Saratoga Springs Urology
1 West Ave | Suite 215
Saratoga Springs, NY 12866-6045

Urinary Incontinence

Urinary incontinence is any involuntary leakage of urine. It can be a common and distressing problem, which may have a profound impact on quality of life. Urinary incontinence almost always results from an underlying treatable medical condition but is under-reported to medical practitioners.

Anatomy and function of the urinary bladder

The urinary bladder is a hollow muscle equipped with nerves, that is closed by passive and active closure mechanisms. The bladder can contract so that its filling volume is diminished, the active closure mechanisms, the muscular sphincter, can contract too so that the urethra is closed tightly. Both different muscular structures cannot actively relax, they relax by stopping their nerval stimulation.

Therefore the bladder has two distinctive functions:

  1. Holding the urine that is continually produced by the kidneys
  2. Getting rid of the urine during situations that are socially acceptable

These two functions of the bladder work autonomously, but under the influence of the central nervous system.

During the filling phase the bladder receives almost no nerval impulses so it is relaxed and can receive up to 300-500ml of urine. The passive sphincter closes during that phase due to the anatomic situation, and is supported by the active, muscular sphincter.

If it comes to urination the bladder musculature receives signals from its nerves so it contracts and reduces its filling volume, at the same time the anatomic structure of the passive sphincter opens as like the active sphincter does because it's stimulation is ceased completely.

So there are two mechanisms that can lead to leakage of urine:

  1. If the bladder hollow muscle contracts during a time it should not do so
  2. Failure of the closure mechanism

These are two completely different causes.

Diagnostic procedures

Since the treatment focuses on totally different causes it is crucial to differentiate these causes of incontinence properly.

To achieve this goal many different methods exist. They start with simple ones like taking the history and having the patient fill out a micturition protocol, continue with laboratory examinations of the urine, ultrasound examination of kidneys and bladder, and end with cystoscopy (endoscopic examination of the bladder), x-ray and urodynamic measurement (measuring the pressures in the bladder during filling and emptying of the bladder) if applicable and necessary.

Treatment

If we have an overactive bladder the treatment has to be targeted to the hollow muscle of the urinary bladder. Here we have to weaken the bladder musculature. Usually this treatment will be an oral medication while other applications (transdermal systems) exists, in rare cases where drug therapy is not sufficient surgical treatment may be successful.

In the case of a loose closing apparatus (that can appear after child birth) the approach is to strengthen the muscular sphincter. Here special physical exercise can be successful in a large number of patients. Since the muscles of the urethra are very small and tiny and usually are activated unconsciously, special education by skilled personnel over 10-12 weeks is required. Cases of unsuccessful treatment receive additional electrotherapy. This cause of urinary incontinence can also be treated very successfully by surgical procedures that tighten the bladder outlet precisely. Medication is available for this kind of incontinence too. What kind of treatment will be suggested and in which sequence depends on the individual situation of the patient.

It should be emphasized that urinary incontinence is not a fate that must be endured; it can be treated.