Urinary Incontinence: Online Diagnosis and Treatment

If you have urinary incontinence, more commonly called bladder leakage, you may feel alone in your struggles to locate a nearby bathroom every time you leave your home, but you are not. Bladder leakage is very common and has a wide range of potential causes. Bladder leakage can vary from a small release of urine when coughing or laughing to a complete lack of control over your urine flow.

Urinary leakage or incontinence affects 20 million people worldwide and is under treated.¹ Approximately half of all adult women experience urinary incontinence at some point in their lives, especially during pregnancy. The US National Health and Nutrition Examination Survey (NHANES) study estimated that 9.6 million women over the age of 50 have bothersome incontinence symptoms. Researchers found that stress, urgency, and mixed incontinence affected 6.7%, 4.8%, and 19.3% of women and 0.6%, 3.5% and 1.9% of men, respectively.²

Approximately 50% to 70% of people with urinary incontinence do not seek treatment. Scheduling a consultation with a virtual doctor on the Telegra MD telehealth platform for urinary incontinence diagnosis and treatment is simple and convenient. You will receive a diagnosis, a treatment protocol full of strategies to manage urinary incontinence, and an appropriate online prescription to help you gain control over incontinence.

Telehealth for urinary incontinence treatment makes it easy to consult with a virtual doctor and receive a prescription medication to treat your urinary incontinence quickly and easily, even if you don’t have insurance. Schedule an appointment today to learn whether you might have urinary incontinence and receive a personalized treatment plan to regain your confidence to leave your home.

What Is Urinary Incontinence?

The urinary system typically comprises two kidneys, two ureters, one bladder, and one urethra. Urine is produced in the kidneys and travels down the ureters to the bladder, where it is stored until it is released to the outside via the urethra. Your bladder can hold between 1.5 and 2 cups of urine.

Two round bands of muscle called sphincters control the urine flow from the bladder to the urethra. One of these sphincters is under voluntary control, and the other is not. When the sphincters are contracted, they hold urine in the bladder. When they relax unexpectedly, urine can leak out of the body.

The bladder is a muscular sac that expands when urine fills it. It is designed to increase in volume without a significant increase in pressure until a certain point. When the pressure in the bladder increases, nerves from the bladder wall signal to the brain that it is time to urinate (empty the bladder).

What Are the Common Symptoms of Urinary Incontinence?

Symptoms associated with urinary incontinence:

• Urinary frequency
• Urinary urgency
• Waking up frequently at night to urinate
• Skin breakdown and rash from urine stasis

Can Urinary Incontinence Be Treated Through Telehealth?

Consulting a medical professional via telehealth is a convenient way to diagnose and treat urinary incontinence. You can schedule an online medical consultation appointment with a virtual doctor using the Telegra MD platform and receive a personalized treatment plan. Your virtual doctor can give you tips on managing your symptoms and call your online prescription to a local pharmacy. Online doctors who prescribe urinary incontinence treatment medications provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Why Do You Get Urinary Incontinence?

When you have healthy urinary tract function, nerve control over your bladder switches from storing urine to emptying your bladder via a reflex loop in your lower spinal cord. As the bladder fills, it sends signals to your brainstem. If you do not inhibit these impulses, your urinary sphincters will relax, bladder muscles will contract, and your bladder will empty. Continent adults are able to postpone voiding until it is an appropriate time and place.

With increasing age, signals in the bladder control network may weaken. This can be due to neurologic diseases, such as Parkinson’s disease, dementia, or cerebral infarction (stroke). These brain changes can cause overactivity of the detrusor (bladder emptying) muscles., which can cause bladder spasms and incontinence.³

Urinary incontinence is classified into the following types:¹

• Stress incontinence: increased abdominal pressure causes urine to leak from the bladder as it overcomes the ability of the sphincter to hold urine back. Pregnancy and prostate surgery are common causes as they weaken the pelvic floor muscles. This sling of muscles provides support for the urinary sphincters and urethra. Stress incontinence is more common in younger and older women.
• Urge incontinence (overactive bladder): strong and abnormal contractions of muscles in the wall of the urinary bladder can cause involuntary urine leakage. Common in older adults, especially after a stroke. Symptoms include urinary urgency, frequency, and frequent nighttime urination.
• Overflow incontinence: when the bladder does not empty completely due to weak bladder wall muscles or an obstruction to the bladder exit, or you don’t have the sensation that the bladder is full when it is, it can cause overflow incontinence. Bladder outlet obstruction is more common in men.
• Functional incontinence: neurologic, muscular, or joint problems can make getting to the bathroom in time difficult. This type of incontinence does not originate with the bladder.
• Mixed incontinence: combines the symptoms of stress and urge incontinence. In this case, the bladder sphincter muscles are weak, and the bladder wall muscles are much stronger.

