- What is incontinence?
- Can medications I take affect my bladder or bowel control?
- Can my diet affect my bladder control?
- What are Kegel, or pelvic muscle, exercises?
- Can I retrain my bladder and take control again?
- Can surgery help my "dropped" bladder? (women only)
- Will I be incontinent after prostate surgery? (men only)
- How can periurethral injections improve bladder control?
- How do I control odor associated with incontinence?
- What is the safest way to reuse catheters?
- Is there financial help for prescription drugs?
Incontinence (in-CONT-ti-nunce) is the loss of bladder or bowel control.
There are four basic types of incontinence:
- Stress incontinence occurs when pelvic muscles have been damaged, causing the bladder to leak during exercise, coughing , sneezing, laughing, or any body movement which puts pressure on the bladder.
- Urge incontinence, the urgent need to pass urine and the inability to get to a toilet in time, occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited.
- Mixed incontinence is very common and occurs when the quantity of urine produced exceeds the bladder's holding capacity.
- Overflow incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder's holding capacity. Incontinence from surgery follows such operations as hysterectomies, cesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery. This is not considered a diagnostic category. Incontinence can also occur due to other reversible factors, often outside of the urinary tract, such as restricted mobility. Mobility aids can help remove barriers to self-toileting on a timely basis. Other factors such as arthritis, may interfere with managing zippers, buttons, and articles of clothing — or moving quickly enough to reach the toilet.
Several classes of medicines affect the bladder muscle and the bladder outlet muscle. Sometimes these medicines are prescribed for conditions outside the urinary system and cause unwanted changes in bladder control. Classes of Drugs Which May Contribute to Incontinence
- Diuretics (water pills) - examples: Esidrix®, Lasix®, Maxide®
- Sedatives, muscle relaxants, alcohol - examples: Valium®, Librium®, Ativan®
- Narcotics - examples: Percocet®, Demerol®, morphine
- Antihistamines -examples: Benadryl®
- Anticholinergics - examples: Pro-Banthine®
- Antipsychotics/Antidepressants - examples: Elavil®, Prolixin®, Haldol®
- Calcium channel blockers - examples: Calan®, Procardia®, Cardizem®
There is no "diet" to cure incontinence. However, there are certain dietary matters you should know about. Some foods and beverages are thought to contribute to bladder leakage. Their effect on the bladder is not always understood, but you may want to see if eliminating one or all of the items listed improves your urine control. Common Bladder Irritants:
- Alcoholic beverages
- Carbonated beverages (with or without caffeine)
- Milk or milk products
- Coffee or Tea (even decaffeinated)
- Medicines with caffeine
- Citrus juice & fruits
- Tomato-based products
- Highly spiced foods
- Corn Syrup
- Artificial sweeteners
Click here to read more about how diet and daily habits can affect bladder control.
Pelvic muscle exercises, also called Kegel exercises or pelvic floor exercises, have been shown to improve mild to moderate urge and stress incontinence. When performed correctly, these exercises help to strengthen the muscles at your bladder outlet. Through regular exercise you can build strength and endurance to help improve, regain, or maintain bladder and bowel control.
How to find and recognize the muscles
Imagine that you need to hold back gas. Squeeze and lift the rectal area, and for women also the vaginal area, without tightening the buttocks or belly (abdomen). When you first begin your exercise program, check yourself frequently by looking in a mirror or by placing your hands on your abdomen and buttocks to insure that you do not feel your belly, thighs, or buttocks move. If there is movement, continue to experiment until you have isolated the correct muscles of the pelvic floor.
Another technique used only to help you identifying the correct pelvic muscles is to attempt to stop or slow the flow of urine. While urinating, partially empty your bladder then try to stop or slow the flow of urine. Remember to relax and completely empty your bladder when you have finished this test. Do not be discouraged if you are unable to stop or change the flow. Slowing the flow is a good start. Twice a month, you may try to stop the stream as a test to see if your muscle strength is improving. Do not do this start-and-stop test on a regular basis. It is not a helpful way to exercise the pelvic floor muscles.
There are two types of exercises you need to do. Doing both types of exercises is the best way to help improve your bladder control.
The first exercise, type 1, works on the holding ability of the muscles (building a strong dam to hold back urine). It is done by slowly tightening, lifting, and drawing in the pelvic floor muscles and holding them to a count of five. At first, you will probably notice that the muscles do not want to stay contracted or tightened very long. If you feel the contraction letting go, just re-tighten the muscles. In a week or two, you will probably notice an improvement in the control and holding power of the contractions. In fact, in the beginning, you may only be able to hold the contraction for 1-2 seconds. Concentrate on lifting the muscles and holding the contraction while progressing slowly over a period of weeks to a goal of 10-seconds. Rest for 10 seconds between each contraction.
The second exercise, Type 2, is a quick contraction. The muscles are quickly tightened, lifted up, and let go. This works the muscles that quickly shut off the flow of urine (like a faucet) to help prevent accidents.
