Urinary incontinence is the involuntary leakage of urine; in simple terms, it means a person urinates when they do not want to. Control over the urinary sphincter is either lost or weakened.
Urinary incontinence is a much more common problem than most people realize.
According to the American Urological Association, one-quarter to one-third of men and women in the United States experience urinary incontinence.
Urinary incontinence is more common among women than men. An estimated 30 percent of females aged 30-60 are thought to suffer from it, compared to 1.5-5 percent of men.
Here are some key points about urinary incontinence. More detail and supporting information is in the main article.
- Urinary incontinence is much more common in females than men
- There are a number of reasons why urinary incontinence can occur
- Obesity and smoking are both risk factors for urinary incontinence
Symptoms of urinary incontinence
The main symptom is the unintentional release (leakage) of urine. When and how this occurs will depend on the type of urinary incontinence.
Millions of Americans suffer from urinary incontinence.
This is the most common kind of urinary incontinence, especially among women who have given birth or gone through the menopause.
In this case "stress" refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure, the person may urinate involuntarily.
The following actions may trigger stress incontinence:
- A sudden cough
- Heavy lifting
Urge incontinence (effort incontinence)
Also known as reflex incontinence or "overactive bladder," this is the second most common type of urinary incontinence. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be stopped.
When the urge to urinate comes, the person has a very short time before the urine is released, regardless of what they try to do. The urge to urinate may be caused by:
- A sudden change in position
- The sound of running water (for some people)
- Sex (especially during orgasm)
Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.
This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. An enlarged prostate gland can obstruct the bladder.
The bladder cannot hold as much urine as the body is making and/or the bladder cannot empty completely, causing small amounts of urinary leakage. Often, patients will need to urinate frequently, and they may experience "dribbling" or a constant dripping of urine from the urethra.
This is where a patient experiences both stress and urge incontinence at the same time.
With functional incontinence, the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem.
Common causes of functional incontinence include:
- Poor eyesight
- Poor mobility
- Poor dexterity (cannot unbutton pants in time)
- Depression, anxiety, or anger (unwilling to go to the toilet)
Functional incontinence is more prevalent among elderly people and is common in nursing homes.
Gross total incontinence
This either means that the person leaks urine continuously, or has periodic uncontrollable leaking of large amounts of urine.
The patient may have a congenital problem (born with a defect), there may be an injury to the spinal cord or urinary system, or there may be a hole (fistula) between the bladder and, for example, the vagina.
Risk factors for urinary incontinence
The following are risk factors linked to urinary incontinence:
- Obesity - obese people have increased pressure on their bladder and surrounding muscles, which weakens the muscles and makes it more likely that a leak occurs when the person sneezes or coughs
- Smoking - regular smokers are more likely to develop a chronic cough, which may result in episodes of incontinence
- Gender - women have a significantly higher chance of experiencing stress incontinence than men, especially if they have had children
- Old age - the muscles in the bladder and urethra weaken during old age
- Some diseases and conditions - people with diabetes, kidney disease, spinal cord injury, or neurologic diseases (in particular, residual deficits after a stroke)
- Prostate disease - patients with a history of prostate surgery or radiation therapy
Causes of urinary incontinence
We will divide the causes up between the four types of incontinence:
Causes of stress incontinence
- Childbirth (labor)
- Menopause - when estrogen levels drop the muscles may get weaker
- A hysterectomy - surgical removal of the uterus (womb)
- Some other surgical procedures
Causes of urge incontinence
The following causes of urge incontinence have been identified:
- Cystitis - inflammation of the lining of the bladder
- CNS (central nervous system) problems - examples are multiple sclerosis, stroke, and Parkinson's disease
- An enlarged prostate - the bladder may drop, and the urethra could become irritated
Causes of overflow incontinence
This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:
- An enlarged prostate gland
- A tumor pressing against the bladder
- Urinary stones
- Urinary incontinence surgery which went too far
Causes of total incontinence
The following can cause total incontinence:
- An anatomical defect the person has had from birth
- A spinal cord injury which messes up the nerve signals between the brain and the bladder
- A fistula - a tube (channel) develops between the bladder and a nearby area, most typically the vagina
Other causes of urinary incontinence:
- Some medications - especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants
- Urinary tract infection
Diagnosis of urinary incontinence
Ways to diagnose urinary incontinence include:
- A bladder diary - the doctor may ask the patient to record how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.
