How Is Incontinence Diagnosed
Often, the diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:
- How often do you urinate?
- Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
- How long have you been experiencing incontinence?
These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, its important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.
There are also several specific tests that your provider might do to diagnose incontinence, including:
While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. Youll then bring this journal with you to your appointment and talk about it with your provider.
How Is Urinary Incontinence Diagnosed
Urinary incontinence is easy to recognize. The primary symptom most people experience is an involuntary release of urine. But the type and cause of the incontinence can be more difficult to determine and may require a variety of exams and tests. Most physicians will use the following:
A bladder diary Your doctor may have you track your fluid intake and output over several days. This may include any episodes of incontinence or urgency issues. To help you measure the amount of urine you pass during an episode of incontinence, you may be asked to use a calibrated container that fits over your toilet to collect the urine.
Urinalysis A urine sample can be checked for infections, traces of blood, or other abnormalities, such as the presence of cancer cells. A urine culture can assess for infection urine cytology looks for cancer cells.
Blood testsBlood tests can look for chemicals and substances that may relate to conditions causing the incontinence.
Pelvic ultrasound In this imaging test, an ultrasound device is used to create an image of the bladder or other parts of the urinary tract to check for problems.
Postvoid residual measurement In this procedure, the patient empties the bladder completely and the physician uses a device to measure how much urine, if any, remains in the bladder. A large amount of residual urine in the bladder suggests overflow incontinence.
UI is usually curable, and if not, then controllable.
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Three Common Urinary Problems In Men And What You Can Do About Them
As you age you may notice changes in your urination. Perhaps you have noticed that you have difficulty starting or stopping the flow, or maybe the flow is weaker and slower than before. In addition to problems with flow, you might notice that you dont always empty your bladder completely and you always feel like you have to go. Or, perhaps you have just noticed that you are going to the bathroom more often, especially at night.
While many of these problems can be attributed to aging, there may be other issues besides aging that could be causing three of the most common urinary problems that occur in men, and many are treatable.
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Urinary Symptoms And Abnormal Urination In The Elderly
Urinary disorders are one of the common types of problems experienced by the elderly. Almost all seniors will experience some bladder related problem at some time or the other and the likelihood of this increases after the age of 70. However, not all bladder problems are the same and urinary symptoms may overlap among the different disorders. It is therefore important to report these symptoms to a medical doctor and undergo further investigation to identify the exact problem. The use of medication and surgery can subsequently improve symptoms and in some instances totally resolve the condition.
How A Health Professional Can Help
The first health professional that youre likely to talk to about incontinence is your primary care provider, but they may refer you to another physician or professional who can better help. Urologists and gynecologists are surgeons who see men and women for incontinence, and nurse continence advisors can run specialized interprofessional clinics.
Diagnosing the cause of incontinence
What your doctor will ask about: The treatment of incontinence depends on the cause of the symptoms, which your doctor will evaluate by asking questions, doing a physical examination, and probably order a few preliminary investigations.
Your doctor will review your personal medical history, especially any history of prostate surgery for men, and for women, the history of any pregnancies and number and types of births. Lifestyle issues like smoking, alcohol intake, caffeine consumption, exercise , and body weight are likely to come up.
A careful review of the patterns of incontinence will help to determine the cause of urine loss.
To review, three common patterns of urinary incontinence are:
- Stress: if you lose urine when doing certain activities,
- Overflow: you lose urine all the time in a dribble,
- Urge: feeling an urgent need to get to the toilet that you sometimes cant meet,
In older adults, its common for there to be a mixture of more than one pattern .
Your doctor will want to know:
The physical examination
Tests
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Bladder Problems In Older Men What Are My Risk Factors
Risks Are Not Like Rolling a Dice
Different diseases or bladder problems have different risk factors. Some can be changed eg smoking while others like age or family history cannot be changed.
But having a risk factor or even several risk factors does NOT mean that you will necessarily have a bladder problem or disease.
Furthermore, some people who have a bladder disease may have few or no known risk factors .
Types Of Male Urinary Dysfunction
At NYU Langone, our urologists treat men who have urinary dysfunction, which arises when the bladder or urethral sphincter doesnt work properly or an enlarged prostate blocks urine flow. Causes may include conditions such as benign prostatic hyperplasia and neurogenic voiding dysfunction, both of which may be accompanied by bothersome urinary symptoms, such as the inability to empty the bladder.
