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The Minimally Invasive Gynecologic Surgery (MIGS) Center at Massachusetts General Hospital delivers innovative, multidisciplinary care for a full range of gynecologic conditions including endometriosis, fibroids, abnormal uterine bleeding, ovarian cysts/masses, pelvic pain, urinary incontinence and gynecologic cancers.
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The Voiding Dysfunction and Incontinence Program at Massachusetts General Hospital features a team of specialists who treat urinary disorders with today's safest and most effective methods.
The Massachusetts General Hospital Geriatric Urology Program specializes in the innovative diagnosis, treatment and management of urological conditions experienced by patients age 60 and older.
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The Massachusetts General Hospital Female Urology Program provides advanced and comprehensive care for urinary tract disorders including incontinence, voiding dysfunctions and pelvic prolapse.
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The physicians in the Massachusetts General Hospital General Urology Program evaluate patients for urological diseases and common disorders, and provide outstanding care to patients diagnosed with urological conditions.
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What is urinary incontinence?
Urinary incontinence (UI) is the loss of urine control. You may not being able to hold your urine until you can reach a restroom. It may be a short-term problem caused by another health issue. Or it may be a long-term problem that you’ll have to manage. UI can range from a slight loss of urine to severe, frequent wetting.
Fear of wetting yourself can keep you from enjoying activities with your family and friends. Incontinence during sex can cause great stress.
UI is not a normal part of aging, but it is common in older people.
The following are some of the different types of UI:
- Urge incontinence is when the need to urinate comes on very quickly. Often, you may not be able to get to a restroom in time. It’s common in people who have certain conditions, such as diabetes, stroke, dementia, Parkinson disease, and multiple sclerosis. It may be a sign that these other conditions that need attention. It’s more common in older adults and may be a sign of a urinary tract infection or an overactive bladder.
- Stress incontinence is the most common type of incontinence. It’s more common in women. You may leak urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other movements that put pressure on the bladder.
- Functional incontinence is when you have urine control, but can’t get to a restroom in time. This may be due to conditions that make it hard to move, such as arthritis.
- Overflow incontinence is the leakage of small amounts of urine caused by an over-filled bladder. It may feel like you can’t fully empty your bladder.
- Mixed incontinence is a mix of more than one of the types listed above.
What causes urinary incontinence?
Changes from certain diseases or medicines may cause UI. It may also happen at the start of an illness.
Women are most likely to have incontinence during pregnancy and childbirth. Hormone changes of menopause may also cause it. This is because of weakened and stretched pelvic muscles.
Some of the other common causes include:
- Pregnancy and childbirth
- Birth defects
- Urinary tract infection (may be the first and only symptom)
- For men, an enlarged prostate gland or treatment of a prostate problem
- Stool build-up in the bowels
- Being overweight (this increases pressure on the bladder and the muscles that control it)
- Nerve damage from spinal cord injuries, diabetes, Parkinson disease, and multiple sclerosis
- Overactive bladder (the bladder squeezes at the wrong times and without warning)
What are the symptoms of urinary incontinence?
These are the most common symptoms of UI:
- Not being able to urinate
- Pain related to filling the bladder or urination without bladder infection
- Stream of urine gets weaker and weaker with or without a feeling that you have not emptied your bladder completely
- Urinate more without bladder infection
- Needing to rush to the restroom or losing urine if you do not get to a restroom in time
- Abnormal urination or changes related to stroke, spinal cord injury, or multiple sclerosis
- Urine leakage that prevents activities
- Leakage of urine that starts or continues after surgery
- Leakage of urine that causes embarrassment
- Frequent bladder infections
The symptoms of UI may look like other conditions or health problems. Always see your healthcare provider for a diagnosis.
How is urinary incontinence diagnosed?
The most important step in diagnosing UI is talking to a healthcare provider. Don’t let embarrassment keep you from getting help.
It’s important to see a health care provider for a physical exam that focuses on the urinary and nervous systems, reproductive organs, and includes testing urine samples. You may be referred to a urologist or urogynecologist, a healthcare provider who specializes in diseases of the urinary tract.
How is urinary incontinence treated?
Your healthcare provider will figure out the best treatment based on:
- How old you are
- Your overall health and health history
- How sick you are
- How well you can handle specific medicines, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
Treatment for UI depends on the cause and may include the following.
These will to help you regain bladder control. They include:
o Bladder training. This teaches you to resist the urge to void and expand the times between voiding over time.
o Scheduled toileting. This therapy uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder every 2 to 4 hours to prevent leaking.
Pelvic muscle rehab
This will improve pelvic muscle tone and prevent leakage. This treatment includes:
o Kegel exercises. Regular, daily exercise of pelvic muscles can make the bladder muscles stronger and improve, and even prevent, urinary incontinence. This is most helpful for younger women. Should be performed 30 to 80 times daily for at least 8 weeks.
o Biofeedback. Used along with Kegel exercises, biofeedback helps you gain awareness and control of their pelvic muscles.
o Vaginal weight training. Small weights are held within the vagina by tightening the vaginal muscles. This may be done for 15 minutes, twice daily, for 4 to 6 weeks.
o Pelvic floor electrical stimulation. Mild electrical pulses stimulate muscle contractions. This may be done along with Kegel exercises.
- Medicines. This includes specific medicines for incontinence as well as estrogen therapy. These may be helpful along with other treatments for women with urinary incontinence who are past menopause.
- Surgery. This is an option if the incontinence is related to problems such as an abnormally positioned bladder or a blockage. It may be used if other treatments don’t work, or if the incontinence is severe.
- Diet changes. This includes avoiding caffeine and alcohol.
- Adult diapers. Newer undergarments are no more bulky than normal underwear. You can wear them under everyday clothing.
You can also manage incontinence with other devices and products. This includes catheters, pelvic organ slings, urethral plugs, urine collection systems, and penile compression devices. Talk to your health care provider about which treatment might work best for you.
Consult your health care provider with your questions about the management and treatment of UI.
Key points about urinary incontinence
- Urinary incontinence (UI) is the loss of urine control, or not being able to hold your urine until you can get to a restroom. It’s a symptom, not a disease.
- There are many different causes of incontinence. It can be a short-term problem or it can be a long-term issue that must be managed.
- Symptoms of UI can range from dribbling urine to not having any control over it to being unable to pass urine at all. UI is also linked to frequent bladder infections.
- For people with urinary incontinence, the most important step is talking to a health care provider about the problem.
- Treatment depends on the severity of symptoms and the type of incontinence. It can include things like bladder training, special exercises, medicines, and even surgery in severe cases.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
There is life after a pelvic floor disorder - 5/11/2009, Mass General
Nearly one-third of American women have one or more pelvic floor disorders such as urinary incontinence, fecal incontinence or pelvic-organ prolapse. The Pelvic Floor Disorders Service at Mass General offers expert care and helps bring lasting relief to those suffering from a pelvic floor disorder.
Liliana G. Bordeianou, MD, describes what causes incontinence in maturing women and treatment options
Liliana G. Bordeianou, MD, a colorectal surgeon at the Massachusetts General Hospital Digestive Healthcare Center says incontinence is not just a normal part of getting older and explains the treatments that can dramatically improve your quality of life.
Milena Weinstein, MD, explains what you can do about the symptoms of pelvic floor disorders
Milena Weinstein, MD, urogynecologist at the Mass General Department of Obstetrics and Gynecology says urinary incontinence or vaginal bulge can be related to pelvic floor disorders, which affect one out of three women. Learn more about the treatments available for pelvic floor disorders, from exercise to support devices to surgery.