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 Medical Center.

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 condition.

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Created: 10/20/2002  -  Roger Dmochowski, M.D.