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Are Certain Types Of Incontinence More Common In Men
Certain types of incontinence are more common among men. Urge incontinence, which occurs when UI occurs after a sudden need to urinate, is the most common.
This condition is often associated with an enlarged prostate gland, which can lead to an overactive bladder.
Stress incontinence, which occurs alongside actions and movements that put pressure on the bladder, is also common in men.
Written byDr. Victor MarchionePublished onAugust 8, 2016
Urinary incontinence or loss of bladder control in men is not uncommon, but it can be treated once the cause is determined.
Uncontrollable urine in men or urinary incontinence occurs in eleven to 34 percent of older men, but it is not just an issue that impacts the aging. Younger men can also experience UI due to health problems. Urinary incontinence also happens to women, but the biggest issue with UI in men is that they are less likely to speak with their doctors about it. This means that the statistics could actually be much higher in men that the current numbers indicate. Discussing the problem is the first step to addressing the symptoms and finding a treatment.
There are different types of urinary incontinence, so it is important to get a proper assessment from a doctor to determine what type you might have and how to go address it. The types of UI men experience include urgency incontinence, stress incontinence, functional incontinence, overflow UI, and transient UI.
When To See A Doctor
If you or a loved one is experiencing any of the above symptoms that might indicate a urinary tract infection, it is time to see a doctor. While a bladder infection or urethra infection might only be uncomfortable or inconvenient, it can become far more severe if the infection spreads up to the kidneys.
It is also worth visiting a doctor if you notice a change in how frequently you urinate, are unable to hold your urine , or if you are having trouble urinating when you need to. All of these are additional signs that there might be a bladder problem at hand.
Common ways that doctors can test for bladder problems include:
- A physical exam. This can be a pelvic or prostate exam depending on your gender
- A urine sample. This will allow your doctor to test for different types of bacteria
- A bladder ultrasound. This can help determine whether or not you are able to empty your bladder completely
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What Are The Symptoms Of Urinary Retention
The signs can vary. Some people with the chronic form have a hard time starting the flow of urine. Some have a weak flow once they start. Others may feel the need to go but cant start. Others have to go a lot, while others still feel the need to go right after going. You may leak urine when you arent going because the bladder is full.
With the acute form, youre all of a sudden not able to go at all, or only able to go very small amounts. This occurs even though you have a full bladder. See a healthcare provider right away if this happens to you.
What Are The Major Differences In Bladder Problems In Older Men And Women
An infection by bacteria can occur in any part of the urinary system kidneys, ureters, bladder, or ureter. Most urinary tract infections affect the bladder and the urethra
1. Age-related urinary tract problems are more common in men than in women where pregnancy, childbirth and the drop and fluctuating levels in hormonal estrogen levels at menopause tend to affect the urinary tract.
2. Men are less likely to develop a bladder infection than women mainly due to the following differences in anatomical features:
- Women have a shorter urethra than men, which means bacteria have a shorter distance to travel to reach and infect a womans bladder
- In women the opening to the urethra is closer to the rectum, where the bacteria that cause bladder infection live
3. Men can experience an enlarged prostate blocking the flow of urine. If left untreated, urine flow can get completely blocked, leading to further health issues, including kidney damage
4. Older men rarely develop UTIs. When it does develop, it is treated as a complicated UTI because it is more likely to spread to the kidneys and upper urinary tract.
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Catheterisation For Detrusor Under
The main treatment strategy for a poorly contractile bladder is clean intermittent catheterisation. Drugs with parasympathetic activities are not widely used because of poor efficacy and poor side effect profile. New treatment modalities like neuromodulation, neurostimulation or reconstruction with muscle transposition have been explored but data is limited for the elderly .
Reducing The Risk Of Developing Utis Behavioral Changes
Preventative measures help reduce the occurrence of many bladder problems. The measures proposed by medics may appear restrictive but following them will promote a healthier lifestyle
- Hydration- Remain hydrated by drinking at least 6 -8 eight ounce glasses of water a day.
- Dont smoke. If you are a smoker, it is time to quit! Why? Non smokers have a lower risk of developing bladder and kidney cancer.
- Limit consumption of alcohol and caffeinated drinks or beverages. The key word is limit and not necessarily cut out.
- Maintain a healthy high fiber diet fruits, vegetables and whole grains to prevent constipation.
