The following is a description of the four major types of incontinence.
- Stress Incontinence
- Urge Incontinence
- Total Incontinence
- Overflow incontinence
Increases intrabdominal pressure (e.g. cough) causes the involuntary release of urine through the urethra. Most cases are due to pelvic relaxation or insufficient support from the pelvic fascia and muscles with a hypermobile bladder neck causing unequal pressures between the bladder and the urethra. Risk factors include vaginal births, age, genetic predisposition, conditions causing chronic increased abdominal pressure, and conditions causing urethral weakening. Treatment may include Kegel exercises, medications, noninvasive support mechaisms or surgery.
Detrusor Instability (a.k.a. urge incontinence)
This occurs in about 10-15% of the population and is due to involuntary contractions of the muscle within the bladder wall. The cause is often unknown but may be caused byany stimulus to receptors in the bladder wall (Infections, Stones, Foreign bodies, Bladder cancer, Suburethral diverticula) or neurologic disease (stroke, Alzheimer’s, Parkinson’s, Multiple Sclerosis, Diabetes). Medications are effective in about 50-80% of people suffering this condition. Other treatments may include Kegels, bladder training exercises and, rarely, surgery.
When a urinary fistula forms between the bladder and the vagina, urine may leak out continuously at all times. This is often due to previous radiation or surgery, but can be due to childbirth complications. Treatment is generally through surgical repair. Often, your urologist may choose to wait 3-6 months for post-surgical fistulas to heal before attempting repair. Antibiotics may be prescribed to prevent or treat accompanied infection.
Decreased or no tone in the detrusor bladder muscle may produce weak contractions and cause urinary retention. This, in turn, will cause the bladder to become overdistended and, once full, incontinence may occur. Obstruction may also cause similar symptoms. Treatment may include medications, intermittent self-catheterization or surgery.
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