Urinary Incontinence Quiz: Test Your Medical IQ

Incontinence refers to a loss of bladder control or involuntary leakage of urine. Loss of urine may occur due to weak muscles that control the exit of the bladder, a problem with the nerves that control the bladder muscles and urethra, or by the inability to hold urine when the urge to urinate occurs.

Several types of incontinence exist including:

• Stress incontinence is associated with coughing, sneezing, or exercising.
• Urge incontinence, also called "overactive bladder," occurs when the bladder feels as if it needs to be relieved immediately, regardless of how much urine is in the bladder, resulting in an incontrollable urge to urinate.
• Mixed incontinence is a combination of stress incontinence and urge incontinence.
• Overflow incontinence occurs when the body makes more urine than the bladder can hold, causing leakage or dribbling.

Urinary incontinence affects women twice as often as men. Conditions unique to women such as pregnancy, childbirth, and menopause all affect the bladder, urethra and other parts of the urinary tract. Urinary incontinence can occur any time in a woman's life, but it is more common in older women because of menopause, affecting 40% of women 65 and older.

In addition to changes due to pregnancy, childbirth, and menopause in women, and prostate problems in men, causes of urinary incontinence can include:

• aging
• bladder infections
• diabetes
• overweight or obesity
• constipation
• birth defects
• urinary tract blockage (such as from a tumor or urinary stone)
• some medications
• chronic cough
• anxiety
• diabetes
• Alzheimer's disease
• stroke
• Parkinsons disease
• multiple sclerosis
• spinal cord injury
• drinking alcohol or caffeinated beverages
• physical inactivity
• smoking

Symptoms of urinary incontinence include:

• uncontrollable leakage of urine
• feeling a strong need to urinate immediately (urgency)
• difficulty starting the urine stream (hesitancy)
• urinating more than usual (frequency)
• leaking urine without warning
• inability to reach the toilet in time
• pain or burning with urination (may be associated with infection)
• blood in the urine
• urinating at night (nocturia)
• dribbling urine
• bearing down to start the urine stream (straining)

The doctor will ask about your medical history and do a physical exam to check for problems that could cause incontinence. Other tests that may be done include:

• Urinalysis – urine is checked for infection or other causes of incontinence.
• Ultrasound - an ultrasound wand is used on the outside of the abdomen to take pictures of the kidneys, bladder, and urethra.
• Bladder stress test – involves coughing or bearing down as the doctor observes if there is loss of urine.
• Cystoscopy - a thin tube with a tiny camera is inserted into the urethra and bladder to look for damaged tissue.
• Urodynamics - a thin tube is inserted into the bladder that fills it with water, so the pressure in the bladder can be measured to see how much fluid it can hold.
• Diary – you may be asked to keep a diary for several days to track bladder emptying and leakage to look for patterns that may lead to diagnosis of a possible cause.

There are some steps you can take on your own that may help reduce or eliminate symptoms of urinary incontinence, including:

• Kegel exercises help strengthen your pelvic floor muscles and may help with stress incontience.
• Bladder retraining involves going to the bathroom at set times and may help control overactive bladder or urge incontinence.
• Weight loss can help reduce the pressure on the bladder and nearby muscles.
• Avoid drinks with caffeine, carbonation (such as sodas), or alcohol that can worsen bladder leakage or urinary incontinence.
• Quit smoking. It can worsen urinary incontinence.
• Treat constipation. Eat more fiber to reduce constipation, since constipation can worsen urinary incontinence.
• Protective pads or underwear can be purchased over-the-counter and can help minimize problems in public while you work on treatment.

If home remedies do not work to help with stress incontinence, there are medical treatments available such as:

• Vaginal creams, rings, or patches with estrogen can help strengthen the muscles and tissues in the urethra and vaginal areas after menopause.
• Medicines that help relax the bladder muscle and increase the amount of urine your bladder can hold can help with urge incontinence.
• A reusable vaginal pessary is a small plastic or silicone device shaped like a ring or small inserted into the vagina that pushes up against the wall of the vagina and the urethra to support pelvic floor muscles and help reduce stress incontinence. There are other disposable devices available in drug stores that are inserted like tampons and have a similar effect.
• Bulking agents, such as collagen, can be injected into tissues around the bladder and urethra to cause them to thicken which reduces the urine leakage.
• Botox injections into the bladder can help relax the bladder and increase the amount of urine the bladder can hold.
• Nerve stimulation treatment uses mild electric pulses to increase blood flow to the bladder and strengthen the muscles that help control the bladder.
• Biofeedback can help you learn to control the bladder muscles.

When home remedies and medical interventions do not work, surgery may be used in cases of severe urinary incontinence. All surgery comes with the risk of complications so discuss all treatment options with your doctor.

The most common types of surgery for urinary incontinence include:

• Sling procedures in which a narrow piece of synthetic mesh or a piece of tissue from your own body is placed under your urethra, acting like a hammock to support the urethra and hold the bladder in place.
• Colposuspension (Burch procedure) also helps hold the bladder in place with stitches on either side of the urethra.