Urinary incontinence is the loss of voluntary bladder control leading to the leakage of urine. It can be temporary or chronic. Incontinence is a symptom, not a condition in and of itself.
More permanent urinary incontinence may be classified as one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. The cause may also be unclear.
This results when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise. This is the most common type of incontinence. It may be caused by:
Weakening of the muscles that suspend the bladder
Weakening of muscles that control the flow of urine
Urge Incontinence
Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is unable to hold urine long enough to make it to a toilet. This is also known as overactive bladder. It may be caused by:
This occurs when there is normal bladder control, but an inability to reach the toilet in time. An example would be severe arthritis. Drugs which cause confusion or sedation can also cause functional incontinence.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You will be asked how often you empty your bladder and patterns of urine leakage. A physical exam will look for any physical causes, such as blockages or nerve problems. You will be asked to keep a diary of your bladder habits. You may also be referred to a urologist or a urogynecologist.
Tests may include:
Stress test—You relax, then cough as your doctor watches for loss of urine, confirming diagnosis of stress incontinence.
Urine tests
Blood tests to detect diabetes
Ultrasound
—This test uses sound waves to examine structures inside the body to determine the residual urine volume after voiding.
Cystoscopy—A thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder.
Urodynamic tests—These tests are used to measure the flow of urine and pressure in the bladder.
Treatment
Treatments may include:
Behavioral Therapy
Behavioral therapy includes:
Making muscles stronger by doing Kegel exercises. This strengthens the muscles that hold the bladder in place and those that control urine flow. Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence.
Bladder training can be done by setting a regular timed schedule for emptying your bladder and by drinking fewer liquids.
Medication
Medications may be prescribed to either strengthen muscles that control the flow of urine or to relax the bladder.
Surgery
In men, surgery may be performed to relieve a physical blockage due to an enlarged prostate. In women, surgery can help repair weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra, or surgical repair/implants into the bladder sphincter.
Devices
Absorbent diapers are often used by men and women with incontinence.
Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases. Alternatively, pessaries (devices that raise the uterus and decrease pressure on the bladder) may be used in women.
External (condom) or internal (Foley) catheters may be used for men. Penile clamps are sometimes used as well.
Prevention
Incontinence is really a symptom of another condition. There are several ways to help prevent incontinence including the following:
Exercise.—Women can decrease their chances of developing incontinence by doing Kegel exercises. This is especially helpful in women who have given birth, because childbirth weakens muscles around the bladder.
Reduce oral intake of substances which lead to incontinence (such as caffeine, alcohol, and certain drugs).
Lose weight.
Avoid and treat constipation.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) http://www.niddk.nih.gov
National Kidney Foundation http://www.kidney.org
UrologyHealth.org http://www.urologyhealth.org
CANADIAN RESOURCES:
Health Canada http://www.hc-sc.gc.ca/index_e.html
Women's Health Matters http://www.womenshealthmatters.ca/index.cfm
References:
American Foundation for Urologic Disease website. Available at:
http://www.afud.org
.
Corcos J, Gajewski J, Heritz D, et al. Canadian urological Association guidelines on urinary incontinence.
Can J Urol
. 2006;13:3127-3138.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://www2.niddk.nih.gov/
.
Norton P, Brubaker L. Urinary incontinence in women.
Lancet
. 2006;367:57-67.
Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study.
Int Urogynecol J Pelvic Floor Dys Function.
2007 Aug 18.
United States Food and Drug Administration website. Available at:
http://www.fda.gov/
.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
