Urinary incontinence

Description
Incontinence is the loss of bladder control or involuntary leakage of urine. Urinary incontinence is not a disease, but it may be a symptom of certain diseases. It can happen to people of any age, but is especially common among older people. Urinary incontinence is not an inevitable consequence of aging, but changes that occur with the natural aging process may contribute to the problem. In fact, at least one in 10 people over age 65 have some type of urinary incontinence. Women are affected more often than men.
Incontinence can range from mild leaking of urine to severe and uncontrollable wetting. Conditions such as incomplete voiding and retained urine in the bladder may increase the risk of bladder and urinary tract infections. The leakage may also cause skin rashes. Despite its rather mild symptoms, urinary incontinence is considered a major health problem because it can lead to disability and dependence. This is particularly true for older people.

Fortunately, most cases of urinary incontinence are curable, or at least treatable. If you are having bladder control problems, consult your doctor. Even if your incontinence cannot be completely cured, you can learn to manage it in a way that will enable you to continue an active life.


Types of urinary incontinence
Stress incontinence: This is the most common type of incontinence, particularly among women. It happens when a sneeze, cough, laugh or any other activity puts pressure on the bladder, causing urine to leak. Stress incontinence often occurs when the pelvic muscles have been stretched or damaged. Pregnancy is often a major contributing factor to this type of incontinence.

Urge incontinence: With this type of incontinence, the person feels an urgent, sudden need to urinate and, in many cases, is unable to reach a toilet in time.

Mixed incontinence: This is a combination of both stress and urge incontinence.

Overflow incontinence: With this type of incontinence, the person is unable to completely empty his or her bladder. As a result, the bladder is always a little bit full and urine dribbles out. Overflow incontinence is more common in men than in women.

Unconscious or reflex incontinence: People with this type of incontinence have no sensory awareness, or warning, that they are about to lose urine.

Functional incontinence: This happens in people who have normal bladder control but can't get to the toilet in time because of arthritis or another physical problem.


Causes
Potential causes of incontinence may include:
infection
constipation
weak or overactive bladder muscles
weak pelvic floor muscles
nerve damage
illnesses such as diabetes, stroke, Parkinson's disease, multiple sclerosis, Alzheimer's disease, or other conditions affecting the nervous system or muscles
certain medications, such as sedatives, antihistamines, diuretics and tranquilizers
for women, large fibroid or ovarian tumors or the decline in estrogen that occurs after menopause
for men, enlargement of the prostate gland

Symptoms and diagnosis
Symptoms of urinary incontinence include an urgent need to urinate and the inability to hold back urine, resulting in dribbling or leaking. If you're having bladder control problems, consult your doctor. He or she will give you a complete medical evaluation, which may include urine tests. Your doctor may then refer you to a urologist (a doctor who specializes in the treatment of conditions involving the urinary tract).

Treatment
The type of treatment your doctor recommends will depend on what's causing your bladder problems. Often, simple lifestyle changes -- such as eating more high-fiber foods to avoid constipation or reducing the amount of caffeine and alcohol you drink -- can eliminate the problem. Your doctor may also want to change the dosage of some of your medications or give you an antibiotic if you have an infection. If any current medications are causing the incontinence, your doctor may recommend an alternative. Do not make any medication changes without consulting your doctor, however.
For persistent cases of incontinence, your doctor may recommend behavioral treatments, such as bladder training. This involves urinating at scheduled intervals -- usually every 30 or 60 minutes. The intervals are then gradually increased to several hours. Biofeedback -- a technique that uses sophisticated equipment to teach you how to control various physiological functions -- may also help you regain control of your bladder. Pelvic muscle rehabilitation, also called pelvic muscle exercises, may be used alone or in conjunction with biofeedback.

For women, several devices may be used to treat incontinence. For example, a disposable urethral plug fits inside the urethra to stop leakage. Another device helps support the pelvic organs. Collagen implants are another option for some people, and are generally more successful in women. With this procedure, which can be done in the doctor's office, purified collagen from cows is injected around the urinary sphincter. The body forms scar tissue that adds support to the area. Various medications designed to help strengthen the muscles involved in urination are also commonly prescribed for incontinence.

If these treatments are unsuccessful, your doctor may recommend surgery. Surgery is particularly effective if the incontinence is caused by a structural problem, such as an abnormally positioned bladder or blockage due to an enlarged prostate. The type of surgery depends on the cause and type of incontinence.


At-home care
Keeping a written record of when you lose control of your bladder can be helpful. Make note of what you were doing at the time. Take this information with you when you visit your doctor. It will help you and your doctor develop an effective treatment plan.
You might want to wear special underwear or pads that absorb moisture. Change these often to keep your skin dry and to help prevent skin rashes. Do your best to eliminate alcohol, coffee, tea or other caffeinated drinks from your diet. They can irritate the bladder. If you smoke, quit. Nicotine can irritate the bladder.

For women who have stress incontinence, try crossing your legs when sneezing or coughing to decrease leakage. Your doctor may suggest wearing a tampon when exercising or during other activities to prevent or decrease incontinence. The tampon will press against the vagina wall and compress the urethra. These methods do not cure the causes of incontinence. They only help to relieve symptoms.


Prevention
To prevent incontinence, maintain a healthy weight. Excess pounds can put pressure on your bladder muscles. Avoid getting constipated, which can also put pressure on the bladder. Eat plenty of fruits, vegetables and whole grains.
For women, daily Kegel exercises can help strengthen the muscles that control urine flow. You can identify the muscles you need to exercise while you're urinating by slowly tightening the muscles of your pelvic floor until you stop the flow of urine. To perform your daily Kegels, contract these same muscles while sitting, standing or lying down. Hold for 10 seconds, then release. Repeat 10 to 15 times.


How will incontinence affect your life?
Urinary incontinence can disrupt your life. It may lead to embarrassing moments, which could eventually cause you to be afraid to leave home. If you withdraw from social activities, your relationships with your friends and family could suffer. You could become depressed, even despondent. Incontinence can also lead to painful skin rashes that might cause you to cut back on your activities. And it can interfere with your sex life. Fortunately, this can all be avoided. If you are experiencing a loss of bladder control, don't try to ignore or hide the problem. Consult your doctor right away. Chances are good that your incontinence is treatable. You may soon be back to your normal routine, doing the things you like.