What Urinary Incontinence Means

Dr. Cornella introduces himself and describes urinary incontinence and the associated symptoms. Additionally, he shares how often someone should urinate.

My name is Dr. Jeffery Cornella and I am professor of Obstetrics and Gynecology at the Mayo Clinic. I work at Mayo Clinic, Arizona, which is one of the primary institutions in the Southwest treating patients in multiple specialties. It is a tertiary care center and my area of expertise is pelvic reconstructive surgery and urogynecology. I have been treating patients with urinary incontinence or prolapsed for over 23 years and I have had the privilege of working at the Mayo Clinic and it’s been an exciting endeavor to try to help people with this problem because we know that we can improve a variety of aspects of their life as we make improvements in their urinary leakage or prolapse. What is urinary incontinence and what are the associated symptoms? Female urinary incontinence is loss of urine into the pad or clothing. It’s an involuntary loss of urine, and patients may exhibit incontinence at any point in their life. There’s a variety of factors, which may contribute to urinary incontinence and they include childbearing, aging, and there’s comorbidities as well, such things as obesity and other factors that can contribute to urinary leakage. One of our former fellows, Dr. Ingrid Nygaard, who is now at Salt Lake City, did a study looking at prevalence and for patients between the ages of 20 and 40, their prevalence is 7%, between 40 and 60 – 17%, 60 and 80 – 23%, and over 80 – 32%. So it increases with age and it’s a significant problem in the United States with financial outlays approaching $26 billion a year. The symptoms of urinary incontinence primarily relate to mechanism. There’s a variety of mechanisms, which may result in leakage, but the two most common are – number one, either a weakness of the tube that drains the bladder, the urethra, or over activity of the muscle of the bladder. So for patients who have a weakness of the tube that drains the bladder, they may lose urine with coughing, laughing, sneezing, exercise, sometimes even from going from a sitting to a standing position. For patients who have bladder over activity, where the muscle of the bladder contracts, they feel an urge to go to the bathroom and have dribbling on the way. How much time usually elapses between each urination? Often patients may ask, what is the normal time between voids or emptying their bladder? I would say a good interval would be approaching two hours. If a patient has urinary incontinence or urgency, sometimes patients will tend to go more frequently to the bathroom, but this can result in a cascading issue. In other words, the more often you go to the bathroom, the more often you will need to go to the bathroom and thus, we utilize bladder retraining where the patient voids by the clock to decrease the frequency of voiding. During the night there may be other conditions, which result in the patient getting up and going to the bathroom. Some of these may include such things as sleep apnea. And patients in that setting would need to have the sleep apnea addressed in terms of decreasing their comorbidity related to sleep apnea.