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Incontinence is the involuntary loss of urine. This is a very common problem affecting close to 30 million Americans. For practical purposes, there are two basic types of incontinence, stress and urge.

Urge incontinence is the type that occurs when there is an associated strong desire to void quickly. The patient is unable to control or stop the emptying process. This is the type of incontinence which is seen in overactive bladder, for example. Bladder infections can cause urge incontinence, but this is an acute problem relieved by curing the infection. Chronic urge incontinence may be caused by strokes, estrogen deficiency, cystocele (dropped bladder), among others.

Stress incontinence is the leakage of urine with straining and physical activity. Pure stress incontinence is not associated with the desire to void. However, the two types of incontinence commonly occur together. This type of incontinence is frequently caused by a cystocele or weakness of the sphincter muscle. The latter can be caused by such things as prior radiation, surgery, multiple births.

The initial history and physical examination may indicate the underlying cause of the incontinence. Frequently, other tests are employed to confirm the diagnosis or to separate the types of incontinence. These tests may include urodynamics and cystoscopy. Urodynamics is a sophisticated test of bladder function which is based on measurements of bladder pressures and volumes after infusion of water into the bladder through a specially designed small catheter. This test usually takes between 20-25 minutes and is performed in the office. Cystoscopy, another office procedure, involves inspection of the inside of the bladder using a specially designed scope and filling of the bladder with water. It takes usually under one minute.

It is important to determine the type and severity of the incontinence because treatment will vary based on the diagnosis. Urge incontinence may be treated by oral medications, vaginal estrogen cream, behavioral therapy and/or pelvic floor muscle exercises (Kegel’s). For unresponsive cases a neural stimulator may be needed (Interstim).

Stress incontinence occasionally may be improved or cured with the exercises. However, frequently repair of a cystocele and placement of a urethral sling may be needed. These involve placement of mesh supports for the bladder and urethra placed through vaginal incisions under anesthesia. It may be done as an outpatient or with a one night stay in the hospital.