If you have any questions or difficulties with these exercises, talk to a health care provider. Other behavioral treatments include pelvic weights (vaginal cones), biofeedback training to help isolate and use the correct muscles, and electrical stimulation of the muscles that may help with your exercise efforts. Sometimes a combination of all or some of these techniques is most helpful in managing and improving your incontinence. NAFC publishes a kit for both men and women, designed to assist with pelvic muscle exercises. It is most helpful for women with mild to moderate stress and urge incontinence and men experiencing urine leakage after prostate surgery. The audio recording teaches how, coaches through, and encourages continuously. The accompanying manual helps you to follow the verbal instructions with written descriptions and detailed drawings. Refer to our Online Store for ordering information.
In 1991, a gynecologist, Dr. Andrew Fantl, announced the success of a bladder retraining program conducted at the Medical College of Virginia. More than 100 healthy women, 55 years and older, participated in the program. 12% were cured of their bladder leakage, and 75% were greatly improved. Some women had stress incontinence; some had urge incontinence; and others had symptoms of both types. (Only women tested this program in Virginia. Men with urge incontinence in other centers have benefited by it too.) Bladder retraining consists of urinating on a schedule and gradually increasing the amount of times between bathroom trips. For a complete guide to bladder retraining, refer to our Online Store for ordering information.
An operation may be the best treatment when the bladder and/or other pelvic organs have fallen out of their normal position (a condition called pelvic organ prolapse), particularly when conservative therapy has not been successful. The goal of surgery for stress incontinence is to restore the urethra and bladder to their normal position in the pelvis up behind the pubic bone. The most durable operations are performed through an incision in the lower abdomen (the Burch or "MMK" operations). Other procedures may require a small abdominal incision and a vaginal incision. These operations are often named after the doctors who developed them - Pereyra, Stamey, Raz, etc.
Recently many newspapers have run articles about "no-incision" surgery. Although there is no vaginal incision with this technique, two small punctures are made above the pubic bone. Also, many people are now talking about laparoscopic, or percutaneous, bladder suspension surgery. This is a minimally invasive procedure usually requiring less than a 24-hour hospital stay with local anesthesia. Because these are fairly new procedures, long-term results are not yet available.
Women with severe stress incontinence or women who have previously had failed surgeries may be told that they need a "sling procedure". In this operation a piece of fascia (the strong tissue that covers many of the body's muscles), or some kind of synthetic material, is placed underneath the urethra like a hammock to support and compress it, preventing urine leakage.
Before agreeing to a surgical procedure, make sure you understand all of the treatment options that are available to you. Please refer to our section on Prolapse to read more about this condition.
Most men do not have trouble with incontinence for more than a few days or a few weeks after a transurethral resection of the prostate (TURP). Sometimes the leakage is a result of irritation from the catheter that was in place after surgery. Sometimes it is due to weakness or damage to the bladder outlet muscle, called the sphincter [SFINK-ter] muscle, that normally holds the urine in. Most men find that the little leakage they do have disappears in four to six months.
When a radical prostatectomy is performed to remove a cancerous prostate, the possibility of incontinence is greater. Some loss of urinary control occurs in almost all cases following surgery for at least four to six weeks. Often, doctors recommend that men practive pelvic muscle exercises before and after surgery. The causes of urinary incontinence can be related to the damage of the external sphincter mechanism, which is the muscle you control; or damage to the internal sphincter and bladder muscle itself, which is not the kind of muscles you can control. Most often, urine control improves gradually over a period of weeks. Sometimes it may take months and, in some individuals, there may be a permanent problem with bladder leakage that varies from minor leakage with coughing, sneezing, or lifting or more serious leakage that may happen all the time.
The injection of "bulking" material into the tissues around the urethra sometimes results in a closing of the sphincter (bladder outlet muscle) and, therefore, protects against incontinence by increasing the resistance to the outflow of urine. Contigen® Bard® Collagen Implant has been used routinely for these cases since 1993 as a safe and effective treatment for sphincter malfunction. Collagen is a natural protein found in the body. Contigen Implant is a sterile, purified collagen taken from the skin of cows. It is chemically treated to prevent any allergic reaction, but a skin test is still performed to be extra safe. There are other materials used as bulking agents, and even more are being tested in clinical trials.
A doctor will perform urodynamic pressure tests on the bladder and sphincter to make certain that the incontinent patient is a good candidate for this treatment. The best results occur when the patient's incontinence is a result of poor urethral function combined with good pelvic muscle support. The majority of patients with this type of urinary incontinence have had previous surgery. In men this is most commonly encountered following radical prostatectomy (surgical removal of a cancerous prostate). In women, the primary cause is multiple surgical bladder suspension procedures for stress incontinence which may interfere with nerve input to the sphincter and, ultimately, cause it to not function properly.
Eighty percent of women are dry or improved after three treatment sessions in properly selected patients. Seventy-seven percent will remain dry once this has been attained. Unfortunately, results in men are not so astounding, where only 40% attain dryness. When broken down as to cause of the incontinence, we see that men following resection of the prostate through the urethra (TURP) do as well as women, 88% dry. However, after radical prostatectomy, the more common problem, only 25% are dry, and after radiation therapy for prostate cancer, the results are even worse at 14% dry.
Most major pharmaceutical companies have an Indigent Drug Program that provides medications to people who cannot afford them. Also there are organizations devoted to helping individuals obtain the medications they need. To read more, visit the Indigent Drug section of our site.