Urinary Incontinence

Definition

Urinary incontinence is the loss of voluntary bladder control that can cause leakage of urine. It can be temporary or last for a long time.

There are four types of long-term or permanent incontinence:

• Stress incontinence—Most common type. Leakage occurs when there is extra pressure on the bladder. Triggers may include laughing, sneezing, lifting heavy objects, or exercise.

• Urge incontinence—Known as overactive bladder, a loss of bladder control following a strong urge to urinate. The bladder is unable to hold urine long enough to make it to a restroom.

• Overflow incontinence—The bladder will not empty, so urine builds up and the bladder overflows.

• Functional incontinence—There is normal bladder control, but the toilet cannot be reached in time.

People may have just one or a combination of these types.

Causes

Incontinence has several different causes. The cause could also be unclear.

Temporary incontinence can be caused by:

• Medication

• Constipation

• Infection

• Muscle weakness

• Restricted mobility

• Obesity

• Endocrinological disorders such as diabetes

• Muscles Involved in Incontinence in Women

Stress incontinence may be caused by:

• Weakening of muscles that suspend the bladder

• Weakening of muscles that control urine flow

• Obesity

Urge incontinence is the accidental loss of urine when the bladder spasms for no reason. It may be caused or worsened by:

• Urinary tract infection

• Diabetes type 1 and type 2

• Bladder irritation such as a stone or a tumor

• Drugs such as hypnotics or diuretics

• Caffeine

• Alcohol

• Constipation

• Excessive fluid intake

Nerve damage due to:

• Spinal cord injury

• Stroke

• Multiple sclerosis

• Parkinson disease

Overflow incontinence is caused by overfill and overflow of the bladder. It may be caused or worsened by:

• A bladder that is blocked, such as by a scar in the urethra

• Fecal impaction

• Drugs such as antidepressants, hypnotics, antipsychotics, antihistamines, or calcium channel blockers

• Vitamin B12 deficiency

• Weak bladder muscles

Nerve damage due to:

• Surgery

• Diabetes

• Spinal cord injuries

• Other factors

Functional incontinence may be caused by:

• Medical conditions that make it difficult to move like severe arthritis

• Drugs that cause confusion or sedation

Some incontinence may be caused by a fistula. A fistula is an abnormal opening between the bladder and another nearby structure. The fistula can make it difficult for the bladder to act as it should.

Risk Factors

Urinary incontinence is more common in women age 65 years or older.

Factors that may increase your chances of urinary incontinence:

• Childbirth—History of multiple pregnancies or vaginal deliveries

• Urinary tract infection

• Obesity

• Chronic lung disease

• Urethritis

• Previous hysterectomy or urethral surgery

• Pelvic organ prolapse

• Depression

• Dementia, including Alzheimer disease

• Menopause

• Diabetes

• Stroke

• Multiple sclerosis

• Spinal cord injury or disease

• Use of certain substances such as caffeine or alcohol

• Use of certain medications, such as cholinergic agents or alpha-agonists

Symptoms

Any loss of bladder control can be considered incontinence.

When Should I Call My Doctor?

Call your doctor if you have a loss of urine control. Your doctor can help you determine the underlying cause.

Diagnosis

You will be asked about your symptoms and medical history. You will be asked how often you empty your bladder and patterns of urine leakage. A physical exam will be done to look for any physical causes, such as blockages or nerve problems. You may be referred to a specialist.

Your bodily fluids will be tested. This can be done with:

• Blood tests

• Urine tests

The flow of your urine will be assessed. This can be done with:

• Stress test

• Urodynamic tests

Your bodily structures may need to be viewed. This can be done with:

• Ultrasound

• Cystoscopy

Treatments are based on the cause of the urinary incontinence.

Temporary incontinence may be relieved by managing the conditions associated with the incontinence. Weight loss may help reduce the number of episodes due to stress or urge incontinence in people who are overweight or obese. Talk to your doctor about a weight loss program that is right for you.

Stress Incontinence

Initial treatment relies on behavior changes and strengthening pelvic floor muscles. Behavior changes include:

• Decreasing caffeine—caffeine has been linked to worsening of urinary incontinence

• Planning frequent bathroom trips throughout the day to prevent accidents

Methods to increase strength in the pelvic floor muscles include:

• Kegel exercises —focuses on muscles that hold the bladder in place and those that control urine flow

• Painless electrical stimulation—may strengthen the muscles more quickly; helpful for stress incontinence

• Pelvic floor exercises using cone-shaped weights that are placed in the vagina

• Biofeedback—a device signals how strong you are at contracting your muscles during exercise

Surgical procedures may be done for incontinence that is not responding to these treatments. Surgical options include:

• Placement of strips of material or sutures to support structures in the area and relieve pressure on the urethra. There are several different types of surgery, but a common option, called a urethral suspension , uses mesh to help support the urethra.

• Collagen injection into the wall of the urethra. This substance bulks up the wall of the urethra to help stop leaks.

Urge Incontinence

Initial treatment depends on behavior changes and strengthening pelvic floor muscles. Behavior changes include:

• Drinking less fluid throughout the day

• Avoiding caffeine and alcohol

• Avoiding drinking at bedtime

• Keeping a log of your urination schedule and accidents.

Kegel exercises can help strengthen pelvic floor muscles and relieve some symptoms. Medications may be recommended. Anticholinergics are the most common medication. They can relax the muscles of the bladder. Other medications may be used in combination to help manage symptoms, such as botulinum toxin injections. Nerve stimulation may be used if urge incontinence does not respond to behavior modification or medication. A device will send pulses to the nerves that control the bladder. This has been shown to help stimulate bladder control. In some cases, the device is implanted in the back.

Overflow Incontinence

Treatment for overflow incontinence is to allow the bladder to completely empty. If a blockage is causing the problems, surgery may be needed to open the urine pathways. Other causes of overflow incontinence may require the use of a tube called a catheter to allow urine to drain from the bladder. People can use certain catheters at home.

Other Management Steps

Absorbent pads or diapers can be used to manage urinary leakage. Plugs and patches can also be used to help hold urine in place. A supportive device called a pessary may also be used. Pessaries are devices that raise the uterus or the prolapsed bladder. It can decrease pressure on the bladder.

Prevention

Incontinence is a symptom of many other conditions. There are several ways to prevent incontinence:

• If advised by your doctor, do exercises to strengthen your pelvic floor muscles, such as Kegel exercises. This is especially important if you are pregnant.

• Reduce your intake of substances that lead to incontinence such as caffeine, alcohol, and certain drugs.

• Lose weight, if needed.

• Eat a healthy diet to avoid constipation.

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