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Urinary incontinence, or UI, is the accidental leakage of urine. It occurs because of problems with muscles and nerves that help in holding or releasing urine. While urinary incontinence can happen to anyone, it is more common in older people. Women are more likely than men to have incontinence. This is because of the structural differences in the pelvic region and the changes induced by pregnancy and childbirth.

Urinary incontinence can often be cured or managed. Talk with your health care provider about the particular problem you have and about treatments available for urinary incontinence.

Bladder Control

Urine is stored in the bladder—a balloon-like organ. During urination, muscles in the wall of the bladder tighten or contract to move urine out of the bladder and into the urethra. At the same time, muscles around the urethra called sphincter muscles relax and let urine pass out of the body. Urinary incontinence occurs if these muscles relax or tighten without warning.

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Types of Urinary Incontinence

There are several types of urinary incontinence, which include:

Stress incontinence. This type of urinary incontinence occurs when urine leaks as pressure is put on the bladder during actions such as coughing, sneezing, lifting, or during exercise. Also, physical changes that results from pregnancy, childbirth, and menopause often cause the condition. Stress incontinence is the most common type of bladder control problem in younger and middle-age women.

Urge incontinence. It occurs when people have sudden need to urinate and aren’t able to hold their urine long enough to get to the toilet in time. This type of incontinence is commonly caused by inappropriate contractions of the bladder muscles.

Some health problems may lead to or worsen incontinence. Such conditions include uncontrolled diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and stroke.

Overactive bladder occurs when abnormal nerves send signal to the bladder at the wrong time, which causes the bladder muscles to contract without warning.

Overflow incontinence. This type of incontinence occurs when small amounts of urine leak from a bladder that is always full. Weak bladder muscles or blocked urethra can cause this type.

Functional incontinence. This type occurs in many older people who have normal bladder. They just have a problem getting to the toilet because of arthritis or other disorders or problems that make it hard to move quickly.

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Causes

Incontinence is often seen as part of aging. But it can occur for many other reasons. For example, urinary tract infections, vaginal infection or irritation, constipation, and some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

 weak bladder muscles

 overactive bladder muscles

 damage to nerves that control the bladder from diseases such as uncontrolled diabetes, multiple sclerosis or Parkinson’s disease

 diseases such as arthritis that may make it difficult to get to the bathroom in time

 blockage from an enlarged prostate in men

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Diagnosis

The first step in solving a urinary problem is talking with your heath care provider. Your doctor will take your medical history and perform a thorough physical examination. He or she will ask about your symptoms and the medicines you use. Also, your doctor will want to know if you have been sick recently or have had surgery.

Your doctor may also recommend a series of tests to find the cause of incontinence. These may include:

 urine and blood tests

 tests that measure how well you empty your bladder

 imaging tests, such as ultrasound and cystoscopy

In addition, you may be asked to keep a voiding diary, which is a record of fluid intake, the number of times you urinate, and the amounts of urine you produce. This voiding diary will provide your doctor a better idea of your problem and help direct additional tests.

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Treatment

There are more treatments for urinary incontinence today than ever before. However, no single treatment works for everyone. The choice of treatment depends on

 the type of bladder control problem you have
 the severity of your problem, and
 what best fits your lifestyle.

As a general rule, the simplest and safest treatments should be tried first

Bladder Control Training

Your health care provider may recommend bladder training to help you get better control of your bladder. With bladder training, also called timed voiding, you can change how your body stores and releases urine. In timed voiding, you urinate on a set schedule or planned regular trips to the bathroom. Other ways to do bladder control training include:

 Kegel exercises, also known as pelvic muscle exercises, which strengthen the pelvic muscles that help hold urine in the bladder.

 Biofeedback uses sensors that can make you aware of signals from your body. This can be helpful when learning pelvic muscle exercises. Biofeedback may be helpful in regaining control over the muscles in your bladder and urethra.

 Lifestyle changes that may help with incontinence include quitting smoking, avoiding alcohol, drinking less caffeine, losing weight, preventing constipation, and avoiding lifting heavy objects.

Other Management

Besides bladder control training, you may want to talk to your doctor about other ways to help manage incontinence:

 Some drugs can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage. Talk with your doctor about the benefits and side effects of using these medicines.

 A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This reduces stress incontinence in women. This treatment may have to be repeated.

 Special devices for both men and women could help control incontinence.

 Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.

 You can buy special absorbent underclothing that can be worn under everyday clothing.

If you suffer from urinary incontinence, tell your doctor. Remember, under a doctor’s care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help you feel more relaxed and confident. (National Institute on Aging)

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References:
National Kidney and Urologic Diseases Information Clearinghouse (June 2007). Urinary Incontinence in Men (NIH Publication No. 07—5280). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/index.htm. Accessed: November 14, 2008

National Kidney and Urologic Diseases Information Clearinghouse (October 2007). Urinary Incontinence in Women (NIH Publication No. 08—4132). National Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD. Web URL: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.htm. Accessed: November 14, 2008

National Institute on Aging (June 2008). Age Page: Urinary Incontinence. National Institutes of Health (NIH), Bethesda, MD. Web URL: http://www.nia.nih.gov/HealthInformation/Publications/urinary.htm. Accessed: November 14, 2008

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