Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is a loss of bladder control.

Urinary incontinence becomes more common as people get older. It is a problem for as many as 1 in 3 Americans age 60 or older. The condition is at least twice as common among women as men.

How does it occur?

There are several different types of incontinence: stress, urge, overflow, and functional.

• A common kind of urinary incontinence in women is stress incontinence. It causes urine to leak during lifting, exercise, coughing, sneezing, or laughing. Stress incontinence is caused by relaxed pelvic muscles that may have been stretched or torn during child-bearing or by previous pelvic surgery.

  Also, during the first 3 months of pregnancy, the growing uterus presses on the bladder and may cause leakage of urine. This is often less of a problem after the fourth month of pregnancy because the uterus rises out of the pelvis and no longer puts as much pressure on the bladder. Later in pregnancy, when the baby drops, urinary incontinence may happen again.

• Urge incontinence is an inability to hold your urine when you feel the urge to urinate. It becomes hard to get to the bathroom in time. It often occurs with Parkinson's disease, stroke, or multiple sclerosis, but it can occur in healthy people, too.
• Overflow incontinence is common in older people, especially men who have an enlarged prostate gland that squeezes the urethra. (The urethra is the tube through which urine drains from the bladder.) The bladder never completely empties and is often full, and small amounts of urine leak from it.
• Functional incontinence happens when you are unable to get to the bathroom in time to urinate because of problems such as Alzheimer's disease or severe arthritis.

Incontinence may be caused or made worse by problems such as:

• constipation
• infection
• a stone in the bladder
• use of diuretics ("water pills")
• thinning of tissue due to decreased estrogen after a woman goes through menopause, which may weaken urethral muscle.

What are the symptoms?

Symptoms of incontinence depend on the type and include:

• leakage of urine when you exercise, laugh, cough, sneeze, or lift something
• urine often leaks in dribbles
• inability to hold urine long enough to get to the toilet
• urine keeps dribbling after your urinate
• the smell of urine on your clothes and in the house.

How is it diagnosed?

Your healthcare provider will ask about your medical history and examine you. Blood and urine samples will be checked for infection or other problems.

You may be referred to a urologist or gynecologist for further investigation and treatment. (A urologist is a doctor who specializes in disorders of the urinary tract in both men and women and in the reproductive tract of men. A gynecologist specializes in women's healthcare and especially in disorders of the reproductive tract.)

How is it treated?

Treatment depends on the type of incontinence and the cause of the problem. Treatment for urinary incontinence can include:

• Kegel exercises to strengthen weak pelvic muscles. The muscles can also be tightened by surgery.
• Medicine that tightens the urethral muscle, stimulates the bladder to empty, relaxes an irritable bladder, or treats infection.
• Bladder training (also called timed voiding), which teaches you to empty the bladder on schedule rather than waiting until you feel the urge. If you have urge incontinence, bladder training can make a big difference. Use the toilet 20 to 30 minutes after each meal, at least twice between meals, and before you go to bed. You can set a timer to remind you. Adjust the schedule as you learn how often you need to use the toilet to best meet your needs.
• A pessary, which is similar to the outer ring of a vaginal diaphragm. It is inserted up around a woman's cervix, where it gives support to the pelvic muscles and helps prevent stress incontinence. Your healthcare provider may advise a pessary to support lax pelvic muscles if this is causing incontinence.
• Incontinence pads and undergarments.
• A collecting device fitted over a man's penis to hold urine.
• A catheter inserted into the bladder so that it can be mechanically drained on schedule. This is usually done only as a last resort.
• Surgery. There are several surgical procedures for incontinence depending on the type:
  • For stress incontinence a vaginal sling procedure is commonly used to support the bladder and the pelvic muscles.
  • For overflow incontinence prostate surgery known as TURP, or transurethral resection of the prostate, is used to relieve urethral obstruction.

Many people may benefit from Kegel exercises to strengthen pelvic floor muscles. You can feel the muscles to use by squeezing the muscles in your genital area, for example, when you stop the flow of urine or try to stop from passing gas.

• Squeeze your pelvic floor muscles and hold the contraction for 4 seconds. Repeat this 10 to 20 times. Let the muscles relax completely between contractions.
• Do these sets of 10 to 20 contractions 3 to 4 times a day. You won't get as much help from the exercises if you do them less often than this.
• Do not do these exercises while you are urinating or having a bowel movement.

You can do Kegel exercises anywhere: while sitting at a desk, waiting for a bus, washing dishes, driving a car, waiting in line, or watching television. No one will know you are doing them.

You may see a change for the better after doing the Kegels for just a few weeks. However, you may not notice a lot of improvement until after 3 to 6 months of daily exercises. You should keep doing Kegels every day to keep the pelvic muscles strong.

How can I take care of myself?

• Talk with your healthcare provider if you begin to have problems with bladder control. Follow your provider's advice for correcting or managing the problem.
• Do not drink a lot of carbonated, caffeinated, or alcoholic drinks. They can irritate the bladder.
• Decrease the amounts of tomatoes, fruit juices, dairy products, spicy foods, sugar, and artificial sweeteners in your diet. These foods in larger quantities can irritate the bladder.
• Don't try to control urinary incontinence by cutting back on fluids. It won't help and may even be harmful. Drink fluids throughout the day, but limit fluids 3 hours before your usual bedtime. To help keep your bladder from becoming too full, be sure to empty your bladder every 2 to 4 hours during the day and before you go to bed.
• If you have stress incontinence, do Kegel exercises regularly.
• Wear incontinence pads if you need to prevent wetting your clothing. Be sure to change the pads regularly.
• Keep your groin area clean and as dry as possible.
• Urinate before and after intercourse to empty the bladder.
• Find ways to stay within easy reach of a bathroom. Have a night-light and grab bars in your bathroom to help prevent falls when you are in a hurry. Don't try to hold your urine, and be willing to ask where the toilet is when you are away from home.
• If you have burning, lower abdominal pain, back pain, or fever as well as incontinence, call your healthcare provider.

How can I prevent urinary incontinence?

You may not be able to prevent incontinence because it is a symptom of several other problems, rather than a condition with a single cause. This is why it is important to discuss incontinence with your healthcare provider.

Incontinence caused by an enlarged prostate can sometimes be prevented with medicine that you start taking when you have early symptoms of prostate enlargement, such as frequent urination.

You can help keep your pelvic floor muscles strong by doing Kegel exercises every day.