PHS Canada

Generic selectors
Exact matches only
Search in title
Search in content
Generic selectors
Exact matches only
Search in title
Search in content



    • An increase in the size of the prostate gland (a walnut-sized body part made of glandular and muscular tissue)
    • The prostate surrounds part of the urethra, which is the tube that carries urine and sperm outside of the body
    • Almost all men will develop some enlargement of the prostate as they grow older          
      • By age 60, 50% of men will have some signs of BPH
      • By age 85, 90% of men will have signs of the condition   
    • Approximately 50% of men will develop symptoms that need to be treated                                            
Potential Causes


      • Increased prostate cell growth from lower levels of testosterone and higher levels of estrogen and dihydrotestosterone (DHT)
    • Urinary frequency
    • Urinary urgency
    • Slowness/dribbling of your urinary stream
    • Hesitancy/difficulty starting to urinate
    • Nocturia (Nighttime voiding)
    • Pain after ejaculation/while urinating
    • Urine that has a different odour/colour than usual
    • The enlargement of the prostate can lead to blockage of the urethra, which can lead to:
      • Bladder stones
      • Bladder infection
      • Blood in your urine
      • Kidney damage from back pressure caused by retaining large amounts of extra urine in the bladder

Medical history to address:

    • Symptoms
    • Current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption      

Physical exam

Digital rectal exam: To feel the prostate and estimate its size

Urine flow study: May be conducted to measure how slow the urinary stream is compared with normal urine flow

Ultrasound post-urination: To determine if there is any urine left in the bladder

Cystoscopy: Bladder is looked at through a cystoscope


Oral Medications:

    • Finasteride and Dutasteride work by decreasing the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland
    • Drugs that relax the muscle in the prostate (to reduce the tension on the urethra) are more commonly used and include doxazosin, tamsulosin, alfuzosin and silodosin
    • Dutasteride and tamsulosin are combined to help treat symptoms and improve the flow of urine



    • Transurethral resection of the prostate (TURP): The tissue that blocks the urethra is removed with a special instrument
    • Transurethral incision of the prostate (TUIP): Two small cuts are made in the bladder neck (where the urethra and bladder join) and in the prostate to widen the urethra to improve urine flow
    • Transurethral electrovaporization: Electrical energy is applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. The enlarged tissue area can then be vaporized to relieve urinary blockage
    • The GreenLight laser: Prostate tissue is removed with a laser


Minimally Invasive Treatments:

    • Prostatic Urethral Lift: Separates the enlarged prostate lobes to make the urethra wider so that it is easier to urinate
    • Water Vapor Therapy:
      • Delivers very small amounts of steam to the enlarged prostate
      • This process damages the cells causing obstruction, thus reducing the overall size of the prostate
    • Inflammation of the prostate gland
    • When symptoms start gradually and linger for more than 2 wks
    • Affects adult men of all ages and from all backgrounds
    • About 5% of men experience symptoms of chronic prostatitis at some point in their lives
    • The four types of prostatitis are:


1.  Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS)

    • Inflammation of the prostate and an irritation of the nerves which supply this area
    • No bacteria are found in a urine sample 

2.  Chronic Bacterial Prostatitis

    • Uncommon
    • Tends to come and go over a long period of time


3.  Acute Bacterial Prostatitis

    • Uncommon
    • Bacteria is present in the urine

4.  Asymptomatic Inflammatory Prostatitis

    • No evidence of prostate infection or inflammation is found
    • Could potentially be a result of abnormal buildup of pressure in the urinary tract
Potential Causes
    • Most often, the nerves and muscles in the pelvis cause pain because of a local inflammation that effects the nerves in the area, or less commonly, bacterial infection (if it’s a bacterial type of prostatitis) when infected urine flows backwards from the urethra
    • Nonbacterial prostatitis may be linked to stress, nerve inflammation/irritation, injuries or prior urinary tract infections
    • Can be a reaction to an infection/past injury
    • Chills & fever (Bacterial prostatitis only)
    • Burning during/after urination
    • Difficulty starting the urine stream
    • Dribbling after urination is complete
    • Frequent/urgent need to urinate
    • A sensation that the bladder cannot be fully emptied
    • Pain felt above the penis, in/below the scrotum or in the back/rectum
    • Pain experienced during or after orgasm