- Exercise regularly to maintain a healthy weight.
- Practice good toileting habits Do not hold your urine when you feel pressure to go to the bathroom, and when you do go, do not rush. Regular voiding regularly every 3-6 hours will help keep your bladder healthy
- Avoid bladder irritants. Avoid or eliminate any foods that irritate your bladder. Some of these may include spicy and acidic foods, caffeine, alcohol and carbonated beverages
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Bladder Anatomy And Physiology
The anatomy and physiology of the bladder are complex, but a basic understanding of these topics is essential in order to appreciate the various types of UI and their management., illustrates the basic anatomic structures and nervous system wiring involved in bladder function, including the detrusor muscle, the internal and external sphincters , and their neurological components.
Bladder anatomy and physiology.
Reduced activation of the sympathetic nervous system results in relaxation of the detrusor muscle, closure of the sphincter, and bladder filling. When the volume of urine in the bladder reaches 200 to 400 mL, the sensation of urge to void is relayed via the spinal cord to the brain centers. Voluntary voiding involves the parasympathetic nervous system and the voluntary somatic nervous system. Influences from these systems cause contractions of the detrusor muscle and corresponding somatic nervous activity, leading to sphincter relaxation.
When To See A Health Care Provider And What To Expect
Talk to your health care provider if you have urinary incontinence or any signs of a bladder problem, such as:
- Needing to urinate more frequently or suddenly
- Urinating eight or more times in one day
- Passing only small amounts of urine after strong urges to urinate
- Trouble starting or having a weak stream while urinating
Your doctor may recommend urodynamic testing and perform the following to try to figure out what might be causing your bladder problem:
- Give you a physical exam and take your medical history.
- Ask about your symptoms and the medications you take.
- Take urine and blood samples.
- Examine the inside of your bladder using a cystoscope a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
- Fill the bladder with warm fluid and use a cystoscope to check how much fluid your bladder can hold before leaking.
- Order or perform a bladder ultrasound to see if you are fully emptying your bladder with each void.
- Ask you to keep a daily diary of when you urinate and when you leak urine. Your primary care doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.
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Can I Prevent Urine Infections
Unfortunately, there are few proven ways to prevent urine infections. No evidence has been found for traditional advice given, such as drinking cranberry juice or the way you wipe yourself.
There are some measures which may help in some cases:
- It makes sense to avoid constipation, by eating plenty of fibre and drinking enough fluid.
- Older women with atrophic vaginitis may wish to consider hormone replacement creams or pessaries. These have been shown to help prevent urine infections.
- If there is an underlying medical problem, treatment for this may stop urine infections occurring.
- For some people with repeated urine infections, a preventative low dose of antibiotic taken continuously may be prescribed.
What Is The Treatment For A Urine Infection In Older People
- A course of anantibiotic medicine will usually clear the infection quickly. You should see a doctor if your symptoms are not gone, or nearly gone, after a few days.
- Paracetamol or ibuprofen will usually ease any pain, discomfort, or high temperature .
- An underlying cause such as an enlarged prostate gland or constipation may be found and need treatment.
Note: if you have an infection of your bladder then having plenty to drink is traditional advice to flush out the bladder. However, there is no proof that this is helpful when you have cystitis. Some doctors feel that it does not help and that drinking lots may just cause more toilet trips, giving you more unnecessary pain. Therefore, it is difficult to give confident advice on whether to drink lots or just to drink normally when you have mild symptoms of cystitis. However, if you have a high temperature and/or feel unwell, having plenty to drink helps to prevent having a lack of fluid in your body .
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How Common Are Urine Infections
Urine infections are much more common in women. This is because in women the urethra – the tube from the bladder that passes out urine – is shorter. Also it opens nearer the back passage than in men. Half of all women will have a urine infection that needs treating in their lifetime.
Urine infections are less common in men. They are very uncommon in young and middle-aged men. They are more common in older men. They are more likely to occur in men who have to use a catheter. A catheter is a thin, flexible, hollow tube used to drain urine. Older men are more likely to need a catheter because of prostate problems, which become more common with age.
Urine infections tend to become more common as you get older.
Urinary Problems In Men At Old Age
Many men develop bladder control problems as they get older. Urine leakage, frequent urination and an urgent need to urinate are embarrassing symptoms to deal with, but they dont have to be unavoidable parts of aging. There are many successful treatment options available for bladder control problems in males.
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