Urinary incontinence is the involuntary loss of urine that has a negative impact on the individual's quality of life. It is estimated that approximately 17 million people in the United States have bladder control problems. Between 15-30% of women experience urinary incontinence and the prevalence as well as the severity of the leakage increases with age. Although loss of bladder control can be common as women grow older, it is not considered a normal part of aging. The good news is that most cases of urinary leakage can be treated successfully.
There are several different categories of urinary incontinence. Stress incontinence occurs when there is involuntary leakage of urine during increased abdominal pressure. You may feel leakage when you stand, lift, or cough. Urge incontinence is the leakage of urine associated with a strong urge and is often referred to as overactive bladder. Women with this condition do not feel they can hold their urine long enough to reach the restroom. Mixed urinary incontinence is a combination of stress and urge incontinence. Overflow incontinence is caused by incomplete emptying of the bladder, so that the bladder "overflows" when it becomes too full.
What is stress urinary incontinence (SUI)?
Stress urinary incontinence is the involuntary leakage of urine during activities such as coughing, sneezing, lifting, or exercising.
What causes SUI?
Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra, or because of dysfunction of the urethral sphincter. If the urethral sphincter is weak, any activity that puts pressure on the bladder (such as a sneeze) causes the urethra to lose its seal and allows urine to escape.
What is urge urinary incontinence (UUI)?
UUI occurs when someone feels a strong urge to urinate and is unable to hold her urine until she gets to the restroom. A common cause of UUI is a contraction of the bladder which can result in leakage of a few drops of urine or more. The leakage can sometimes be enough to soak through your clothes. Some women feel this strong urge when they hear running water, wash the dishes, unlock the door to their house, or step out into cold temperatures. The prevalence of UUI is higher in post-menopausal women compared to younger women.
What causes UUI?
Although UUI can be associated with medical problems like a stroke or neurologic disorder, the exact cause is often not known in the majority of women that suffer from this problem.
How is incontinence evaluated?
Successful treatment begins with a through evaluation. This includes a detailed questionnaire, careful history, and a complete physical exam. The physical exam will include collection of a urine specimen, a pelvic exam, and a neurologic exam. In some instances, further evaluation may be required and can include urodynamic studies to measure the pressure and function of the bladder and urethra and cystoscopy to look inside the bladder.
What treatments are offered at the University of Maryland?
Our physicians have specialized training in evaluating and treating urinary incontinence and can offer conservative as well as surgical treatment options. All patients will be offered an individualized treatment plan that will be directed to correct reversible factors that might be causing the problem. There are many non-surgical options available. The specific plan depends on the patient's complaint, the diagnosis, and the type of treatment the patient desires. Some patients will benefit from changes in fluid management and toileting. Some may require medication change or dietary alteration or targeted bowel management. Pelvic floor muscle exercises and/or biofeedback treatments are often effective treatments as well. If non-surgical treatments fail, surgical repair or reconstruction may be necessary. Many procedures can be done as an outpatient or with minimally invasive techniques.
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