Medical history to address:

      • Symptoms
      • Current health issues
      • Over-the-counter and prescription drugs being taken
      • Diet and liquid consumption
      • Sexual history


      • Your doctor will examine your prostate gland by inserting a gloved and lubricated finger into your rectum. In chronic prostatitis, the gland may be swollen or firm or it may feel normal
      • Urine sample prior to and post exam to check for white blood cells and bacteria

Oral Medications:

    • Antibiotics (for chronic and acute bacterial prostatitis)
    • Nonsteroidal anti-inflammatories (NSAIDs) and muscle relaxants for pain and muscle spasms
    • Alpha-blocker medications to relax the muscles that control the bladder and relieve symptoms of urgency, hesitancy or dribbling

Heat application: Baths, heating pads and hot water bottles

Acupuncture: The insertion of very fine needles to alleviate pain in strategic points

Biofeedback: Designed to ease pressure and reduce pelvic floor tension

Diet modification: Cutting out caffeine, alcohol, carbonated beverages and spicy/acidic foods may reduce irritation of the bladder and prostate

  • When the bladder does not empty properly
Potential Causes
  • Obstruction in the urinary tract
  • Enlarged prostate gland can press on the urethra (in men)
  • Cystocele: a bladder that sags (in women)
  • Rectocele: Rectum that sags into the back wall of the vagina (in women)
  • Drugs including antihistamines, antispasmodics, anticholinergics and tricyclic antidepressants that can change the way the bladder muscle works
  • Urethral stricture
  • Urinary stones
  • Catheter use
  • Nerve problems that interfere with signals from the brain to the bladder
  • Nerves can be damaged from vaginal childbirth, spinal cord injuries/infections, diabetes, stroke, multiple sclerosis, pelvic injury/trauma and benign prostatic hyperplasia
  • If the bladder tries to release but cannot, due to weak pelvic floor muscles or the sphincter not relaxing at the right time
    • A struggle to start the flow of urine
    • Weak flow
    • Feeling the need to go, but cannot start
    • Feeling the need to urinate right after you’ve gone
  • Medical history: To address past and current health issues and over-the-counter and prescription drugs being taken
  • Physical exam: Of the lower abdomen (for men and women) and prostate check (for men)
  • Urinalysis: To test for infection/blood/abnormalities
  • Bladder ultrasound: To show how much urine is still in the bladder post-urination
  • Cystoscopy: To look at the lining of your urethra and bladder, determine if there’s a urethral stricture, a blockage caused by a stone, an enlarged prostate or a tumour
  • CT Scan: Can help find stones or anything else blocking the flow of urine
  • Catheter Tests: Can determine urine flow rate and how well the bladder empties
  • Prostate-specific Antigen (PSA) blood test: To screen for prostate cancer
  • Electromyography (EMG): Uses sensors to measure electrical activity of muscles and nerves in and near the bladder and urethral sphincter

Enlarged Prostate

    • Drugs: Alpha-blockers and 5-alpha reductase inhibitors to help shrink the prostate
    • Surgery: Transurethral resection of the prostate to remove a section of the prostate
    • Laser therapy: To break up the blockage


    • Pelvic Physiotherapy: To strengthen the pelvic floor muscles
    • Vaginal Pessary: Insertion of vaginal pessary (ring) to support the bladder
    • Estrogen Therapy: For post-menopausal women
    • Surgery: To lift the sagging bladder/rectum

Urethral Stricture

    • Using catheters and balloons to open the urethra
    • Stent: Can prop open a closed urethra (in men)
    • Surgery: Using a knife/laser that is moved through the urethra to make a cut to open the stricture


