneeze, or exercise and check if urine is leaking while performing these activities
• Cystoscopy: Your doctor will insert a cystoscope into your urethra and bladder for a detailed visualization
• Pad test: your doctor gives you a pad to wear, which will catch any leaked urine. At the end of the test, this pad will be checked to see how much urine you lost.
• Urodynamic testing: This test helps to check how much urine your bladder can hold

Management and treatment for bladder incontinence:

Depending on the type of bladder incontinence, severity of symptoms experienced by the patient, underlying medical conditions, age and mental health of the patient, treatment method varies. They vary from medication, dietary and lifestyle changes, bladder training, medical devices, and at the last stage, surgery. 

Medications:

Medications can help very well to return to normal functioning of the bladder. The following are the medications usually prescribed to control bladder incontinence:

• Anticholinergics: This type of drug helps to calm the overactive bladder and help patients with urge incontinence.
• Topical estrogen: It helps to reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms.
• Imipramine: It is a tricyclic antidepressant that helps to improve the mental health of patients.

Lifestyle changes:

Following are the tips to improve bladder incontinence:

• Empty your bladder at regular intervals
• Empty bladder before doing physical activities
• Avoid lifting heavy objects
• Perform regular Kegel exercises  that help to strengthen your pelvic floor muscles
• Avoid or limit drinking caffeine and liquid beverages before physical activities
• Practice bladder training to help stretch out the amount of time between each trip to the bathroom. The goal of bladder training is to try and wait a little longer between urinating each time to build up strength.
• Wear pads or other products to avoid wetting clothes
• Maintain a healthy body weight

Medical devices:

The following are the medical devices that are designed for women to control incontinence:

• Urethral inset: A woman can insert this device before physical activities and she can remove it when she wants to urinate
• Pessary: It is a rigid ring inserted into the vagina and can be worn throughout the day. It helps to hold the bladder and prevent leakage
• Radiofrequency therapy: In this, tissue in the urinary tract is heated. Once it heals, it becomes firmer and offers better urine control
• Botox: It is injected into the bladder to calm the overactive bladder
• Bulking agents: these are injected into the tissue around the urethra to keep it closed
• Sacral nerve stimulator: It is attached to the skin under the buttocks to control bladder movement

Surgery:

Surgery is the last preferred option if any other treatment works. Women who are of childbearing age and wish to conceive should discuss this with their doctor before planning to undergo surgical procedures. The different surgical methods include:

• Sling procedures: In this type, a mesh is inserted under the neck of the bladder to support the urethra and prevent urine from leaking out
• Colposuspension: In this type, the bladder neck is lifted which can help to relieve stress incontinence
• Artificial sphincter: In this type, a valve or artificial sphincter is inserted to control urine flow from the bladder to the urethra

Other treatment options:

If medical devices or treatment can not help you control bladder incontinence, you can use the following products to ease difficulties:

• Pads and protective garments
• Catheter 
   

Conclusion:

Bladder incontinence can cause involuntary leakage of urine which can be an embarrassing condition. Weakening or stoppage of sphincter muscles to hold your bladder results in this condition and it affects many people around the world. But don’t hesitate to discuss this with your healthcare provider.  Following some lifestyle modifications, taking some medicines, and using some medical devices can help you to overcome these symptoms. Even if these methods do not help you to overcome the symptoms, don’t worry much as there are so many surgical methods available in modern medicine to help you. 

FAQs

Q: What are the first signs of bladder incontinence?

A: You will experience uncontrolled urine leakages while performing routine activities such as exercising, lifting, laughing, sneezing, and coughing. You will also experience difficulty holding urine after passing urine, or you will feel an urgency to urinate.

Q: Can you heal bladder incontinence naturally?

A:   Following a healthy lifestyle, practicing bladder control exercises, limiting the intake of caffeine, and alcohol, and practicing exercises to strengthen the pelvic muscles will help to control bladder incontinence to an extent.
 

By -Dr Aaksha Shukla | April 15, 2024 | 9 Min Read