Urinary Incontinence

Bladder infection (cystitis) is a common cause of urinary incontinence. Other causes include weakened pelvic muscles as a result of childbirth; abnormal function of the bladder and/or urinary sphincter muscle; gynecological surgery, such as hysterectomy; obesity; overconsumption of alcohol or caffeinated beverages; enlarged prostate or prostate surgery; damage to the nervous system from disease, injury, or a brain tumor; and prolapsed (dropped) bladder, which can occur after menopause. Urinary incontinence can also be the side effect of certain drugs, the result of disease or injury that either impairs the individual’s ability to recognize that he or she must urinate or makes it difficult to get to the bathroom in time, constipation, an unusually small bladder, or an obstruction in the urinary system. The bladder can also become irritated by concentrated urine, which occurs when a person does not take in enough fluids. Urinary incontinence can be acute, which means it occurs suddenly. In this case, the cause and condition are usually temporary. Chronic urinary incontinence develops over time and the cause is not reversible.

What are the symptoms?

Urinary incontinence is categorized by symptoms. These symptoms can range from leakage or “dribbling” of urine, to complete loss of bladder control. Urge incontinence is the sudden, uncontrollable need to urinate. A person cannot hold the urine in until he or she can reach the bathroom. Overflow incontinence occurs when urine builds up in the bladder because of some obstruction or dysfunction of the bladder. Urine leaks without warning because the bladder never empties completely. Stress incontinence occurs when any type of pressure on the abdomen, such as laughing, sneezing, coughing, etc., causes urine to leak. Reflex incontinence is the sudden loss of bladder control because of some type of neurological disorder. Functional incontinence occurs when some type of physical disability, such as multiple sclerosis or arthritis, makes it difficult to get to the bathroom at a reasonable pace. There is no problem with the urinary system.

How is it diagnosed?

To diagnose urinary incontinence, your doctor will take a complete medical history and perform a thorough physical examination, including a pelvic exam (for women) or a prostate exam (for men). You may want to see a urologist, who specializes in the urinary tract. Your doctor will want to know how often and under what conditions you experience incontinence. To determine the cause of your incontinence, he or she will perform some diagnostic tests, which could include urinalysis, ultrasound, x-rays, and urine flowmetry. He or she may also order a special test called a urodynamic evaluation, which measures your bladder capacity, pressure, and rate of urinary flow by placing a catheter in the bladder and filling the bladder with water.

What is the treatment?

In many cases, urinary incontinence can be reversed by addressing the cause, such as treating a urinary infection, discontinuing drugs that can cause incontinence as a side effect, and limiting consumption of alcoholic and caffeinated beverages. Drinking enough fluids each day, which means six to eight 8-ounce glasses of water, will prevent urine from becoming too concentrated. Emptying the bladder frequently, rather than waiting for the urge to urinate, can help urge incontinence.

Other types of treatment include bladder training, biofeedback, a skin patch containing oxybutynin, and drugs to relax the bladder. When overflow incontinence is caused by a blockage, surgery to remove the blockage is usually necessary. However, men with enlarged prostates may respond to drugs to reduce prostate size, which can make surgery unnecessary. Surgery to enlarge the bladder may be necessary if an extremely small bladder causes overflow.

Stress incontinence in women can be relieved with estrogen cream or tablets, drugs that tighten the sphincter, and Kegel exercises, which strengthen the pelvic floor muscles. The muscles in the perineal area can be strengthened by electrically stimulating the muscles to contract. Collagen injections around the urethra may also be useful. Surgical techniques include placing an inflatable insert into the urethra, raising the bladder neck and urethra, and urinary sphincter implant.

Reflex and functional incontinence may require the insertion of a catheter, which drains urine from the bladder through a tube attached to some type of container. A catheter can be permanent or used at regular intervals. Pads and undergarments are available to give the wearer security and comfort during times of urinary incontinence. They protect your skin and clothing from urine leakage, reduce odor, and are designed to be unnoticeable.

Self-care tips

Many men and women do not seek treatment for urinary incontinence because they are embarrassed. If you are experiencing urinary incontinence, see your doctor. Treating the source of the problem could reverse your condition. Talk with your doctor about the types of drugs that can cause urinary incontinence so you can avoid them, if necessary.