    • Self-catheterization
Fowler's Syndrome
  • Caused by spasms of the external urethral sphincter, a band of muscle that opens and closes at the exit of the bladder
  • Affects young women (under the age of 30), leading to urinary retention
Potential Causes
  • Unknown 
  • Often seen in women who have had a surgical procedure, childbirth, opiate exposure or an infection or illness
    • Inability to urinate
    • Inability to feel that the bladder is full
    • Abnormality of the urethra 
    • Dysuria (painful/difficult urination)
    • Stomach pain
    • EMG abnormality
    • Polycystic ovaries
    • Rule out more common causes of urinary retention
    • Determine how much urine the bladder can hold 
    • Concentric Needle Electromyography (EMG): Will often show a characteristic abnormality
    • Sacral Neuromodulation (SNM) Therapy: A device is implanted in the body to help stimulate the nerves to the bladder
  • A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
  • Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
  • Typically 2-3x more common in women than in men
  • Risk increases with age
Potential Causes
  • What causes IC/BPS is not exactly known, but there are many theories including:
    • A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
    • A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
    • An agent in the urine that causes damage to the bladder
    • Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
    • The immune system attacks the bladder
    • Vary for each patient and range from mild to severe
    • Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
      • Can be felt in other areas including the urethra, lower abdomen, lower back,
        pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
      • Pressure/Discomfort: When the bladder is filling
      • Urinary frequency: Often of small amounts, upwards of 60x a day
        • Average number of times a person urinates per day: 7
      • Urinary urgency: Persistent and can be triggered by
        • Certain foods/beverages
        • Physical/mental stress
        • Menstrual cycle
        • Sexual intercourse

Medical history to

    • Address symptoms
    • Past and current health problems
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption


    • Baseline Pain Evaluation: Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
    • Voiding Diary: To evaluate your voiding patterns (Bladder diary is available to PHS members)
    • Urodynamic Evaluation: The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties
      • IC patients have a low capacity and potential pain with filling
    • Cystoscopy: Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
      • If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain
    • All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you

Diet: Certain foods can worsen symptoms

    • Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
    • Determining which foods irritate your bladder can be discovered through an ELIMINATION DIET
      • Stop eating all foods that could irritate your bladder. After 1-2 weeks, introduce 1 food back into your diet. Continue bringing foods back into your diet one at a time so you know if that food is an irritant or not
      • Food & Symptom Tracker provided to PHS Canada members

Physical Activity: Walking and gentle stretching

Stress Reduction: Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger

Pelvic Physiotherapy: To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage

    • The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
    • Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
    • Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved

Bladder Retraining: Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom

    • Track the number of times and how often you have the urge to urinate (Bladder Diary provided to PHS Canada members)
    • Use the diary to gradually increase the length of time between bathroom breaks

Medications (Oral & Intravesical):

    • Pentosan polysulfate sodium (Elmiron): Used for treating the pain of IC
    • It could take up to 6 months before any improvement is noticed
    • Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of this maculopathy
    • Heartburn medications: To reduce the amount of acid made by the body
    • Muscle relaxants: Can help relieve the symptoms by keeping the bladder from squeezing at the wrong time
    • Antihistamines: Decrease the amount of histamine in the bladder that leads to pain and other symptoms
    • Tricyclic antidepressants: Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain message
    • Bladder Instillations: The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
      • DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
      • Combined with Heparin/steroids to decrease inflammation

Bladder Stretching/Hydrodistension:

    • The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold

Neuromodulation Therapy:

    • Delivers harmless electrical impulses to nerves to change how they work
      • More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain

Sacral Neuromodulation (SNS):

      • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
      • Electrical wire is implanted under the skin in the lower back
      • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
      • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted

Cauterization/Steroid Injections:

      • May provide long-term relief for those with Hunner’s ulcers for up to a year or more


      • To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
      • These often need to be repeated every 6-9 months


