“In this world nothing can be said to be certain, except death and taxes.” - Benjamin Franklin
This is still true today. Unless of course you're some large U.S. corporation and then taxes seem to be optional. What is not so certain is becoming permanently incontinent. Although there are a number of permanent conditions in medicine, bladder incontinence does not need to be one of them.
Too many women incorrectly assume that bladder leakage is “a normal part of getting old” and you “just have to live with it” like mom or grandma. Neither are true. Safe bladder incontinence therapies are available so you can get back to the life you deserve.
To be honest, there are some women and men who have severe incontinence. When left ignored for too long, permanent bladder damage can occur. Catheters and major surgeries may be necessary to avoid permanent incontinence.
At Pazona MD Urology we believe prevention is the best medicine. Let’s review why someone would become incontinent, what you should do about and how to prevent this from turning into something more serious.
Why have I suddenly become incontinent?
At some point in almost every woman’s life, she will ask herself this question.
First and foremost, you’re not alone. 58 million Americans suffer from an overactive bladder and may develop urge incontinence (“I had a warning but couldn’t get there in time”). The cause of an overactive bladder is most often literally out of a woman’s control. Somewhere, somehow the signaling pathway between the brain and the bladder has malfunctioned.
If this occurs all of a sudden (“I was normal yesterday, now today I’m peeing my pants”) then it’s important to have an evaluation to rule out:
- Urinary tract infection (UTI) - usually associated with burning or pain
- Urinary retention - bladder has slowly stretched over the years and now is overflowing
- Neurologic cause - pelvic surgery, multiple sclerosis
- New onset diabetes - high blood sugars wreck havoc on the bladder
Don’t worry we’ll get into the treatment options for an overactive bladder shortly.
There are other types of urinary incontinence as well. Up to 35% of women have leakage with coughing, sneezing, or laughing at their husbands (stress incontinence). The main risk factors for stress incontinence include:
- Age
- Number of pregnancies/vaginal deliveries
- Obesity
- Smoking
- Genetics (“thanks mom!”)
Worry not! We can treat stress incontinence as well.
Now men, you don’t get off the hook on this one. You may also suddenly become incontinent.
The number one cause of incontinence in men is called overflow incontinence. This most commonly occurs because the prostate is blocking the flow of urine out of the bladder. Over time the bladder becomes stretched. Eventually the bladder yells “No Mas!” and urine starts leaking out.
Men may also develop incontinence after prostate surgery (most commonly radical prostatectomy for prostate cancer). This is a known risk factor of the surgery and develops in almost all men. The good news is 98% of men will regain most if not all bladder control.
What happens if incontinence is left untreated?
Depending on the cause and the severity of urinary incontinence, there are a number of consequences if you choose to ignore your symptoms.
High volume or complete incontinence usually requires several diapers or pads a day. When you constantly expose your genitalia, perineum, and buttocks to urine you may develop:
- Discomfort, itching, redness
- Yeast infections
- Skin breakdown including fissures and ulcers
- Serious bacterial infections
Assuming that you’re not suffering with these complications, there are still some life-altering sequelae of ignoring your incontinence:
1. You may be delaying the diagnosis of a serious medical condition.
Multiple sclerosis can cause new onset bladder leakage in young women. So can a variety of neurologic disorders including spinal cord compression and brain tumors. This is not common but can occur. I’ve diagnosed patients with new onset, out-of-control diabetes because they saw me for bladder problems.
A blocked bladder may also lead to blocked kidneys and kidney failure. Sometimes the urine overflows outside the body. Sometimes the urine refluxes up to the kidney and causes damage. Not good.
2. You may be impacting your mental and physical health.
Too many women have shared with me, “I don’t exercise anymore because I’m worried about peeing my pants” or “I stopped going out for coffee with my friends because I don’t trust my bladder.”
Untreated incontinence can lead to social isolation, lack of physical activity and depression. None of this is good for your overall health. It doesn’t have to be this way.
It is amazing how often I see a woman in follow-up after curing her bladder leakage and she is just beaming with confidence and joy . . . “Doc you’ve changed my life!”
That’s how important bladder health is to all of us.
3. You may become permanently incontinent.
If that doesn’t scare you, I don’t know what will.
As a caveat, there are options to treat permanent bladder incontinence. However they may involve major surgeries or lifelong catheters (umm no thanks).
You might be asking yourself, “How can an overactive bladder or stress incontinence become permanent? Aren’t there plenty of treatments if the leakage gets worse?” Yes and no.
Recall from above that bladder incontinence can lead to a downward spiral in your health. As your health deteriorates, not only does the bladder leakage worsen, but the success rates and risks of incontinence therapies worsen as well.
Treating mild bladder incontinence in a healthy 46 year old woman is typically easier and more successful than treating a 75 year old woman wearing 7-8 diapers a day with obesity, heart disease and bum knees.
Does incontinence ever go away?
Will incontinence ever go away with zero action? No. However there are some temporary causes of incontinence that will resolve with appropriate therapy. For example: treating a UTI, stopping a new medication or fixing a herniated disc.
In most circumstances, you’ll need to do SOMETHING beyond practicing denial if you want your incontinence to improve. Don’t worry, relief may be easier than you think.
How do I stop being incontinent?
