PELVIC FLOOR DISORDERS
URINARY INCONTINENCE
Urinary incontinence (UI) describes a range of symptoms (from occasional and mild to frequent and severe) that involve a loss of control of bladder emptying. The bladder is the organ that collects urine (waste products) produced in the kidneys and transported to the bladder via the ureters. On the bottom (the ureteral opening or bladder neck), the bladder opens into the urethra, through which the urine is discharged from the body. There are two urinary sphincters (thick rings of muscle), which control bladder function and urine release. The internal sphincter is located at the bladder neck (between bladder and urethra), the external sphincter is located towards the lower end of the urethra, right before it opens to the outside. When bladder or sphincter muscles do not contract properly, the result is often urinary incontinence. There are different causes for and types of urinary incontinence, including stress incontinence (caused by sphincter weakening due to stresses such as laughing, coughing, sneezing), urge incontinence (a feeling that the bladder is full, even though it really is not, which can be the result of harmless conditions such as infection or serious issues such as nerve damage) or incontinence caused by chronic bladder conditions, which often result in an inability of the bladder to empty completely (overflow incontinence).
Risk Factors
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​Female gender
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Number of (natural) births
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Physical disability or pelvic trauma
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Increased age and hormonal decline (menopause)
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Chronic neurological conditions (MS, ALS, diabetes)
Causes
Urinary incontinence can have many causes. One reason for urinary incontinence is the weakness of urinary sphincter muscles, which can cause the sphincters to relax involuntarily when subject to stresses such as sneezing, coughing, laughing or exercising (stress incontinence). Another reason is weakness of the smooth muscles surrounding the bladder. If these muscles cannot contract properly, the bladder never empties completely, thereby increasing the risk of a full bladder that cannot hold its contents (overflow incontinence). This is often the result of chronic conditions, such as diabetes or multiple sclerosis (MS). Urinary incontinence can also be caused by an oversensitive bladder (overactive bladder syndrome), for instance due to neurological dysfunction of the nerves stimulating the bladder or simply because of a urinary tract infection, which can lead to urinary urgency and spontaneous bladder discharge even though the bladder is not actually full (urge incontinence).
Diagnosis
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Physical exam: Examination of the pelvic area
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Imaging: MRI or ultrasound
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Cystoscopy: Similar to a colonoscopy, a small catheter with camera is inserted into the bladder via the urethra to visualize the inside of the bladder and any possible abnormalities
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Urodynamic testing: Mechanical tests (e.g. insertion of a balloon catheter) measuring the strength of the bladder and urinary sphincters
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Urine analysis: Lab testing for infection, hematuria, proteinuria, glycosuria or other chemical imbalances in the urine
Treatments
There are different treatments for urinary incontinence, depending on the severity of the symptoms. For instance, physical therapy ad exercises can strengthen the bladder and sphincter muscles so that they will contract and relax more easily, thereby improving bladder control. Medications (e.g. anticholinergics) can also help alleviate urinary incontinence, most often urge incontinence, which can be improved by reducing bladder sensitivity and urinary urgency. Similarly, Botox injections can help relax an oversensitive bladder. If urinary incontinence is the result of aging and menopause, estrogen-containing topicals might help tighten the urethral opening (external sphincter). If the incontinence is caused by nervous system dysfunction, nerve stimulation (e.g. of the sacral nerve) may improve badder and sphincter muscle function. In severe cases, surgery may be necessary. These include urethral sling surgery (insertion of a mesh or synthetic material near the urethral bulb or bladder neck) and other supportive surgeries (e.g. bladder neck suspension) reinforcing the internal sphincter and helping it close. In especially severe cases, the urinary sphincters may even have to be replaced with artificial ones.