Urinary Incontinence

The Incontinence and Voiding Dysfunction Center at Vanderbilt University offers many ways to diagnose and treat voiding disorders (problems with emptying the bladder or urethra), including incontinence (the inability to control urination).

The Center has state-of-the-art technology, including an advanced computerized urodynamics laboratory.

Our doctors use many advanced methods to diagnose and treat voiding disorders, including:

  • Urodynamics
  • Biofeedback
  • Injection therapy
  • Nerve stimulator implants
  • Innovative drug combinations

In addition, we specialize in the surgical reconstruction of lower urinary tract abnormalities, such as:

  • Genitourinary fistulae
  • Urethral diverticula
  • Complex pelvic prolapse

Many procedures can help stress urinary incontinence (when urine leaks with coughing, sneezing or other physical pressures). Sling procedures and laparoscopic (minimally invasive surgeries) are just two of the options.

From noninvasive techniques, such as biofeedback, to complex surgery, Vanderbilt provides experience, support and customized treatment for each patient.

About Urinary Incontinence

More than 10 million men and women of all ages suffer from incontinence. Urinary incontinence is the uncontrollable or accidental leakage of urine. It is embarrassing, uncomfortable and can affect a person's quality of life. Our faculty and staff talk with each patient about personalized solutions to their incontinence.

The bladder is often compared to a balloon that stores urine. The kidneys make urine. To fill and store urine, the bladder expands, and when it needs to empty, it contracts and pushes urine out. Urine leaves the bladder through a tube called the urethra. The urethra is surrounded at the top by a muscular valve (the urinary sphincter) that stays closed to keep urine in and opens to let urine out. The bladder must coordinate the opening and closing of the sphincter and the relaxing of bladder muscle to work properly. This function relies on messages from the nerves and the brain. When injury or illness affects any of these parts, incontinence can occur.

Diagnosis

Treating incontinence starts with an evaluation, including a physical exam and a discussion of each patient's health history. Often, a urologist (a doctor specializing in incontinence and other urinary-related health issues) may diagnose the problem with tests that study the urinary tract and its functions. For example, a urodynamic test can reveal how much urine the bladder can hold, whether there are uncontrollable muscle contractions, whether the urinary sphincter is injured and cannot close, or whether the bladder muscle contracts properly. Treatment for incontinence can be complicated, because there can be more than one problem involved.

Urinary Incontinence: Causes and Symptoms

There are four kinds of incontinence: transient incontinence, urge incontinence, stress incontinence and overflow incontinence.

  • Transient incontinence is caused by factors outside the urinary tract, such as drugs, or problems with mobility that make it hard for someone to go to the bathroom. It may be related to someone's level of consciousness or perception of their surroundings.
  • Urge incontinence is described by patients as the urge to urinate but being unable to hold the urine in long enough to get to a bathroom. It is characterized as an uncontrolled spasm of the bladder muscle resulting in its contraction and emptying of urine. Sometimes these uncontrolled spasms may occur without a patient's awareness. It can be caused by a variety of disease, including diabetes, strokes, Parkinson's disease or even simple urinary tract infections.
  • Stress incontinence happens when a physical event -- for example, a cough or sneeze -- causes a leak. These events cause an increase in pressure from outside the bladder. Normally, the sphincter and support structures at the base of the bladder prevent urine from seeping out. However, if any of these structures are damaged or weakened from events such as surgery, childbirth or diseases, stress incontinence can happen.
  • Overflow incontinence occurs when the bladder is completely full, and urine spills out or overflows. This occurs when the bladder muscle for various reasons does not contract, or when some kind of blockage doesn't allow the bladder to empty completely. A typical example of this kind of blockage is when a man's prostate gland is enlarged (grown larger than normal size). Bladder muscle weakness can occur in patients whose nerves connected to the bladder are injured after surgery, damaged by diabetes or harmed in other ways by diseases of the nervous system.

Urinary Incontinence: Treatment

There are several different treatments for incontinence. Each treatment plan is tailored to a patient's type of incontinence, personal needs, expectations and medical conditions. These plans can be classified into four main groups: behavioral therapies, drugs, devices and surgery.

  • Behavioral therapies include Kegel exercises that strengthen the pelvic floor muscles; and biofeedback, a computerized training process that helps a patient control the muscles involved with urinating.
  • Drugs include antibiotics that treat infections; drugs that treat bladder spasms; and drugs, including estrogen and others, to make tissue healthier in postmenopausal women.
  • Devices include pessaries (a device inserted in the vagina), pads, plugs, clamps and catheters.
  • Surgical treatments can be as simple as a 20-minute office procedure to bulk up the sphincter muscle, to complex surgical procedures to strengthen support of the pelvic floor and base of the bladder.

The field of urology is rapidly evolving. Research continues to clarify the causes of incontinence and leads to improvements in treatments.