Are Some People at Increased Risk for Urinary Incontinence?

Risk factors associated with urinary incontinence include:

• Age: both the prevalence and severity of urinary incontinence increases with age
• Sex: urinary incontinence is twice as common in women than in men
• Pregnancy: pregnancy and vaginal delivery increase the risk of damage to the pelvic floor
• Family history: urinary incontinence, especially urge incontinence, is more prevalent in some families
• Overweight and obesity: excess abdominal weight can increase pressure on the bladder
• Prostate surgery: removal of the prostate to treat cancer or reduce prostate size may affect bladder sphincter tone and ability to hold back urine
• Chronic cough: may increase abdominal pressure and cause stress incontinence
• Medications: cholinergic, anticholinergics, alpha-blockers, and allergy medications are just a few of the medication classes that may worsen urinary incontinence
• Bladder irritants: common bladder irritants can worsen incontinence symptoms in sensitive people
• Recurrent Urinary Tract Infections
• Neurodegenerative diseases
• Menopause

Bladder irritants that may worsen incontinence symptoms

• Caffeine
• Alcohol
• Artificial sweeteners
• Carbonated beverages
• Milk
• Coffee
• Tomatoes and tomato-based products
• Citrus juices and fruits
• Corn syrup
• Chocolate
• Highly spiced foods

How Do You Diagnose Urinary Incontinence?

 A thorough medical history and physical exam can help isolate potential causes of urinary incontinence. To help with diagnosis, keep a voiding diary such as this one:

Date	Frequency and volume of urination	Fluid intake	Episodes of incontinence	Associated activities such as laughing or coughing
Day 1
Day 2
Day 3
Day 4
Day 5

A three to seven-day voiding diary is usually sufficient.⁴ In most cases, urinary incontinence will gradually worsen in severity and frequency. Keeping a voiding diary can help identify the type and degree of urinary incontinence you might have.

How Do You Treat Urinary Incontinence?

According to the National Association for Continence, the most important first step when treating incontinence is to take action, assess your condition, develop a voiding strategy, and talk with your doctor.

There is a wide range of potential treatment options for urinary incontinence, but their effectiveness varies depending on the cause of your symptoms. Judicious use of absorbent pads and garments can minimize the impact of symptoms and protect skin integrity in all types of urinary incontinence.

Pelvic floor exercises are used to treat stress, urge, and mixed incontinence. These exercises, also called Kegel exercises, involve stopping your urine stream by contracting your buttocks, abdominal and thigh muscles. After learning which muscles to contract, perform three sets of eight to 10 contractions three to four times weekly.¹

Stress incontinence

No medications are FDA-approved to treat stress incontinence. Medications used off-label to treat this condition include:

• Alpha-adrenergic agonists: pseudoephedrine, phenylephrine
• Duloxetine: an antidepressant, serotonin/norepinephrine reuptake inhibitor

A minimally invasive surgical procedure is sometimes recommended to reduce leakage from stress incontinence. Radiofrequency energy is delivered to the bladder neck and urethra to stiffen collagen and help reduce bladder leakage. Cure rates range from 22% to 67%, and up to half of patients report continued improvement three years after treatment.^1,5

Pelvic floor exercises and pessaries can also reduce bladder leakage from stress incontinence.

