Urinary Incontinence

Attention to lifestyle issues is an essential part of management. A fluid intake of approximately 1,500 mls in twenty-four hours is usually an adequate amount, except in very warm environmental conditions. Excessive caffeine and alcohol intake will promote urine production and may increase urinary frequency. Fluid intake in the evening or at night may contribute to night-time voiding and incontinence. Smoking promotes coughing and is also associated with SUI. Attention to regular bowel function and avoidance of constipation is important.

Behavioral interventions may be effective in reducing or resolving urinary incontinence. These include timed voiding (bladder retraining) and pelvic muscle exercises. Pelvic muscle exercises can strengthen and improve the responsiveness of the pelvic floor and external sphincter. If the pelvic muscles are contracted rapidly during episodes of urinary urgency, the urgency may be suppressed. Biofeedback and electrostimulation are other modalities that have been tried for various types of incontinence with varying success.

Medications that relax or reduce bladder-muscle overactivity are often effective in reducing urinary urgency and urge incontinence. Side effects such as dry mouth or urinary retention may limit their use in some people, however. For overflow incontinence, medications that reduce the sphincter tone may improve bladder emptying. Intermittent catheterization two to three times per day or, rarely, an indwelling catheter, are appropriate options. Surgery in men to relieve prostatic obstruction that doesn’t respond to medication is often indicated. In women, estrogen replacement for symptoms of estrogen deficiency may reduce urinary urgency or frequency. For urogenital prolapse, vaginal support devices (pessaries) can resolve the prolapse, but not necessarily the associated SUI.

Stress urinary incontinence that doesn’t respond to behavioral interventions responds to a variety of injectable bulking agents, such as collagen, or surgical procedures in up to 90 percent of women. Five-year follow-up studies of these procedures show some return of incontinence. For bladder-vaginal fistula, surgery is successful in 50 to 100 percent of women. Containment of incontinence may be improved with specially designed absorbent pads or external catheter devices in men.