Urinary Incontinence

Urinary tract infection Diabetes type 1 and 2Bladder irritation (stone, tumor)Drugs (eg, hypnotics, diuretics)CaffeineAlcohol Nerve damage due to: Spinal cord injuryStrokeMultiple sclerosisParkinson's diseaseConstipation Overflow Incontinence This occurs when the bladder will not empty. Urine builds up, and this causes an overflow and leaking of urine. It may be caused by: A bladder that is blocked, such as by a scar in the urethra (stricture)Fecal impactionDrugs (eg, antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)Vitamin B12 deficiencyProstate enlargement in menWeak bladder muscles Nerve damage due to: SurgeryDiabetesSpinal cord injuriesOther factors Functional IncontinenceThis 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: Sex: femaleAge: older than 65having been pregnant multiple timesUrinary tract infectionObesityChronic lung diseaseUrethritis Previous hysterectomy or urethral surgery Pelvic organ prolapseDepression Dementia including Alzheimers diseaseMenopauseDiabetesEnlarged prostate Prostate surgery ( prostatectomy ) DementiaStrokeMultiple sclerosisSpinal cord injury or disease Use of certain substances/medications: CaffeineAlcoholBeta-blockersAlpha-agonistsCholinergic agentsCyclophosphamide SymptomsUrinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

DiagnosisThe 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 testYou relax, then cough as your doctor watches for loss of urine, confirming diagnosis of stress incontinence.Urine testsBlood tests to detect diabetesUltrasound This test uses sound waves to examine structures inside the body to determine the residual urine volume after voiding. CystoscopyA thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder.Urodynamic testsThese tests are used to measure the flow of urine and pressure in the bladder. TreatmentTreatments 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. MedicationMedications may be prescribed to either strengthen muscles that control the flow of urine or to relax the bladder.

SurgeryIn 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. DevicesAbsorbent 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 Foundationhttp://www.kidney.org UrologyHealth.orghttp://www.urologyhealth.org CANADIAN RESOURCES: Health Canadahttp://www.hc-sc.gc.ca/index_e.html Women's Health Mattershttp://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/ .

Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007. Wein AJ, Rackley RR: Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol . 2006;175:S5-10. Last reviewed January 2008 by Adrienne Carmack, MDPlease 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.