If you leak urine and have sudden, strong urges to urinate or if you urinate excessively, you may have urge incontinence or overactive bladder.
This urge and the spasm of the bladder muscles may occur at any time, regardless of the amount of urine in the bladder.
In many women, there is no known cause. In some cases, the condition is caused by neurological injuries such as spinal cord injury or stroke; neurological diseases such as multiple sclerosis; bladder conditions such as bladder stones, cancer, infection and inflammation; and damage to the bladder muscles caused by childbirth, hysterectomy or injury.
Diagnosis
Incontinence is a common treatable condition. If you have a problem, make an appointment at the UCSF Women's Continence Center. Keep a diary that includes how often you urinate during the day, a record of the times and events surrounding leakage, and what you are drinking. This can help your health care provider make the proper diagnosis and decide on the appropriate treatment.
At your first visit, your UCSF Women's Continence Center provider will complete a medical history and physical exam, including a pelvic exam and urinalysis. If your problem is complex, additional tests may be performed at a later visit.
Depending on your condition, your doctor may conduct some of the following evaluations:
Neurologic Examination — This is performed to evaluate the strength, sensation, and reflexes in your legs.
Pelvic Examination — This exam is performed to assess pelvic relaxation or prolapse.
Postvoid Residual Urine Assessment — The assessment will measure how much urine remains in your bladder within 15 minutes of voiding. It offers an estimation of your bladder's ability to efficiently "empty the tank."
Other Urine Tests — When a postvoid residual assessment is made, the same urine sample may be analyzed for other factors such as blood, sugar, crystals or signs of infection. This evaluation can be accomplished with an office urine dipstick or the hospital laboratory's microscopic urinalysis.
If a urine dipstick or urinalysis suggests signs of acute infection, a urine culture will be sent to the microbiology lab. In about 24 to 48 hours, bacterial growth can be detected and the specific strain identified.
Pelvic Floor Assessment — A pelvic floor assessment may be performed to evaluate the strength of your pelvic floor muscles, and particularly, your ability to contract and relax the appropriate muscle group.
Cough Stress Test — Your doctor will instill water into your bladder and ask you to cough or strain in the same manner that would cause you to leak urine. This test can be performed in a visit to your doctor's office or as part of urodynamics testing.
Urinary Diary — For some patients, details about fluid intake and urine output are crucial to making the right diagnosis. Your provider will give you a bladder diary and a measuring receptacle.
You may be asked to carefully record the time and amount of any fluids you drink and the urine you void over a complete 24-hour period. You may be asked to repeat this 24-hour diary for three to five days. This allows us to notice patterns that might be important to planning your treatment.
If your condition is complex or previous therapies have been unsuccessful, your doctor may conduct additional tests. These studies evaluate the bladder and urethra to reproduce your symptoms. Testing may include:
Cystometrogram — Catheters are placed in your bladder and vagina or rectum so that the physician can reproduce your daily urinary symptoms. During the test, fluid will be infused in a controlled fashion to determine various characteristics about your bladder's function, including:
Your perception of water filling the bladder
Any urgency to urinate
Any uncontrollable bladder contractions
The volume at which your bladder cannot comfortably hold any more
The pressures that develop within your bladder during the fluid storage process
Stress Testing — You may be asked to perform a number of maneuvers such as coughing, changing positions or bouncing on your heel with the catheter in place in an effort to reproduce any symptoms of urine leakage or incontinence.
Urethral Pressure Profile — A catheter in your urethra is manipulated to measure urethral function.
Uroflometry — During urination, a specially devised receptacle will measure the varying rate of urine flow, as well as duration of urination.
Pressure Voiding Study — This test is performed to identify abnormal voiding patterns or urine obstruction.
Other Tests
Cytoscopy mdash; A slender camera is inserted via the urethra into the bladder to enable your doctor to view the interior anatomy of the bladder and urethra. It is typically an outpatient diagnostic procedure performed for the following common symptoms:
Blood or pus in urine with no bacteria present
Bladder infections that are unusually difficult to treat
New onset voiding irritation
New onset bladder pain
Suspected foreign body in the bladder
Urodynamics tests fail to duplicate incontinence symptoms
Radiologic Tests — These identify upper or lower urinary tract structural abnormalities.
