Alphabetical List of Conditions Treated / Urinary Incontinence

Urinary Incontinence (loss of bladder control)

Urinary Incontinence: Female Urinary Incontinence | Male Urinary Incontinence

Urinary incontinence, or loss of bladder control, significantly affects an estimated 17 million people in the United States, many of whom are otherwise healthy. It is much more common in women (female urinary incontinence) than in men (male urinary incontinence), and the likelihood of becoming incontinent increases with age. One study found that among women between the ages of 20 and 80, more than half experienced some degree of female urinary incontinence (ranging from mild leaking to uncontrollable wetting); even among women ages 20-49, the prevalence was 47 percent. But fewer than half of people with the problem report it to their physician. Instead, many suffer silently, often isolating avoiding social situations for fear of embarrassment. This is unfortunate because the condition can be well managed, if not cured.

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Anatomy

The process of urination involves a coordinated set of activities in which the bladder muscles tighten, pushing urine out of the bladder and into the urethra, a tube that transports it out of the body. As the bladder muscles contract, the smooth muscle tissue around the urethra relaxes to help the urine pass. These muscles are controlled by spinal nerves. When any of these actions occur involuntarily, leakage can result.

Causes

There can be numerous causes for urinary incontinence – anatomic, physiologic, or caused by disease. Short-term incontinence can result from childbirth, urinary tract infection (UTI), vaginal infection or irritation, constipation, or certain medications. Chronic causes can include weak or overactive bladder muscles, a pelvic floor muscle weakness, blockage from an enlarged prostate, brain or spinal cord injury, damage to nerves that control the bladder from conditions such as Parkinson’s disease and multiple sclerosis, and disorders involving muscle innervation, such as spina bifida and Lou Gehrig’s disease.

Types: Stress Urinary Incontinence, Urge Incontinence, Overflow / Functional

Stress incontinence is the most common type among young and middle-aged women – it can be related to childbirth, or it may begin with menopause. In this form of incontinence, urine is leaked during any physical activity that puts pressure on the bladder, such as coughing, sneezing, laughing, exercise or heavy lifting. Urge incontinence refers to the inability to hold urine in the bladder long enough to make it to the toilet. This form is more common among people with diabetes, stroke, or other neurological conditions, although it can occur in healthy people. Some people have both types of incontinence.

Less common forms include overflow incontinence, in which small amounts of urine leak from a chronically full bladder; and functional incontinence, in which the individual has adequate bladder control but has difficulty getting to the toilet in time because of an inability to move with sufficient speed.

Treatment: Urinary Incontinence

Treatment for urinary incontinence varies depending on its type and severity. Simple strategies include quitting smoking (nicotine can be a bladder irritant) and reducing consumption of diuretics and certain medications, such as antihistamines and cough/cold medicines. Bladder-control training approaches include daily Kegel exercises – a regular routine of squeezing and holding the pelvic floor muscles used to stop the flow of urine for a certain count, then relaxing them. Patients can also exercise the muscle by double-voiding – stopping and starting the urine stream while on the toilet. The bladder can be retrained to urinate less often, or charts can be used as a way to anticipate when voiding will be necessary and thus act ahead of time. For urge and overflow incontinence, biofeedback is often incorporated to heighten awareness of signals from the body.

Medications to treat incontinence include drugs that either prevent involuntary bladder contractions, tighten the bladder muscles to reduce leakage, or relax the muscles to enable more complete emptying during urination. For stress incontinence, an implant can be injected into the area around the urethra to add bulk. The most common surgical approach for stress incontinence involves pulling up and securing the bladder, sometimes with the use of a wide sling, as a way of narrowing the urethra.

As the problem is being addressed, protective devices such as absorbent pads and adult diapers can help to mitigate the effects of urinary leakage; special absorbent underclothing is also available. Women can use a throwaway patch, a tampon-like plug or similar devices to manage stress incontinence.