Urinary incontinence Health Article

Call your health care provider if

Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.

Call your local emergency number (such as 911) or go to an emergency room if any of the following accompany a sudden loss of urine control:

• Difficulty talking, walking, or speaking
• Sudden weakness, numbness, or tingling in an arm or leg
• Loss of vision
• Loss of consciousness or confusion
• Loss of bowel control

Call your doctor if:

• You have been constipated for more than 1 week
• You have difficulty starting your urine flow, dribbling, nighttime urination, pain or burning with urination, increased frequency or urgency, or cloudy or bloody urine
• You are taking medications that may be causing incontinence -- DO NOT adjust or stop any medications without talking to your doctor
• You are over 60 years old and your incontinence is new, especially if you are also having trouble with your memory or caring for yourself
• You have the urge to go often, but are only passing small amounts of urine
• Your bladder feels full even after you have just urinated
• Incontinence persists for more than 2 weeks even with exercises to strengthen your pelvic muscles

What to expect at your health care provider's office

Your doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.

Medical history questions may include:

• How long has incontinence been a problem for you?
• How many times does this happen each day?
• Are you aware of the need to urinate before you leak?
• Are you immediately aware that you have passed urine?
• Are you wet most of the day?
• Do you wear protective garments in case of accidents? How often?
• Do you avoid social situations in case of accidents?
• Have you had urinary tract infections in the past? Do you think that you may have one now?
• Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
• Is it more difficult to control your urine when running, jumping, or walking?
• Is your incontinence worse when sitting up or standing?
• Are you constipated? For how long?
• Is there anything you do to reduce or prevent accidents?
• Have you ever been treated for this condition before? Did it help?
• Have you tried pelvic floor exercises (Kegel)? Do they help?
• What procedures, surgeries, or injuries have you had?
• What medications do you take?
• Do you drink coffee? How much?
• Do you drink alcohol? How much?
• Do you smoke? How much each day?
• Do you have diabetes or a family history of diabetes?
• Do you have any other symptoms?

Diagnostic tests that may be performed include:

• Urinalysis
• Urine culture to check for infection if indicated
• Cystoscopy (inspection of the inside of the bladder)
• Urodynamic studies (tests to measure pressure and urine flow)
• Uroflow (to measure pattern of urine flow)
• Post void residual (PVR) to measure amount of urine left after urination

References

American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol. 2005; 105(6): 1533-1545.

Madersbacher H, Madersbacher S. Men's bladder health: urinary incontinence in the elderly (Part I). J Mens Health Gend. 2005; 2(1): 31-37.

Kielb SJ. Stress incontinence: alternatives to surgery. Int J Fertil Womens Med. 2005; 50(1): 24-29.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, Straus SE. What type of urinary incontinence does this woman have? JAMA. 2008;299:1446-1456.

Rogers RG. Clinical practice. Urinary stress incontinence in women. N Engl J Med. 2008;358:1029-1036.

Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008;148:459-473.