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Urinary Incontinence is the involuntary excretion of urine from one's body. It is often temporary, and it almost always results from an underlying medical condition. Frequent urination, which may or may not be a symptom of underlying pathology, is not synonymous with urinary incontinence.
In this article, the term "incontinence" will be used to mean urinary incontinence. The scope of this article does not encompass fecal incontinence which may or may not accompany urinary incontinence. A wealth of urinary and fecal incontinence is available on our links page like healthfinder®
Urinary Incontinence in Men and Women
Stress urinary incontinence is incontinence that is caused by actions such as coughing, laughing, sneezing, exercising or other movements that increase intrabdominal pressure and thus increase pressure on the bladder. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress urinary incontinence. It is the most common form of urinary incontinence in women and is treatable.
The bladder is supported by muscles of the pelvic floor. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress urinary incontinence also occurs if the muscles that do the squeezing weaken.
Stress urinary incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of bladder leakage. The incidence of stress incontinence increases following menopause.
Types of Incontinence
Stress Incontinence
Stress incontinence is incontinence that is caused by actions such as coughing, laughing, sneezing, exercising or other movements that increase intrabdominal pressure and thus increase pressure on the bladder. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress urinary incontinence. It is the most common form of urinary incontinence in women and is treatable.
The bladder is supported by muscles of the pelvic floor. If these muscles weaken, the bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken.
Stress urinary incontinence can worsen during the week before the menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of bladder leakage. The incidence of stress incontinence increases following menopause.
Urge Incontinence
Urge urinary incontinence is involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is inappropriate bladder contractions.
Medical professionals describe such a bladder as "unstable," "spastic," or "overactive bladder." It may also be called "reflex incontinence" if it results from overactive nerves controlling the bladder. Patients with urge incontinence can suffer incontinence during sleep, after drinking a small amount of water, or when they touch water or hear it running.
Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury--including injury that occurs during surgery--all can harm bladder nerves or muscles.
Functional Incontinence
People with functional urinary incontinence may have problems thinking, moving, or communicating that prevent them from reaching a toilet. A person with Alzheimer's disease, for example, may not think well enough to plan a timely trip to a restroom. A person in a wheelchair may be blocked from getting to a toilet in time. Conditions such as these are often associated with age and account for some of the incontinence of elderly men and women in nursing homes.
Overflow Incontinence
Overflow urinary incontinence occurs when the patient's bladder is always full so that it frequently leaks urine. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence predominately affects men.
Mixed Incontinence
Stress and urge urinary incontinence often occur together in women. Combinations of incontinence - and this combination in particular - are sometimes referred to as "mixed urinary incontinence."
"Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.
outflow.
Diagnosis of Incontinence
Patients with urinary incontinence should be referred to a medical practitioner specializing in this field. Urologists specialize in the urinary tract, and some urologists further specialize in the female urinary tract. Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urological problems in women. Family practitioners and internists see patients for all kinds of complaints and can refer patients on to the relevant specialists.
A careful history taking is essential especially in the pattern of voiding and bladder leakage as it suggests the type of incontinence faced. Other important points include straining and discomfort, use of drugs, recent surgery, and illness.
A test often performed is the measurement of bladder capacity and residual urine for evidence of poorly functioning bladder muscles. Other tests conducted to test for bladder leakage or urinary incontinence include stress tests, urinalysis, blood tests and ultrasound.
Early diagnosis is the key to successful treatment of urinary incontinence in males. It is recommended that men over 50 years old should have annual prostate screenings. Those with adverse family histories and African American men should have annual screenings after the age of 40.
Patients are often asked to keep a diary for a day or more, up to a week, to record the pattern of voiding, frequency of urination and the amounts of urine produced.
Incontinence Treatment
Exercises for Incontinence Treatment
Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce or cure bladder leakage. Men and Women of all ages can learn and practice these exercises as effective urinary incontinence treatment, which are taught by a health care professional.