Intravenous pyelogram (IVP) involves the administration of intravenous (IV) dye to your bloodstream to obtain X-ray snapshots of the entire urinary tract while the kidneys are processing the injected dye. This test cannot be performed if you have an allergic reaction to IV contrast dye, or abnormal kidney function
CT scan of abdomen and pelvis in which an X-ray machine takes a rapid sequence of two-dimensional thin cross-sections of the body in the area of interest. This exam can be performed with or without contrast dye, depending on what your doctor is looking for. The X-rays provide great detail of most of the internal organs.
Ultrasound doesn't involve X-rays. It uses a skin probe that directs sound waves to bounce off the body's internal organs to produce an anatomic picture. It can be a very useful screening tool.
Treatment
Behavioral therapies and medications are treatments for this condition. The objective is to rehabilitate the pelvic floor by building the strength and function of the muscles that support the bladder, urethra and other organs contained within the pelvic region.
Behavioral treatments are simple, self-directed, have no side effects and are often used in conjunction with other treatments. They have been effective for many women with certain types of incontinence.
Bladder Training — Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence.
The goals are to increase the interval between each time you urinate and to increase the amount of fluids your bladder can hold. This training can help diminish the sense of urgency and leakage.
Bladder training requires that a fixed schedule be established, whether or not the urge to urinate is present. If urge occurs before the assigned interval, urge suppression techniques, such as relaxation and Kegel exercises, should be used. As success is achieved, the interval is lengthened in 15 to 30 minute increments until it is possible to remain comfortable for three or four hours. This goal can be adjusted to suit each woman's needs and desires.
Keeping a diary of your bladder activity is very important. This helps your health care provider determine when to start the training and to monitor your progress throughout your program.
Pelvic Muscle Exercises — Pelvic muscle exercises, also called Kegels, can help improve incontinence and prevent the condition from worsening. They can help you suppress the urge to urinate. The exercises strengthen and tone the muscles that support the pelvic organs. These muscles contract and relax to control the opening and closing of the bladder. When these muscles are weak, urine leakage may occur. To achieve the best results, you need to build strength and endurance of your muscles. This requires commitment and regular exercise. Correct technique also is very important.
Biofeedback — Biofeedback takes information about something happening in the body and presents it in a way that we can see or hear and understand. Getting on a scale to check your weight or having your blood pressure taken are very simple examples of biofeedback. Biofeedback can be used to measure any body response such as heart rate or muscle contraction and relaxation. The measurement can be displayed on a computer screen or heard as a tone and used to learn about a subtle body function.
Biofeedback has been effective in treating urinary incontinence. It can help you learn to control and strengthen your pelvic floor muscles and play an important role in bladder control.
Because you can't see the pelvic floor muscles, you may find it difficult to locate them. Biofeedback therapy uses computer graphs and audible tones to show you the muscles you are exercising. It also allows the therapist to measure your muscle strengthen and individualize your exercise program. It is a teaching tool to help you learn to control and strengthen the pelvic floor area.
Urge Suppression — Urge suppression is a way to help control the sudden urge to urinate so that going to the bathroom is not an emergency. Running to the bathroom is the worst thing you can do as it actually causes bladder irritability to increase and interfere with your ability to concentrate on controlling your bladder.
When the urgency strikes, an "urge suppression" technique can help maintain control. Your goal is to maintain bladder control until you reach a toilet. A normally functioning bladder can wait until the appropriate opportunity to empty, an unstable bladder can not.
Medications — Medications can help relax the bladder and provide relief from symptoms. They can be used alone or in combination with behavioral treatments. Since they are prescription drugs, they must be used under the supervision of a health care provider. Medications do not cure incontinence but can help reduce or eliminate problems of bladder control.
Urge incontinence and overactive bladder are caused by involuntary bladder contractions. Certain medications called anticholinergic or antimuscarinics can block the chemicals that act on the bladder nerves and decrease bladder contractions. Many of these drugs are safe for long-term use. If you have glaucoma, you should check with your ophthalmologist. Tell your health care provider what other medications you are taking to avoid potential reactions with new medications.
Estrogen replacement therapy taken in pill or skin patch form has not been effective treatment for female urinary incontinence. Vaginal estrogen (creams, vaginal rings or vaginal pellets) have helped reduce recurrent urinary tract infections in postmenopausal women. The effectiveness of these preparations for incontinence is not known.
