Incontinence and Bladder Dysfunction
The following is a description of the four major types of incontinence:
Stress incontinence is caused by increases in intra-abdominal pressure, brought on by sneezing and/or coughing, for example, which results in the involuntary release of urine through the urethra. Most cases of stress incontinence are due to pelvic relaxation or insufficient support from the pelvic fascia (supporting tissues) and surrounding muscles. In conjunction with a "hypermobile" bladder neck, these stress-inducing events may produce unequal pressures between the bladder and the urethra and the involuntary loss of urine. Risk factors for this type of incontinence include vaginal births, age, genetic predisposition, conditions causing chronic increased abdominal pressure, and conditions causing urethral weakening. Treatment may include Kegel exercises, medications, noninvasive support mechanisms or surgery.
Urge incontinence occurs in about 10-15% of the population and is due to involuntary contractions of the muscle within the bladder wall. The causes of this condition are not clearly defined but may be related to abnormal stimuli to the receptors in the bladder wall which may be caused by infections, bladder or kidney stones, foreign bodies, bladder cancer, or suburethral diverticula. This condition is also found more commonly in people suffering from a neurological disease such as stroke, Alzheimer’s, Parkinson’s, multiple sclerosis, and diabetes. Medications are effective in about 50-80% of people suffering this condition. Other treatments may include Kegels, bladder training exercises and, rarely, surgery.
When a urinary "fistula" (an abnormal passage) forms between the bladder and the vagina, urine may leak out almost continuously. The development of a urinary fistula is often due to previous radiation or surgery, but can be due to childbirth complications. Treatment of this type of incontinence is generally by way of surgical repair. Depending upon the individual circumstances, your urologist may choose to wait several weeks or months for post-surgical fistulas to partially heal before attempting a more complete and effective surgical repair. Antibiotics may be prescribed to prevent or treat infections that may accompany the formation of a fistula.
Decreased or complete loss of tone in the detrusor muscle of the bladder may result in contractions that are insufficient to completely empty the bladder. This condition usually leads to urinary retention. This may cause the bladder to become over-distended – the resulting increase in pressure within the bladder can lead to involuntary loss of urine. An obstruction may also cause similar symptoms. Treatment for this type of incontinence may include surgery as well as medications and intermittent self-catheterization.