Causes and Treatments for Urinary Incontinence

By Paul J. Watkins

Defined as the involuntary loss of urine, urinary incontinence causes embarrassment and frustration for those individuals suffering from it, often leading them to avoid social situations and going out in public. 

“Many people are reluctant to ask for help, even from their doctors,” informs Stephen Kraus, MD, a board-certified urologic surgeon at UT Health San Antonio. “Often, they believe incontinence is an inevitable part of aging and nothing can be done about it. They simply suffer in silence.”

Stress incontinence – one of the two main types – occurs when a person coughs, sneezes, laughs, or lifts something heavy, and urine comes out. There’s pressure exerted on the bladder and if the urinary sphincter has been weakened, it can’t hold back the urine.

Risk factors for developing stress urinary incontinence include age, obesity, and smoking. For women, an additional risk factor is having had multiple pregnancies. Each of these risk factors can contribute to a weakening of the pelvic floor muscles that support the bladder and urethra.

Urge incontinence – the other main type – occurs when a person has a sudden need to urinate, but the urine comes out before they can reach the bathroom. A common cause is overactive bladder, in which the bladder muscles involuntarily contract to empty the bladder, even when it’s only partially full. Risk factors for urge incontinence include obesity, smoking, and childbirth, as well as urinary tract infections and neurological disorders.

“If someone is bothered by leaking, that person should consult a doctor to learn the many surgical and nonsurgical treatments available,” says Dr. Kraus. “A primary care provider can manage many of the conservative measures. However, they may not have all of the resources to offer more advanced options. If that’s a concern for the patient, finding a provider who can offer the full range of treatments might be a better choice. Those providers include urologists and gynecologists, some of whom have completed extra training in what is known as Female Pelvic Medicine and Reconstructive Surgery (FPMRS).”

For stress incontinence, noninvasive treatments include pelvic floor therapy, which improves support of the bladder and urethra. A minimally invasive, office-based procedure involves injecting a bulking material into the urethra to help seal it.

Dr. Kraus stresses that a patient doesn’t have to try conservative measures first; they can go straight to surgery if they desire. “The most common surgical treatment is the sling. I lay material underneath the urethra to give it support.” 

Urge incontinence treatments include first-line therapies consisting of behavioral therapies, such as educating patients on improving their diet and controlling fluid intake, and pelvic floor therapy can be added as well. Second-line therapy includes oral medications and can be used alone or combined with first-line therapies. Third-line therapies, which are reserved for when the patient does not achieve satisfactory results with the earlier options, include Botox® injections, which help relax the bladder muscles, and neurostimulation, which can regulate nerve activity in the bladder. Many of these can be done in the office setting.

“Not every treatment option works for everyone,” states Dr. Kraus, “but for every type of treatment, there are patients who are very happy with the results they’ve achieved.

“There’s no need to suffer in silence with urinary incontinence,” Dr. Kraus concludes. “Talk with your doctor or healthcare provider about the available options for treating it. You can reclaim your freedom and quality of life.”

For more information or to make an appointment, please call (210) 450-9600 or visit Urology | UT Health San Antonio uthealthcare.org