Straight Talk About Bladder Control: Part 2

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Thanks for joining me for the second of a 3-part series addressing the important issue of bladder control problems. I hope you had an opportunity to read the first post, but if not, you can check it out here. You’ll find it helpful to review the types of incontinence noted in my previous article before we move on to today’s topics.

As we talk about causes and treatments, I want to stress the importance of consulting your primary medical provider about any bladder control issues. It’s nothing to be embarrassed about. I assure you that you won’t shock your physician; they see this all the time.

Another great resource is a physical therapist. In my opinion, this is one of the best sources of help for bladder control issues, but most people aren’t aware of this option. Look for a physical therapist with specialized training in assessing and treating incontinence.

Now let’s continue looking at the four major types of urinary incontinence with a focus on causes and treatments. (To learn more about specific terms mentioned in this article, I recommend using the search bar on MayoClinic.Org.)

Stress Incontinence

This results from the weakening of the muscles that support the bladder, and it’s worsened by situations that put pressure on the bladder. The most common cause in women is childbirth. Women also often experience stress incontinence during pregnancy. In addition, it can result from surgeries such as a hysterectomy or prostate surgery.

Treatments may include:

1. Kegel exercises are used to strengthen the pelvic floor muscles. It’s challenging to learn how to do these exercises correctly, so don’t be afraid to ask your medical provider for advice.
2. Women use a device called a pessary to help support the bladder.
3. Bulking agents are injected into the urethra.
4. If other treatments aren’t effective, they sometimes recommend surgery.

Urge Incontinence

During urge incontinence, the bladder contracts involuntarily. There are many causes, but most fall into three categories:

• Conditions that irritate the bladder, such as an infection
• Medications such as diuretics
• Neurological deficits resulting from conditions such as Parkinson’s disease, stroke, or diabetes

Medications are the most common form of treatment. Be sure you fully understand the potential side effects and contraindications of these options:

1. Antibiotics to treat a urinary tract infection
2. Oral medications that relax the bladder
3. Botox injections into the bladder wall
4. Topical estrogen in women

Behavior modification is often helpful. This includes such things as scheduled toileting, dietary changes, relaxation techniques, and biofeedback.

Overflow Incontinence

With this condition, the bladder isn’t able to empty completely. Unlike the other types of incontinence, this one is more common in men and usually results from an enlarged prostate. Blockages in the bladder (stones, tumors, etc.), neurological problems, weakened bladder muscles, and some medications also cause overflow incontinence. Treatments may include:

1. Medications to help shrink the prostate in men
2. Surgery to correct the underlying problem
3. Intermittent catheterization to empty the bladder completely. (Because of the danger of complications such as infections, long-term catheters are rarely used anymore.)

Functional Incontinence

Causes fall into two major categories:

• A physical deficit prevents a person from using the toilet normally. This could result from many illnesses such as arthritis, Parkinson’s disease, or multiple sclerosis. Treatment focuses on environmental adaptations or adaptive equipment to help compensate for the disabilities.
• Cognitive deficits result in an inability to recognize the need to urinate. The individual may also forget the location of the toilet or how to use it. This most commonly happens in Alzheimer’s disease and other forms of dementia. It can also result from medications that affect alertness. Treatments include scheduled toileting and environmental adaptations.

I find it sad that so many people think urinary incontinence is an inevitable part of growing older. It’s not, and if left untreated, it can lead to problems such as social isolation, depression, and giving up enjoyable activities.

If you’re experiencing bladder control issues, please make an appointment with your primary care provider as soon as possible. Also, if you have a friend or family member who complains about incontinence, do them a favor and share this series of articles with them!

I hope you’ll join me again next week when we’ll look specifically at bladder control concerns in long-term care settings.