There are different types of incontinence. It is very important to try to sort out which type is playing the greatest role in causing the incontinence because the treatment can be quite different.
Incontinence refers to loss of urine during coughing, laughing, sneezing or other movements that increase abdominal pressure and put pressure on the bladder. Damage to the structures that support the bladder and urethra, such as during childbirth, can result in stress UI. Urge incontinence refers to sudden feeling or urge to urinate with subsequent loss of urine, “can’t make it in time”. This type of incontinence is often caused by inappropriate bladder contractions (spasms). is much less common and occurs when the bladder doesn’t empty properly, causing urine to spill over. This can occur with weak bladder muscles, nerve damage from diabetes or blocked urethra.
Evaluation of UI may involve urinalysis, bladder stress test (cough vigorously and doctor watches for urine loss), ultrasound, cystoscopy or urodynamic studies. Treatment will depend on the underlying cause and type of incontinence. Treatments include bladder training, kegel exercises, medications, neurostimulation, injection of Botox into the bladder, injection of bulking agents into the urethra, surgical placement of urethral sling or surgical repair of pelvic prolapse.
Recent UCSF Urology publications on UI:
Blaschko SD, Yang JH, Baskin LS, Deng DY. Combined method of bladder neck closure and concomitant augmentation cystoplasty in the setting of refractory urinary incontinence. Urology. Apr 2012;79(4):955-957.
Deng DY. Urinary incontinence in women. The Medical clinics of North America. Jan 2011;95(1):101-109.
Deng DY, Rutman M, Raz S, Rodriguez LV. Presentation and management of major complications of midurethral slings: Are complications under-reported? Neurourology and urodynamics. 2007;26(1):46-52.
Lin CS, Lue TF. Stem cell therapy for stress urinary incontinence: a critical review. Stem cells and development. Apr 10 2012;21(6):834-843.
Rahman NU, Minor TX, Deng D, Lue TF. Combined external urethral bulking and artificial urinary sphincter for urethral atrophy and stress urinary incontinence. BJU international. Apr 2005;95(6):824-826.
Rutman M, Itano N, Deng D, Raz S, Rodriguez LV. Long-term durability of the distal urethral polypropylene sling procedure for stress urinary incontinence: minimum 5-year followup of surgical outcome and satisfaction determined by patient reported questionnaires. The Journal of urology. Feb 2006;175(2):610-613.
National Kidney and Urologic Diseases Information Clearinghouse: Urinary Incontinence in Women