|Roger Dmochowski, M.D.
Dr. Dmochowski received his medical degree from the University of Texas
Medical School at Galveston. He completed his residency at the University
of Texas in Houston. He then completed four years of service in the United
States Navy followed by a fellowship at Kaiser Hospital in Los Angeles,
California. Dr. Dmochowski served as Medical Director and Associate Professor
of Urology at the University of Tennessee in Memphis from 1994-1998. He
then served as Medical Director of the North Texas Center for Urinary Control
in Fort Worth from 1998-2001. He is currently a Professor of Urology and
Director of the Vanderbilt Conference Center at the Vanderbilt University
Urinary Incontinence: Figuring Out Why You Lose Urine
Urinary Loss - By the Symptoms
If you have unwanted and uncontrollable urine loss, your most pressing question
is probably "What's causing this?" Many people who suffer from incontinence
know that, at least in some cases, certain activities result in urine loss.
Sometimes, maybe your urine loss is associated with a very strong desire to
get to the bathroom quickly and there's occasional urine loss before you get
there. Maybe, just maybe, you can't tell what brings about your urine loss and
it seems to be totally unprovoked. How can you, as a woman fighting the life
issues that these symptoms cause, determine what your body is telling you and
what you should tell your doctor?
What Makes the Bladder Work - What Makes it Fail
We know that incontinence can stem from two
basic causes. The bladder should hold urine until such time as you are ready
to go to the bathroom, and it should do this without causing the severe desire
or need to go to the bathroom (urinary urgency) or even abdominal cramping (something
that may feel like a menstrual cramp). When it is appropriate for you to urinate,
your bladder should empty to completion (your bladder is a muscle, and contracts
or squeezes to empty itself). While your bladder is storing urine, your urine
channel (urethra) should remain closed without leaking.
How Do I Figure Out Which Type of Incontinence I Have?
Women who experience urge incontinence lose urine due to bladder muscle over-activity.
Sometimes the strong desire to urinate (urge) is present, but sometimes it is
not and the urine loss can occur without warning (spontaneous or unconscious
loss). Often the amount of leakage is significant and associated with frequent
urination (once an hour or more). Some women also have a prominent problem with
nighttime urination (nocturia) that occurs with the daytime symptoms. Those
women may urinate as often as every hour during the night.
A word of caution: If your symptoms appear
only at night, your bladder is not at fault. Women who only have problems
after retiring are usually found to have problems with too much fluid in the
body and /or sleep disturbances, and need treatment directed at these root causes,
rather than aimed at the bladder.
Stress incontinence is much like a kitchen
faucet that cannot be tightened enough. When the urine channel is weakened (due
to loss of your natural hormones, childbirth, prior incontinence surgery or
hysterectomy) urine leaks against your will. In some cases you may be able to
tighten your pelvic muscles and prevent this, but at other times, you may not
be able to do this and urine loss will occur. Typically these symptoms are supposed
to occur with straining activities (lifting, bending over, changing positions
from sitting to standing) or those activities that increase abdominal pressure
(coughing, sneezing, laughing). However, in some women, the urine channel function
is so poor that even the slightest movement results in urinary loss - often
resembling the spontaneous incontinence described above. As one can see, sometimes
sorting out a women's incontinence based on symptoms alone can give a misleading
presumption as to the underlying type of incontinence that she may have.
A Mix That Doesn't Necessarily Match
Further complicating the bothersome symptoms
of incontinence is the fact that the majority of women with unwanted urinary
loss actually have a mixture of stress and urgency incontinence. The
mixed symptoms may have a predominant stress or urge overlay, or the symptoms
may be equally distributed. The reason for this lies in the response of the
bladder and urethra to urine loss and the fact that the bladder, unlike human
nature, only has a limited number of possible symptoms available in its repertoire
of responses. Urine that escapes into the urine channel before actual urination
can irritate the bladder enough to cause an unwanted bladder muscle contraction.
Sorting It All Out
So, with all these possibilities, how does
one know what type of incontinence is present? Approximately one half of women
with incontinence are able to identify the major contribution to their incontinence
with the use of aides such as voiding logs (a diary which keeps track of the
time of urination, urinary incontinence, and fluid intake) and symptom appraisal
tests (tests that ask questions about daily events and experiences and on the
basis of these scores can predict the main cause of leakage). Still, some women
have incontinence that defies identification with these tools.
What Other Kinds of Tests Can Be Done?
Your physician will often recommend a medical history and physical examination
as well as advanced testing to help sort out the questions raised from the tests
mentioned above. Certain facts in your story may help point to key issues that
you may not be able to identify. You may also undergo a pelvic examination with
a comfortably full bladder during which you will be asked to cough and push
down and maybe even do some simple activities, such as walking or bending, to
see if your urine loss can be reproduced. These maneuvers will help identify
the activities related to leakage and potentially complicating issues, such
as loss of bladder and vaginal support (vaginal prolapse). Sometimes this test
is done using protective pads so that the doctor can also determine the amount
(volume) of leakage present.
Very often you will be asked to undergo a test
called "urodynamics," which involves filling the bladder to reproduce the symptoms
that you experience on a daily basis. This test, in conjunction with the symptoms
above, will often give your doctor the best clue as to the underlying cause
of your incontinence and suggest the best direction for possible treatments.
What You Can Do
Track your symptoms as best as you can. Keep
up with what seems to cause your leakage and what makes the urine loss better
or worse. Be sure to inform your doctor if you have had other symptoms such
as blood in the urine, pain in your pelvic area related to urination, and any
other problems that seem to be related.
Together with your doctor, you can regain control
and resume those aspects of your life that you have altered to manage this unwanted
Click here for more information on incontinence.
Created: 10/20/2002  - Roger Dmochowski, M.D.