What is reflex incontinence?
Reflex incontinence is similar to urge incontinence, also known as overactive bladder.
Urge incontinence is when your bladder goes into an involuntary muscle spasm and you get a sudden strong urge to urinate, even if your bladder isn’t full. It often results in leakage of urine before you’re able to reach a bathroom.
Reflex incontinence is caused by the same type of bladder spasm, but it often results in larger amounts of urine leakage with little to no warning.
Reflex incontinence can occur for both men and women, but it’s more common in people who have neurological impairment.
Keep reading to learn more about what causes reflex incontinence, how it’s diagnosed, and more.
Reflex incontinence is caused by a dysfunction in the muscle in your bladder, called the detrusor muscle. Even if your bladder isn’t full, this muscle contracts and squeezes, signaling your body to urinate.
You may be at risk for reflex incontinence if you have serious neurological impairment from:
Although diagnosis and treatment are often similar, incontinence can be caused by different things:
Stress incontinence: This is where urine leakage occurs as a result of pressure on the bladder from things like coughing, sneezing, laughing, or physical activity.
Mixed incontinence: This is when you have a mixture of symptoms of both reflex and stress incontinence.
Overflow incontinence: This occurs when the bladder fails to empty completely, which means you can have some urine leakage even after you’ve gone to the bathroom. This is also called after-dribble in men.
Functional incontinence: This type of incontinence occurs as a result of illness, such as dementia. It’s when an illness or disability prevents you from being concerned to find a bathroom, leading you to urinate anyway.
If you’re experiencing symptoms of incontinence, see your doctor. It’s important to determine the type of incontinence you have, as each type requires slightly different treatment.
Before your appointment, your doctor may ask you to keep a urinary diary. This involves recording your daily habits, accidents, and fluid intake for at least one week and can aid your doctor in making a diagnosis.
At your appointment, your doctor will perform a full physical examination to understand your medical history, symptoms, and determine what diagnostic tests are necessary.
These may include:
Urinalysis: This is a standard urine test.
Cough stress test: Your doctor will have you drink fluids to fill our bladder, then ask you to cough. If you experience incontinence at this time, it will help your doctor diagnose the type.
Urine culture: If your standard urine test indicates infection, your urine will be sent to a lab to detect bacteria that may indicate a urinary tract infection or other type of infection.
Pelvic exam (women): This can help your doctor identify if you have pelvic organ prolapse or relaxation.
Pelvic floor assessment: This can help your doctor assess your ability to contract and relax the pelvic floor muscles and evaluate their strength.
Blood test: This test evaluates kidney function and identifies any chemical imbalances, along with levels of prostate-specific antigen (for men).
Post-void residual urine assessment: This test measures the level of urine in your bladder 15 minutes after going to the bathroom. It’s used to assess your ability to achieve bladder emptying. This urine sample may also be examined for the presence of infections, crystals, sugar, or blood.
Urodynamic testing: This refers to a variety of different tests used to determine bladder flow, capacity, and function. These may include cystometrogram, stress testing, urethral pressure profile, uroflowmetry, or pressure voiding study.
Cystoscopy (post-prostatectomy): This test is used to detect if the neck of the bladder is contracted. This test is done by inserting a small camera into the bladder, where the physician can conduct a closer examination.
Treatment can vary depending on the severity of your symptoms and how they affect your life. Your treatment plan may consist of one or more of the following:
At-home behavioral training
This can include:
Bladder training: This is a behavioral technique that uses distraction or deep breathing techniques to help you learn to restrain overactive nerve signals and to suppress urgent sensations. In other words, you relearn how to hold and release urine at appropriate times.
Double voiding: This is a technique used to help you empty your bladder completely. When you finish urinating, wait a few minutes, and then try to empty your bladder again.
Scheduled bathroom breaks: Your bladder retraining may involve regular, scheduled visits to the bathroom. It usually involves avoiding the bathroom unless scheduled. And you’ll slowly extend your wait times to improve your ability to hold urine.
Pelvic muscle exercises: The pelvic floor muscles support your uterus, bladder, and bowel. The strength of these muscles can support healthy bladder function and assist with your ability to prevent urine leakage. Pelvic floor exercises, also known as Kegel exercises, involve regular contractions of the muscles that control urination. After a few months of regular exercises, the muscles often perform much better.
This can include:
Adult undergarments: These are absorbent products such as incontinence pants and pads.
Patches or plugs: Certain devices can be inserted into the vagina or urethra to prevent leakage. These may be particularly useful during exercise.
Catheters: This involves having a thin tube inserted into your bladder, which drains urine into a bag.
Your doctor may prescribe medications such as:
Anticholinergics and antimuscarinics: These medications are designed to relax the muscles of your bladder to reduce bladder spasms.
- oxybutynin (Oxytrol)
- tolterodine (Detrol)
- darifenacin (Enablex)
- trospium (Sanctura)
- solifenacin (Vesicare)
Beta-3 agonists: Mirabegron (Myrbetriq) is a beta-3 agonist that can help suppress involuntary bladder contractions.
Tricyclic antidepressants: Even though these drugs were designed to treat depression, they can be an effective bladder muscle relaxant in some people. These include imipramine hydrochloride (Tofranil) and amitriptyline hydrochloride (Elavil).
Topical estrogen: Appropriate for women, conjugated estrogen (Premarin) cream can be inserted around or into the vagina, where it helps increase the tone of the urethra muscle and enhance the strength of the pelvic floor muscles.
There are a couple of medical devices that can help treat reflex incontinence in women:
Urethral insert: This is a tampon-like device that is inserted into the vagina to prevent leakage. It’s removed when you need to urinate.
Pessary: This is a ringed device that applies pressure against the urethra to decrease bladder leakage.
Sometimes, more drastic surgical interventions may be necessary:
Slings: Your surgeon can insert a man-made sling designed to cradle the bladder neck and urethra, or to lift up the bladder neck, to take pressure off your bladder and improve urine function.
Artificial sphincter: This procedure is specifically designed for men who have a problem with sphincter malfunction that is causing their bladder or urination issues.
Managing reflex incontinence may take some trial and error to determine what works best for you, but it’s possible. Talk to you doctor about your options. They will be there to support you through the process of finding the best solution.