Most Kegel exercises do not require equipment. However, one technique involves the use of weighted cones. For this exercise, the patient stands and holds a cone-shaped object within her vagina. As the patient becomes accustomed to the weight, cones of increasing weight are substituted to strengthen the muscles that help keep the urethra closed. For more information visit
LadySystem.co.uk.
Electrical stimulation
Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate nearby muscles. This will stabilize overactive muscles and stimulate contraction of urethral muscles. Electrical stimulation can be used to reduce both stress and urge urinary incontinence. Visit www.ifess.org or www.biof.com for more information.
Biofeedback
Biofeedback uses measuring devices to help you become aware of your body's functioning. By using electronic devices or diaries to track when your bladder and urethral muscles contract, you can gain control over these muscles. Biofeedback can be used with pelvic muscle exercises and electrical stimulation as an effective urinary incontinence treatment.
Timed voiding or bladder training
Timed voiding (urinating) and bladder training are techniques that use biofeedback. In timed voiding, you fill in a chart of voiding and leaking. From the patterns that appear in your chart, you can plan to empty your bladder before you would otherwise leak. Biofeedback and muscle conditioning--known as bladder training--can alter the bladder's schedule for storing and emptying urine. These techniques are effective for urge and overflow urinary incontinence.
Incontinence Medications
Incontinence Medications can reduce many types of leakage. Some drugs inhibit contractions of an overactive bladder. Others relax muscles, leading to more complete bladder emptying during urination. Some drugs tighten muscles at the bladder neck and urethra, preventing leakage. And some, especially hormones such as estrogen, are believed to cause muscles involved in urination to function normally.
Some incontinence medications can produce harmful side effects if used for long periods. In particular, estrogen therapy has been associated with an increased risk for cancers of the breast and endometrium (lining of the uterus). Talk to your doctor about the risks and benefits of long-term use of medications.
Collagen Implants
Urinary incontinence products such as implants, are substances injected into tissues around the urethra. The implant adds bulk and helps to close the urethra to reduce stress incontinence. Collagen from cows and fat from the patient's body have been used. Implants can be injected by a doctor in about half an hour using local anesthesia.
Implants have a partial success rate. Injections must be repeated after a time because the body slowly eliminates the substances. Before you receive collagen, a doctor must perform a skin test to determine whether you would have an allergic reaction to the material.
Bladder Surgery
Doctors usually suggest bladder surgery to alleviate urinary incontinence only after other treatments have been tried. Many surgical options have high rates of success. Discuss the pros and cons of any bladder surgery with your surgeon.
Catheterization
If you are incontinent because your bladder never empties completely (overflow urinary incontinence) or your bladder cannot empty because of poor muscle tone; past surgery, or spinal cord injury, you might use a catheter to empty your bladder. A catheter is a tube that you can learn to insert through the urethra into the bladder to drain urine. This urinary incontinence product may be used once in a while or on a constant basis, in which case the tube connects to a bag that you can attach to your leg. If you use a long-term (or indwelling) catheter, you should watch for possible urinary tract infections.
Incontinence Pants and Absorbent Pads
Many women manage urinary incontinence with products such as pads pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol.
Finally, many individuals who could be treated resort instead to wearing absorbent urinary incontinence products like pants especially those confined to nursing facilities. Although incontinence pants or adult diapers can be effective in maintaining an active lifestyle, the downside of using urinary incontinence products can be self-esteem issues and skin irritation. If you are an older adult, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation rather than the continual use of incontinence pants.
Hospitals often use some type of urinary incontinence product called bed pads. A bed pad is a thin but highly absobant sheet placed beneath the patient, to deal with incontinence or other unexpected discharges of bodily fluid. Disposable bed pads are especially useful when it is not practical for the patient to wear a diaper.
The Incontinence Store has a number of links to websites of other organizations offering helpful advice on urinary incontinence. If you know of any helpful links or resources in helping to manage adult urinary incontinence, don’t hesitate to send us an email; and we’re always interested in sharing your success stories.
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