      • Immunosuppressant therapy reserved for severe cases only


      • Bladder/parts of the bladder are removed
      • Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments
    • Chronic testicular pain lasting more than 3 months
    • Can come on suddenly/gradually
Potential Causes
    • Spontaneous
    • As a result of an infection (UTI/STI)
    • Trauma
    • Inflammation
    • Surgery
    • Pain originating from the scrotum
    • Physical exam
    • STI screening (if applicable)
    • Urine sample
    • Ultrasound to rule out other pathology
    • Heat application: Warm baths, heating pads, hot water bottles
    • Wearing tight-fitting underwear
    • Oral anti-inflammatory medications
    • Avoiding heavy lifting
    • Pelvic physiotherapy: If pain is due to muscle spasming
    • Temporary Spermatic Cord Block: Local anesthetic is injected into the spermatic cord (the structure carrying the vas, nerves, blood vessels and lymphatics to the testicle)
    • Surgery: Microsurgical Cord Denervation if the temporary cord block is successful
        • The cord is exposed and the nerve containing structures are cut while the blood and lymphatic supply are maintained
        • Provides long-term pain relief in over 70% of patients who have:
          • Chronic pain lasting more than 3 months
          • Failed other medical interventions and therapies
          • Received temporary relief with a cord block
  • Name for a group of urinary symptoms
  • Sudden, uncontrolled need or urge to urinate
  • The need to pass urine many times during the day and night
  • Can result if the nerve signals between your bladder and brain are not working properly so that your bladder muscle contracts before it’s full
  • You are more susceptible to OAB if
    • You live a sedentary lifestyle and are overweight
    • You do not manage chronic conditions such as diabetes
    • You live with a neurologic condition ie: Multiple Sclerosis, have suffered a stroke
    • You have a hypotonic (weak) pelvic floor
Potential Causes
    • Neurologic disorders/damage to the signals between your brain and bladder
    • Hormone changes
    • Pelvic muscle weakness/spasms
    • A urinary tract infection (UTI)
    • Side effects from a medication
    • Urgency: A sudden, strong urge to urinate that cannot be ignored
    • Urge Incontinence: The loss of bladder control
    • Frequency: Having to urinate over 8 times/day
    • Nocturia: Waking more than once a night to urinate

Medical History to address:

    • Past and current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption

Bladder Diary (Provided to PHS Canada members)

    • Over a few weeks, record
      • When and how much fluid you drink
      • When and how much you urinate
      • How often you have that “gotta go” urgency feeling
      • When and how much urine you may leak

Other Tests

    • Urinalysis: To check for infection/blood/other abnormalities
    • Bladder scan: To show how much urine is still in the bladder after you urinate
    • Cystoscopy: Bladder is looked at through a cystoscope to rule out other conditions

Diet: Limit foods and drinks that irritate the bladder including caffeine, carbonated beverages, alcohol, spicy and acidic foods

Bladder diary: To help you find patterns ie: bothersome foods, liquid consumption

Double voiding: After you think you’ve finished emptying your bladder, try again

Delayed voiding: Try to hold off when you have to urinate if the urgency is not severe

Timed urination: Urinate only at set times during the day

    • The goal is to prevent that urgent feeling and to regain control

Bladder muscle relaxation exercises:

    • Kegels: To strengthen the pelvic floor
    • Quick Flicks: Squeeze and relax your pelvic floor muscles over and over again
    • Biofeedback: Computer graphs and sounds to monitor muscle movement help teach you how your pelvic muscles move and how strong they are

Prescription drugs (Oral & Intravesical):

    • Antimuscarinics & Beta-3 Adrenoceptor Agonists: Can relax the bladder and increase the amount of urine your bladder can hold and empty
    • Botox: Relaxes the muscle of the bladder wall to reduce urgency and urge incontinence
      • Effects can last up to 6 months

Neuromodulation therapy:

    • Electrical pulses are sent to nerves that share the same path for the bladder
    • Help the brain and the nerves to the bladder communicate so the bladder can function properly

Percutaneous Tibial Nerve Stimulation (PTNS):

    • Small electrode is placed near your ankle and pulses are sent to the tibial nerve to help control the signals that aren’t working right
    • 12 treatments are usually required

Sacral Neuromodulation (SNS):

    • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
    • Electrical wire is implanted under the skin in the lower back
    • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
    • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted

Surgery: Bladder Reconstruction/Urinary Diversion:

