Urology

Urinary Incontinence

Incontinence is when you cannot control when you urinate because your urinary sphincter is not working properly.  It’s like a leaky faucet. Common causes of urinary incontinence include:

  • Sphincteric incontinence where the muscular sphincter does not work
  • Involuntary bladder contractions which is overactive bladder
  • Urinary tract infection
  • Urethral stricture or scar
  • Cancer of the bladder
  • Bladder stones
  • Retained sutures (stitches)
  • Low bladder compliance which is a stiff bladder that does not hold urine properly
  • Neurologic conditions (stroke, Parkinson’s disease, multiple sclerosis)
  • Urinary retention with overflow where urine can’t leave the bladder and overflows out

Sphincteric incontinence is not common in men and is often caused by prostate surgery such as a radical prostatectomy (e.g., robot-assisted laparoscopic prostatectomy), radical cancer surgery of the rectum, a neurologic disorder like spina bifida, an injury to the lower spine and ruptured (herniated) intervertebral discs, or an injury to the blood supply of the spinal cord after surgery on the aorta. Incontinence can complicate surgery for benign prostatic conditions.

Incontinence is much more common among women, because women have a shorter sphincter muscle than men. Incontinence occurs, in part, because of repeated stretching and damage to the nerves and muscles of the sphincter during pregnancy and childbirth but can also happen due to the effects of gravity, which tend to make the vaginal muscles sag and weaken. In fact, incontinence is so common among women that many people consider it a normal part of female aging.

The Urinary Sphincter

The urinary sphincter lies in the wall of the urethra and controls urination in both men and women.

The junction between the urethra and the bladder is called the bladder neck or internal sphincter. Its wall is composed mostly of smooth muscle, which is arranged in both a circular and longitudinal pattern around the urethra. The smooth muscle of the urethra is called the internal sphincter. In men it begins at the bladder neck and is intermingled with the tissue of the prostate which adds considerable bulk to the sphincter. Consequently, the internal sphincter in men has considerably more strength than in women.

Diagnosis and Treatment

The first step to diagnosing incontinence is to rule out infection. We do this by analyzing your urine.  If you do have an infection, we will likely treat it with culture-specific antibiotics (antibiotics that have been shown to be effective against the particular bacteria causing your infection).

If you do not have an infection, your doctor may be able to diagnose your incontinence by feeling your distended bladder in your lower abdomen. To confirm the diagnosis, your doctor may “take a look” with an ultrasound or by passing a catheter through the urethra into the bladder and measuring the amount of residual urine after you urinate.

If you have urinary retention, we may treat it with a catheter that stays inside you (called an indwelling catheter) until the surgery has healed (usually a few weeks). If you still can’t urinate well after that, it will be necessary to do some more tests to determine whether the cause is a urethral blockage or a weak bladder. In order to make this distinction, two further tests are necessary, cystoscopy (looking into the bladder) and urodynamic evaluation.