Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is a loss of bladder control. It means that urine leaks from the bladder.

Urinary incontinence gets more common as people get older. It is a problem for as many as 1 in 3 Americans age 60 or older.

How does it occur?

There are different types of incontinence:

• Stress incontinence is a leaking of urine that happens when you lift things, exercise, cough, sneeze, or laugh. It is caused by pelvic muscles that are too relaxed. It is a common problem for women. The pelvic muscles may have been stretched or torn during child-bearing or by 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 doesn’t put as much pressure on the bladder. Later in pregnancy, when the baby drops, leaking urine may be a problem again.
• Urge incontinence happens when you feel the urge to urinate and you cannot hold your urine until you get to the bathroom. It often happens with Parkinson's disease, stroke, or multiple sclerosis. But healthy people can have it, too. When a cause cannot be found for it, the problem may be called an irritable or overactive bladder.
• Overflow incontinence is common in older people, especially men who have an enlarged prostate gland. The enlarged prostate squeezes the urethra, which is the tube that drains urine drains from the bladder. The bladder never empties completely and is often full. This causes small amounts of urine to leak.
• 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 may include:

• leakage of urine when you exercise, laugh, cough, sneeze, or lift something
• urine often leaking in dribbles
• trouble holding urine long enough to get to the toilet
• urine dribbling after your urinate
• a 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. A urologist specializes in problems with the urinary tract in both men and women and in the reproductive tract of men. A gynecologist specializes in women's health and especially in problems with the reproductive tract.

How is it treated?

Treatment depends on what is causing the problem. Treatment may include:

• Kegel exercises to strengthen weak pelvic muscles. Your provider can teach you how to do these exercises.
• Surgery to tighten pelvic muscles.
• Medicine that tightens the urethral muscle, makes the bladder empty, relaxes an overactive bladder, or treats infection.
• Bladder training, 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. It gives support to the pelvic muscles and helps prevent stress incontinence.
• Incontinence pads and undergarments.
• A collecting device fitted over a man’s penis to hold urine.
• A catheter inserted into the bladder to drain urine.
• Surgery. There are several surgical procedures for incontinence depending on the type:
  • For stress incontinence a vaginal sling procedure may be 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 blockage of the urethra.

How can I take care of myself?

• Talk with your healthcare provider if you start having trouble with leaking urine. Follow your provider’s advice for managing the problem.
• Bladder training can do a lot to ease the problem of incontinence. This means that you practice emptying your bladder on schedule rather than waiting until you feel an urge to go. For example, you might sit on the toilet 20 to 30 minutes after each meal, at least twice between meals, and before you go to bed. You can change the schedule as you learn the frequency that works best. You might want to set a timer to remind you when bathroom visits are due.
• Don’t drink a lot of soda, alcohol, or drinks with caffeine. They can irritate the bladder.
• Eat less of the following foods: tomatoes, fruit juices, dairy products, spicy foods, sugar, and artificial sweeteners. Eating a lot of these foods can irritate the bladder.
• Don't try to control urine leakage by cutting back on fluids. It won't help and may be harmful. Drink plenty of fluids throughout the day until about 3 hours before bedtime. To help keep your bladder from getting 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 keep your clothing from getting wet. Be sure to change the pads regularly.
• Keep your groin area clean and as dry as possible.
• Urinate before and after sex.
• 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. 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 leaking urine, call your healthcare provider.

How can I prevent urinary incontinence?

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

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 may not be able to prevent incontinence if it is a symptom of other problems. This is why it is important to talk about it with your healthcare provider.