    • Used only in rare and severe cases
    • Augmentation Cystoplasty: Enlarges the bladder
    • Urinary Diversion: Reroutes the flow of urine
  • Urinary Tract Infection (UTI): Bacterial infection of the urinary system causing an inflammatory response
  • Can affect any part of your urinary system: Bladder, kidneys, urethra and/or ureters
  • Usual Uropathogens: Escherichia coli, Staphylococcus saprophyticus, Klebsiella pneumoniae and Proteus mirabilis
  • A threshold of 3 UTIs in 12 months is used to signify recurrent UTI
  • The Pathogenesis of Recurrent UTI: Involves bacterial reinfection/bacterial persistence, with the former being much more common
    • Reinfection: Recurrence with a different organism, the same organism in more than 2 weeks after treatment or a sterile intervening culture
    • Bacterial Persistence: The same bacteria may be cultured in the urine 2 weeks after initiating sensitivity-adjusted therapy
Potential Causes
    • More prevalent in women
      • Urethra is closer to the rectum
      • Urethra is shorter
      • Diaphragm use
      • The use of products that can change the bacterial makeup of the vagina ie: spermicides, vaginal douches
      • Menopause due to hormonal changes resulting in modified vaginal bacteria
      • Invasion of E.Coli bacteria into the urinary tract as a result of:
        • Improper wiping
        • Toilet water backsplash
        • Sexual intercourse
    • In men
      • Enlarged prostate
        • The bladder does not empty completely, enabling bacteria to more easily grow
    • Neurogenic bladder: More prone to recurrent UTIs, as a result of issues with bladder muscle function (urinary retention)
    • Frequent urination
    • A burning sensation while urinating
    • Bloody/dark urine
    • Pain in your bladder/kidney regions
  • Urine culture: To determine which bacteria are present
  • Cystoscopy: To look inside the urethra and bladder to see if there are any abnormalities/issues that could cause the UTI to keep coming back
    • Antibiotics: For a week followed by long term, low-dose antibiotics after the initial symptoms subside

*When on antibiotics, be sure to take probiotics to replenish good bacteria in your system

    • Antibiotics: Post-intercourse
    • Estrogen therapy: For menopausal women
    • Water: Drink lots to dilute your urine and help flush out bacteria
    • Heat Application: Use a heating pad/hot water bottle on your bladder
Urethral Stricture Disease
    • When a scar from swelling, injury or infection blocks/slows the flow of urine in the urethra
    • Can be painful for some
    • Men are more susceptible, as a result of having longer urethras than women

2 Types

      • Happens in the first 1-2” of the urethra
      • Due to an injury from a pelvic fracture
      • Urethra is disrupted and completely cut/separated
      • Urine cannot pass
      • A catheter is placed through the abdomen into the bladder (suprapubic tube), or through the penis into the bladder so that urine can drain until the stricture can be fixed


    • Happens in the first 9-10” of the urethra
    • Due to trauma from a straddle injury, direct trauma to the penis or from urinary catheterization
    • Trauma to the urethra from a fall
    • Infection
    • Damage from surgical tools
    • Conditions that cause swelling
    • Urinary catheterization
    • Prostate surgery
    • Kidney stone removal
    • Decreased urine stream
    • Incomplete emptying of the bladder
    • Urine stream spraying
    • Straining or pain when urinating
    • Urinary frequency
    • Urinary urgency
    • UTIs in men
    • Physical exam
    • Urethral Imaging: X-rays/ultrasound
    • Urethroscopy: To see the inside of the urethra
    • Retrograde Urethrogram: Uses x-ray images to check for a structural problem/injury of the urethra as well as the length and location of the stricture along the urethra

