Causes of
Incontinence
There are many causes of urinary incontinence. Some of these
causes are related to temporary conditions. Once they are treated, the
incontinence usually goes away. Temporary causes include:
- Urinary tract infection
- Constipation
- Certain medications
- Increased dietary intake of
caffeine, alcohol, artificial sweeteners and carbonated beverages
Some other causes of incontinence are
not temporary. There is, however, treatment available for many of
these conditions. Other causes include:
- Weakness of the muscles that hold
the bladder in place
- Weakness of the bladder and or the
sphincter muscles
- Overactive or underactive bladder
muscles
- Decreases in certain hormones,
especially estrogen
- Neurological disorders (ex:
Multiple Sclerosis, Parkinson's Disease)
There are many causes of urinary
incontinence. Some of these causes are related to temporary
conditions. Once they are treated, the incontinence usually goes away.
Temporary causes include:
- Urinary tract infection
- Constipation
- Certain medications
- Increased dietary intake of
caffeine, alcohol, artificial sweeteners and carbonated beverages
Some other causes of incontinence are
not temporary. There is, however, treatment available for many of
these conditions. Other causes include:
- Weakness of the muscles that hold
the bladder in place
- Weakness of the bladder and or the
sphincter muscles
- Overactive or underactive bladder
muscles
- Decreases in certain hormones,
especially estrogen
- Neurological disorders (ex:
Multiple Sclerosis, Parkinson's Disease)
Overflow
Incontinence
Overflow incontinence occurs due to an inability to completely
empty the bladder. There is a constant or frequent small amount of
urine leakage. Essentially, the bladder becomes overfilled and the
urine leaks out because the bladder can no longer maintain any more
urine. A simple analogy would be like water seeping over the top of a
dam because it has met its capacity. Patients may experience:
- Frequent night time urination
- Taking a long time to urinate
- Dribbling stream with little force
- Urinating small amounts and not
feeling completely empty afterward
Mixed
Incontinence
Many patients have a combination of incontinence types. Especially
prevalent are patients with both stress and urge incontinence. These
patients experience symptoms of:
- Leakage with cough, sneeze and
rise of abdomen pressure
- Leakage which is sudden and with
little warning
- Frequent daytime urination
- Urgency
- Etc. ……please see above for
other symptoms
Fistula
Incontinence
A fistula is defined as an abnormal connection between two organs
lined with some type of skin. It most commonly forms between the
bladder or urethra and the vagina. Though uncommon in developed
countries such as the United States it can occur after surgical
trauma, pelvic cancer, pelvic radiation therapy and obstetric trauma.
Patients may experience.
- Continuous urine leakage
- Leakage with cough, sneezing, or
rise of abdominal pressure
- Uncontrollable leakage
Clinical
Evaluation
All patients should have a comprehensive history and physical
examination, which emphasizes the woman's urogenital tract. A focused
physical examination assesses vaginal tissue and neighboring organ
support. On a patients' first visit to Dr Miklos' office, some simple,
relatively painless tests are conducted and may include the following:
Q-tip test
- a moistened Q-tip or cotton swab is inserted into the urethra.
The patient is asked to strain and the change in angle of the cotton
swab is measured. The change in angle is proportional to the degree
of bladder-neck descent on bearing down or Valsalva maneuver.
Although this anatomical defect is associated with stress
incontinence it is not diagnostic, and may occur in women with
uterovaginal relaxation without incontinence.
Uroflowmetry
- The patient is asked to urinate over a urine catch, which sits
on a scale. This test will measure rate of urination, length of
urination and whether the urine stream is continuous or
intermittent.
Bladder
Scan - Upon completion of the uroflowmetry, an ultrasound
is performed just above the pubic hairline. This is a quick,
painless test that determines the quantity of urine in the bladder.
This is helpful in determining if a person empties the bladder
completely when urinating.
Simple
Cystometry - The patient is then catheterized and the
bladder is filled with sterile water and assessed for bladder spasms
and cough or stress incontinence.
Urinalysis
- The urine obtained at the time of catheterization is tested
for blood and bacterial infection.
The physician may recommend other
testing or more sophisticated urodynamics to provide for accurate
diagnosis and treatment for particular types of incontinence. Advanced
Urodynamic testing is usually performed if the patient is not
responding to conservative therapy and/or is considering surgery.
Advanced
Urodynamic Testing
Advanced Urodynamic Testing is a series of tests and/or x-rays
that give a detailed look at the function of the bladder, urethra and
sphincters. This helps to diagnose any problems with storing urine or
voiding. Urodynamic testing involves having a small catheter placed in
the bladder (via the urethra), the vagina or the rectum. Most patients
consider urodynamic testing painless.
A Complex
Cystometrogram. The bladder is filled with approximately 10-15
ounces of sterile water. Bladder pressures are recorded to determine
whether the patient has spontaneous contractions (bladder spasms).
After the filling phase the patient is asked to cough and any urine
leakage is recorded. Simultaneous coughing and urine leakage is
consistent with stress urinary incontinence.
A Voiding
Pressure Study. The final portion of the study involves having
the person urinate on a special commode with the catheters still in
place.
The entire test takes approximately
20-30 minutes. Other tests such as leak point pressure and urethral
closure pressures are also performed during advanced urodynamic
testing.
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