Now let’s get you the relief you deserve. Some of these therapies are easy. Some, not so much. The good news is that the quicker you address your incontinence, the less likely you’ll need to consider something radical to avoid being permanently incontinent.
Overactive Bladder Therapies
Treatment of OAB starts with lifestyle changes. Avoid bladder irritants (caffeine, alcohol, sugar), go potty every 2 hours, and treating constipation are good places to start.
An evaluation with your primary care doctor can address stopping certain medications (diuretics or water pills) that might be worsening your incontinence. Obstructive sleep apnea (OSA) might be contributing so request a sleep evaluation if you are prone to snoring.
OAB medications are the 2nd line of therapy. They work about 50% of the time over the long-term. Some are better tolerated than others. Cost can be a concern based on your insurance plan (damn insurance companies!).
When one medication fails now you really need a urologist. A female urology specialist will be able to review with the you the pros and cons of minimally invasive therapies including:
- Bladder botox injections
- Sacral neuromodulation (bladder pacemaker)
- Other nerve stimulations
As long as they are under the care of a qualified expert, most women will receive at least some relief from these therapies.
Stress Incontinence Therapy
Stress incontinence can improve with Kegel exercises. Sometimes a diligent woman will improve this on her own. Other times a referral to a dedicated pelvic physical therapist will do the trick.
There are new products on the market (stay tuned for another post) that look to deliver supercharged Kegel exercises from home or at the doctor’s office.
Since stress incontinence is an anatomic issue caused by weakened muscles, medications will not relieve this type of leakage. Don’t worry surgeries are safe and can be quite effective:
- Urethral injections
- Mid-urethral sling with mesh
- Pubovaginal sling using your own tissue
In men stress incontinence is treated in a slightly different fashion because of the different anatomy. Kegel exercises are still the place to start. A mesh sling has been created for men as well. The one difference is sometimes an artificial urinary sphincter (AUS) is used to treat the most severe instances of male stress incontinence.
Overflow Incontinence Therapies
Overflow incontinence occurs because the bladder is TOO full. Once the bladder starts emptying again, then the incontinence usually resolves.
If the bladder fullness is due to a blockage, then relieving the obstruction ASAP is necessary.
Bladder obstruction in women is relatively uncommon. The most common cause is pelvic prolapse. This occurs when the bladder is literally “falling out” (oh my) or bulging through the vaginal wall. Reducing the prolapse with a pessary and ultimately surgery will fix the issue.
Men have bladder blockages more commonly than women. A man’s prostate enlarges with age and can cause an obstruction. Scar tissue of the urethra is also more common in men (strictures are rare in women).
A urinary catheter to drain the bladder is often necessary until a medication or surgery relieves the obstruction.
Unfortunately there are some men and women who have overflow incontinence from weakened bladder muscles (atonic bladder). This is usually caused by a blockage that was ignored for months to years. This blockage can occur without pain so don’t assume this isn’t happening if you otherwise “feel fine”.
Once the bladder muscle has been damaged, you may become permanently incontinent. Although there have been many attempts, no one has successfully been able to regenerate or “kick start” a weakened bladder muscle.
Now there are some alternatives if you truly are permanently incontinent and have failed all other therapies.
What should I do if I become permanently incontinent?
The first question to answer is whether or not your bladder is getting emptied. If your bladder is chronically full then a urinary catheter is necessary.
Why? In addition to bladder leakage, an untreated full bladder can lead to recurrent urinary tract infections and kidney damage. I know a urinary catheter doesn’t sound great, but the alternatives are an intensive care unit or weekly trips to the dialysis center.
There are three types of bladder drainage:
- Self intermittent catheterization - place a temporary catheter every 4-6 hours
- Urethral catheter - traditional tube in the bladder
- Suprapubic catheter - a tube placed through a surgical procedure directly into the bladder via a lower abdominal incision.
Many patients live a very fulfilling life once they become accustomed to their urinary catheter. Again the alternatives are even worse.
If bladder leakage is due to severe stress incontinence or an overactive bladder then a quality-of-life decision needs to be made. What’s worse, sitting in a wet diaper vs. wearing a catheter? This is a very personal decision that a board-certified urologist can help guide you through.
Patients with urinary catheters can also develop recurrent urinary tract infections or incontinence around the tubes. Therefore, in rare cases, a major surgery may be the only option. This surgery is called a urinary diversion.
A surgeon uses a portion of the small intestines to create a stoma (think colostomy but urine instead of poop) which comes out of the body and is drained by a bag. Internally the ureters (tubes draining urine from the kidneys) are reconnected to the piece of intestines.
To prevent future infections, the empty bladder is mostly removed at the same time
Although this is a big deal surgery, for patients with no other options, a urinary diversion can be a life-saver.
Closing thoughts on permanent bladder incontinence
I always say prepare for the worst, but expect the best. Our goal at Pazona MD Urology is to provide accessible urology care with a smile. This includes encouraging you to not ignore bladder leakage!
Whether you’ve been dealing with bladder incontinence for years or it just started recently, a telemedicine visit with an expert can get you going on the right path. When and if you need a surgeon we’d be happy to help you find the best doc for the job!
Although we haven’t figured out immortality, and we recommend you pay your taxes, bladder incontinence doesn’t have to be permanent.
Here’s to a healthy bladder!