*Dependent on the size of the blockage and how much scar tissue there is

    • Dilation: Enlarging the stricture with gradual stretching
    • Urethrotomy: Cutting the stricture with a laser/knife through a scope
    • Urethroplasty: Surgically removing the narrowed section of your urethra/enlarging it
      • The procedure might also involve reconstruction of the surrounding tissues through the use of skin/mouth grafts
    • Condition that affects the urethra (the tube that carries urine from the bladder to outside the body)
    • Inflamed/irritated urethra
    • Most common in women
Potential Causes
    • Physical problems with the urethra such as abnormal narrowing, urethral irritation or injury
    • No bacteria are present
    • The urethra can be irritated by:
      • Scented products (perfumes, soaps, bubble bath and sanitary napkins)
      • Spermicidal jellies
      • Certain foods and drinks containing caffeine
      • Chemotherapy and radiation
    • The urethra can be injured by:
      • Sexual activity
      • Diaphragm use
      • Tampon use
      • Bike riding
    • Increased risk of developing urethral syndrome if you:
      • Are prone to bacterial bladder/kidney infections
      • Take certain medications
      • Have sex without a condom
      • Have an STI
    • Pain with urination
    • Lower abdominal pain/pressure
    • Urinary urgency
    • Urinary frequency
    • Urinary difficulty
    • Pain during sex
    • Blood in the urine
    • Bladder not feeling empty after urinating
    • Swelling of the testicles (men)
    • Pain while ejaculating (men)
    • Blood in the semen/urine (men)
    • Discomfort in the vulvar area (women)
    • Medical history review and symptom evaluation
    • Physical exam including the genitals, abdomen and rectum
    • Urine sample: To rule out bacterial infection
    • Urethroscopy: To see the inside of the urethra
    • Pelvic ultrasound
    • Lifestyle changes: Refrain from using products, eating/drinking food and beverages or doing activities that can irritate the urethra
    • Medications:
      • Anesthetics: Phenazopyridine, lidocaine 
      • Antispasmodics: Hyoscyamine, Oxybutynin
      • Tricyclic Antidepressants: Amitriptyline, Nortriptyline
        • Act on your nerves to help relieve chronic pain
      • Alpha-blockers: Doxazosin, Prazosin
        • Improve blood flow by relaxing the muscles in your blood vessels
    • Dilation/Surgery: To widen your urethra if the syndrome is due to constriction
    • Uncontrolled leaking of urine
    • Affects 1 in 4 women and 1 in 9 men in Canada
    • Only 1 in 12 will seek treatment

5 Types


1. Stress Urinary Incontinence (SUI)

    • Most common, especially in older women
    • Happens when the pelvic floor muscles stretch


2. Overactive Bladder (OAB)

    • Urgency incontinence
    • Urinary frequency

3. Mixed Incontinence (SUI & OAB)

    • Leak urine with activity (SUI) and often feel the urge to urinate (OAB)


4. Urge Incontinence

    • The sudden loss of bladder control secondary to a strong and overwhelming urge to go to the bathroom
    • There can be a small amount of urine loss or complete emptying of the bladder


5. Overflow Incontinence

    • Most common in men with prostate issues
    • The body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing leakage
    • In addition, there may be something blocking the flow or the bladder muscle may not contract as it should
Potential Causes
  • Aging
  • Pregnancy, childbirth and number of children
  • Post-menopause potentially due to the drop in estrogen in women
  • Prostate problems
  • Some medications
  • Neurological diseases
  • Increased risk for those who smoke, are obese, have high blood pressure and/or diabetes

SUI: Leaking when you are physically active


    • Needing to urinate more than normal
    • Urinary urgency that sometimes cannot be controlled
    • May/may not cause your bladder to leak urine
    • Nocturia (nighttime urination)

Mixed SUI & OAB: Leaking AND a sudden strong urge to urinate

Overflow Incontinence: Frequent, small urinations and constant dribbling


Medical History to address:

    • Past and current health issues
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption

The Three Incontinence Questions Tool:

    • Asks if, when and how often urine leakage is experienced
    • Can help categorize the type of urinary incontinence

Three-day Voiding Diary (Provided to PHS Canada members):

    • Used as part of the initial assessment for urinary incontinence symptoms


    • When and how much fluid you drink
    • When and how much you urinate
    • How often you have that “gotta go” urgency feeling
    • When and how much urine you may leak

Cough Stress Test: Most reliable clinical assessment for confirming SUI

Urodynamic Testing: To determine how well the bladder, sphincters and urethra hold and release

Postvoid Residual Urine Measurement: You’re asked to urinate (void) into a container that measures urine output

      • Your doctor then checks the amount of leftover urine in your bladder using a catheter/ultrasound
  • Indwelling Catheters: Flexible tube placed in your bladder all day and night. A balloon holds the tube in your bladder and drains urine into an external bag
  • Intermittent Catheterization: Catheter is inserted into the urethra 3-5x/day. Once the bladder is empty, you remove the catheter
  • Absorbent Products: Pads, adult diapers, protective underwear, guards and drip collection pouches for men
  • Toilet Substitutes: Commode seats, bedside commodes, urinals (plastic jug-type devices)