Urge incontinence

Dietary changes, lifestyle modifications, pelvic floor exercises, and medications treat urge incontinence. Bladder training exercises to gradually extend the wait to urinate can help retrain the bladder and central nervous system to inhibit the urge to urinate.¹

Medications used to reduce bladder spasms and treat urge incontinence include the following:

• Anticholinergics: fesoterodine, oxybutynin, tolterodine, trospium, darifenacin, solifenacin. These medications increase bladder capacity and decrease bladder spasms. According to the American Geriatrics Society, anticholinergic medications are typically not recommended for use in older adults because of an increased risk of side effects.⁶
• Beta-adrenergic agonists: mirabegron relaxes bladder muscles and increases bladder capacity.
• Onabotulinumtoxin A (Botox): FDA-approved treatment in which Botox is injected into the bladder muscle to treat urge incontinence that has not responded to other treatment options. Botox is injected into the bladder muscles to suppress contraction. It can improve symptoms for up to 9 months. Botox injections can trigger pain with urination, urinary retention, and urinary tract infections in some people.

Posterior tibial nerve stimulation is a second-line treatment for urge incontinence. Stimulating this nerve is expected to stimulate the sacral nerve in the lower spinal cord, leading to a reduction in bladder spasms and incontinence symptoms.⁷  In 2019, an implantable posterior tibial nerve stimulation device was released. Early testing indicates it can potentially reduce severe urinary urgency by 94% and severe incontinence by 71%.⁸

Sacral nerve stimulators can be surgically implanted in the lower back to reduce bladder spasms and urge incontinence. Because they are an invasive therapy, they are only considered when other options have been exhausted.

Overflow incontinence

Catheterization is the most common way to treat overflow incontinence. Alpha-adrenergic antagonists can be prescribed to reduce bladder leakage.

Functional incontinence

Treatment of the underlying cause is key when treating functional incontinence.

Mixed incontinence

Anticholinergic drugs and surgical interventions are used to treat mixed incontinence.

When Should You See a Doctor for Urinary Incontinence?

Over half of all adults with urinary incontinence have not sought treatment for their symptoms. Doing so can improve their quality of life and reduce the risk of skin breakdown and infection from urinary leakage.

Telehealth for urinary incontinence is the perfect option for incontinence treatment. You can schedule an online appointment with a virtual doctor using the Telegra MD platform and receive a diagnosis based on the type of urinary incontinence. Your virtual doctor can give you tips on managing bladder leakage and call in a prescription to a local pharmacy. Online doctors who treat urinary incontinence provide 24-hour appointment access, which means you can expect doctor access whenever you need it, leading to an earlier diagnosis and treatment.

Obtaining a urinary incontinence treatment plan after seeing a doctor online through telemedicine is similar to seeing your local doctor. In both cases, you would:

• Make an appointment: Typically, appointments to see virtual doctors through telehealth are much easier to make and are more convenient than in-person appointments, as many telemedicine companies provide online telehealth services for urinary incontinence treatment at any time, day or night.
• Provide a medical history: Whether completing forms in your local doctor’s office or online before consulting with your virtual doctor, you will need to provide a medical history.
• Consult with your doctor: After reviewing your medical history forms, your virtual doctor will discuss your acne treatment options.
• Treatment: After deciding on an optimal and personalized treatment plan for acne, your virtual doctor will transmit your prescriptions to your local pharmacy.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. Hersh L, Salzman B. Clinical management of urinary incontinence in women. Am Fam Physician. 2013;87(9):634-640 https://www.aafp.org/afp/2013/0501/p634.html

2. Daugirdas SP, Markossian T, Mueller ER, Durazo-Arvizu R, Cao G, Kramer H. Urinary incontinence and chronic conditions in the US population age 50 years and older. Int Urogynecol J. 2020 May;31(5):1013-1020. doi: 10.1007/s00192-019-04137-y. Epub 2020 Jan 3. PMID: 31900549.

3. Suskind, A.M. (2017). The Aging Overactive Bladder: a Review of Aging-Related Changes from the Brain to the Bladder. Current Bladder Dysfunction Reports, 12, 42-47.

4. Nygaard I, Holcomb R. Reproducibility of the seven-day voiding diary in women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000. 11(1):15-7.

5. Appell RA, Singh G, Klimberg IW, et al. Nonsurgical, radiofrequency collagen denaturation for stress urinary incontinence: retrospective 3-year evaluation. Expert Rev Med Devices. 2007;4(4):455-461.

6. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616-631.

7. Peters KM, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol. 2009;182(3):1055-1061.

8. Yamashiro J, de Riese W, de Riese C. New implantable tibial nerve stimulation devices: review of published clinical results in comparison to established neuromodulation devices. Res Rep Urol. 2019;11:351-7. doi:10.2147/RRU.S231954