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Urinary Incontinence - Medical Malpractice
Urinary incontinence is the leakage of urine involuntarily. In women, it is a common problem. In men, it is less common of a problem but can occur when a man ages. The leakage problem can be minor or severe; it can also be frequent or uncommon. Many women, unfortunately, are too embarrassed by the problem to seek the advice and treatment by a physician even though there are treatments available.
There are several types of urinary incontinence a woman (or man) can have. Each has its own causative factors and is usually treated differently from one another. The first type, and perhaps the most common, is stress incontinence. It is the type of incontinence that occurs when you laugh, cough, sneeze or lift something heavy. It also can happen with running or walking-any type of exercise can cause this condition to occur. It is caused by a weakening of the muscles that support the bladder and/or weakening of the muscles that support the urethra. It is common in both younger and older women and is made worse by childbirth or pelvic trauma.
Urge incontinence is another type of urinary incontinence. It involves the sudden urge to void and the leakage of urine before the woman has the chance to get to the bathroom. Some people call this problem one of an "overactive bladder". It happens when the muscles of the bladder are too hyperactive and contract the bladder uncontrollably. In addition, damage to the nerves that send signals to the bladder can also cause urge incontinence.
Mixed incontinence is when you have both stress and urge incontinence together. More urine leaks out with this condition that would leak out if you had either of the causes of incontinence separately. Finally, there is a condition called overflow incontinence in which the bladder fails to empty completely, leaving urine always present in the bladder in higher than normal amounts and a steady leakage of small amounts of urine occur. It is caused by the urethra being blocked or underactive muscle activity of the urinary bladder.
Common symptoms of urinary incontinence include leakage of urine, urinary urgency (the urge to urinate frequently and suddenly), frequency of urination (voiding more often), dysuria (painful urination), nocturia (waking up to go at night) and enuresis (wetting the bed).
As mentioned, the leakage can be great or very small. It can be a daily problem or one that occurs only a few times a week or a few times a month. Some can just wear absorbent pads in order to soak up any urinary leakage. Others seek medical attention for medication, surgery or other medical treatments to take care of the problem.
The causes of urinary incontinence include having a urinary tract infection with a hyperactive bladder. This is usually simply treated with antibiotics that can clear up the infection and the incontinence can go away. Certain medications, such as diuretic medication, can contribute to urinary incontinence. It goes away once the medication has been discontinued. Polyps, bladder stones or bladder cancer can cause urinary incontinence. Abnormal growths can also cause blood in the urine. See a doctor if you see blood in your urine.
More long term problems related to urinary incontinence are a lack of support of the pelvic organs. It can also cause uterine prolapse, which contributes to urinary incontinence. A fistula between the bladder and the vagina, caused by damage to the vagina in surgery or childbirth, can cause constant leakage of the bladder into the vaginal space. Certain neuromuscular problems such as occurs in stroke, diabetes and MS can contribute to incontinence of the urine.
The diagnosis of urinary incontinence depends on a complete history and physical exam. Doctors may ask you to fill out a voiding diary, including when you void and when you leak. A pelvic exam is done to see if there is pelvic laxity. A voiding cystourethrogram is done to see how the bladder voids and whether or not there is extra urine in the bladder after voiding. An ultrasound can check for the post-void amount of urine in the bladder. Cystoscopy can look into the bladder for stones or polyps.
Treatment of urinary incontinence involves lifestyle changes like losing weight and doing Kegel exercises to strengthen the pelvic muscles. Drinking less caffeine can change the pattern and amount of leakage. Bladder training can make a difference and the use of a pessary within the vagina can change the angle of the bladder and the urethra, helping urine stay in the bladder. In the worst cases, surgery can be done to suspend the bladder and can help control urinary incontinence.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here