What is Urinary Incontinence?
Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine. Urinary incontinence affects approximately 13 million people in the United States and is more common in women than in men. It occurs in 10 percent to 25 percent of women younger than age 65 and in 15 percent to 30 percent of women older than age 60 who do not live in nursing homes. Among nursing home residents, incontinence is even more common, affecting more than 50 percent of female patients.
The two main types of urinary incontinence are:
* Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise.
* Urge incontinence -- involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate.
* Overflow incontinence -- happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of incontinence.
* Functional incontinence -- happens in many older people who have normal bladder control. They just have a hard time getting to the toilet in time because of arthritis or other disorders that make moving quickly difficult.
The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent and heavy, or it can be small and rather rare. For an active woman or for a woman who loses a large amount of urine each time, even one episode per week may be too much.
Some other common symptoms of urinary incontinence include:
* A strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
* Urinating more than once in a two-hour period or more than seven times a day
* The need to get up and urinate at least twice during sleep
* Painful urination
* Bed wetting or urinating while sleeping
What Causes Urinary Incontinence?
Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:
* Urinary tract infection or inflammation
* Prostate infection or inflammation
* Stool impaction from severe constipation, causing pressure on the bladder
* Side effects of medications (such as diuretics, tranquilizers, some cough and cold remedies, certain antihistamines for allergies, and antidepressants)
* Increased urine amounts, like with poorly controlled diabetes
* Weight gain
* Short-term bed rest -- for example, when recovering from surgery
* Mental confusion
Causes that may be more long-term:
* Spinal injuries
* Urinary tract anatomical abnormalities
* Neurological conditions like multiple sclerosis or stroke
* Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women
* Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
* Large prostate in men
* Depression or Alzheimer's disease
* Nerve or muscle damage after pelvic radiation
* Bladder cancer
* Bladder spasms
Medications for Urinary Incontinence
Many times, urinary incontinence can be corrected with the help of medication. Drugs commonly used to treat incontinence include:
Anticholinergic (antispasmodic) drugs - These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence.
Imipramine (Tofranil). This antidepressant may be used to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.
Hormone Replacement Therapy - After menopause, a woman's body produces less of the hormone estrogen. This drop in estrogen can contribute to changes in the skin lining the urethra and vagina, which can contribute to the development of incontinence in some women. Applying estrogen in the form of a vaginal cream, ring or patch may help relieve some of the symptoms of incontinence in these women.
Antibiotics - If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.
See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic floor:
* Bladder retraining -- this involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1 hour intervals. Gradually, you can increase by 1/2 hour intervals until you are only urinating every 3-4 hours without leakage.
* Kegel exercises -- contract the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises 3 times per day. You can do Kegel exercises any time, any place.
To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. DO NOT contract your abdominal, thigh, or buttocks muscles. And DO NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.
Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 to 4 days.
Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.
Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.
For leakage, wear absorbent pads or undergarments. There are many well-designed products that go completely unnoticed by anyone but you.
Other measures include:
* Regulate your bowels to avoid constipation. Try increasing fiber in your diet.
* Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk of bladder cancer.
* Avoid alcohol and caffeinated beverages, particularly coffee, which can overstimulate your bladder.
* Lose weight if you need to.
* Avoid foods and drinks that may irritate your bladder like spicy foods, carbonated beverages, and citrus fruits and juices.
* Keep blood sugars under good control if you have diabetes.
If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.
American Urological Association
1120 North Charles St.
Baltimore, MD 21201
Phone: (410) 727-1100
Fax: (410) 223-4370
American Foundation for Urologic Disease
1128 North Charles St.
Baltimore, MD 21201
Phone: (410) 468-1800
Toll-Free: (800) 242-2383
Fax: (410) 468-1808
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