- Physical exam - the doctor may examine the vagina and check the strength of her pelvic floor muscles. If the patient is male, the doctor may examine his rectum to determine whether the prostate gland is enlarged.
- Urinalysis - tests for signs of infection and abnormalities.
- Blood test - to assess kidney function.
- PVR (postvoid residual) measurement - measures how much urine is left in the bladder after urinating.
- Pelvic ultrasound.
- Stress test - the patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.
- Urodynamic testing - determines how much pressure the bladder and urinary sphincter muscle can withstand.
- Cystogram - X-ray procedure to visualize the bladder.
- Cystoscopy - a cystoscope (a thin tube with a lens at the end) is inserted into the urethra. The doctor can view abnormalities in the urinary tract.
Treatments for urinary incontinence
Treatment for urinary incontinence will depend on several factors, such as the type of incontinence, the patient's age, general health, and their mental state.
Pelvic floor exercises, also known as Kegel exercises, help strengthen the urinary sphincter and pelvic floor muscles - the muscles that help control urination.
- Delaying the event - the aim is to control urge. The patient learns how to delay urination whenever there is an urge to do so.
- Double voiding - this involves urinating, then waiting for a couple of minutes, then urinating again.
- Toilet timetable (scheduled toilet trips) - this means going to the toilet at set times during the day. The patient learns to go, for example, every 2 hours.
Bladder training helps the patient gradually gain back control over their bladder.
Medications for urinary incontinence
If medications are used, they are usually done so in combination with other techniques or exercises. The following medications are prescribed to treat urinary incontinence:
- Anticholinergics - calm overactive bladders, may help patients with urge incontinence
- Topical estrogen - may reinforce tissue in the urethra and vaginal areas and lessen some of the symptoms of incontinence
- Imipramine (Tofranil) - a tricyclic antidepressant
The following medical devices are designed for females.
- Urethral inserts - the woman inserts the device before activity and takes it out when she wants to urinate.
- Pessary - a rigid ring inserted into the vagina. It is worn all day. The device helps hold the bladder up and prevent leakage.
- Radiofrequency therapy - tissue in the lower urinary tract is heated. When it heals it is usually firmer, often resulting in better urinary control.
- Botox (botulinum toxin type A) - injected into the bladder muscle, to help those with an overactive bladder.
- Bulking agents - injected into tissue around the urethra, to help keep it closed.
- Sacral nerve stimulator - implanted under the skin of the patient's buttock. A wire connects it to a nerve that runs from the spinal cord to the bladder. The wire emits an electrical pulse that stimulates the nerve, helping bladder control.
Surgery is an option if other therapies have not been effective. Women who plan to have children should discuss surgical options thoroughly with their doctors.
- Sling procedures - a mesh is inserted under the neck of the bladder to help support the urethra and stop urine from leaking out.
- Colposuspension - the bladder neck is lifted. The procedure can help patients with stress incontinence.
- Artificial sphincter - an artificial sphincter (valve) may be inserted to control the flow of urine from the bladder into the urethra.
Urinary Catheter - a tube which goes from the bladder, through the urethra, out of the body into a bag which collects urine.
Absorbent pads - There is a vast range of absorbent pads available at pharmacies and supermarkets.
Complications of urinary incontinence
- Skin problems - a person with urinary incontinence is more likely to have skin sores, rashes, and infections because the skin is wet or damp most of the time. This is bad for wound healing and also promotes fungal infections.
- Urinary tract infections - long-term use of a urinary catheter significantly increases the risk of infection.
- Prolapse - part of the vagina, bladder, and sometimes the urethra can fall into the entrance of the vagina. This is usually caused by weakened pelvic floor muscles.