Urinary Incontinence

urinary incontinenceUrinary incontinence, or the loss of bladder control, is a common and often embarrassing problem that occurs in both men and women. About 20 million American women and 6 million men have urinary incontinence or have experienced it at some time in their lives. The actual number, however, may be higher because due to people’s reluctance to discuss incontinence with their doctors.

The severity of urinary incontinence can range from an occasional leakage of urine during a cough or sneeze to having an urge to urinate that’s so sudden and strong that an individual does not have time to make it to a toilet in time.

If urinary incontinence impacts day-to-day activities, please see a doctor. In most cases, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence altogether.

 

Types of Urinary Incontinence

  • Stress incontinence (SI) occurs during physical activity. Urine leaks out of the body when the abdominal muscles contract, leading to an increase in intra-abdominal pressure. (Such as when an individual sneezes, laughs or stands up from a seated position.) Stress incontinence is the most common type of bladder control problem in younger and middle-aged women.
  • Urge incontinence (or overactive bladder OAB) occurs when an individual cannot hold their urine long enough to make it to the toilet in time. This can occur if the flow of urine out of the bladder is constricted or blocked (bladder outlet obstruction), if the bladder muscle has no strength (detrusor atony), or if there are neurologic problems.
  • Overflow incontinence occurs because the bladder is too full and urine passively leaks or overflows through the urinary sphincter. This can occur if the flow of urine out of the bladder is constricted or blocked, if the bladder muscle has no strength, or if there are neurologic problems.
  • Mixed incontinence is caused by a combination of stress and urge incontinence, where the muscle controlling the outflow of the bladder is weak and the detrusor muscle is overactive.
  • Functional incontinence occurs when a person is unable to reach the toilet in time due to a physical or mental impairment, such as arthritis or Alzheimer’s disease.

 

Risk Factors

Factors that increase the risk of developing urinary incontinence include:

  • Sex. Women are more likely than men to have stress incontinence due to pregnancy, childbirth, menopause and the normal female anatomy.
  • Men with prostate gland problems are at increased risk of urge and overflow incontinence.
  • Advanced age. As people get older, the muscles in their bladder and urethra lose some of their strength. Changes with age decrease the amount a person’s bladder can hold and increase the chances of involuntary urine release.
  • Being overweight. Being overweight or obese increases the pressure on a person’s bladder and surrounding muscles, which weakens them and permits urine to leak out when they cough or sneeze.
  • Smoking. Chronic cough associated with smoking can cause episodes of incontinence or aggravate incontinence from other sources. Constant coughing also puts stress on the urinary sphincter and can lead to stress incontinence.
  • A neurological disorder (such as stroke)
  • Certain diseases such as kidney disease or diabetes

 

Causes

It is important to remember that urinary incontinence isn’t a disease, but a symptom. It can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by a doctor can help determine what’s behind the incontinence.

Causes of temporary urinary incontinence (which can often be relieved by a change in habits) include:

  • Alcohol acts as a bladder stimulant and diuretic, which can cause an urgent need to urinate.
  • Overhydration. Drinking large amounts of fluids, particularly in a short period of time, increases the amount of urine a bladder has to handle.
  • Caffeine is a bladder stimulant and diuretic, which can cause a sudden need to urinate.
  • Bladder irritation. Carbonated drinks, tea and coffee, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate a bladder.
  • Medications. Heart medications, blood pressure drugs, sedatives, muscle relaxants and other medications may contribute to bladder control problems.
  • Easily treatable medical conditions, such as a urinary tract infection or constipation.

Causes of persistent urinary incontinence include:

  • Pregnancy. During pregnancywomen can develop SI due to increased pressure on the bladder and/or OAB because of uncontrollable spasms in their bladder
  • After pregnancy and childbirth. Incontinence issues may continue after childbirth due to weakened pelvic floor muscles, causing OAB. Additionally, the following conditions may contribute to the problem:
    • Damage to the nerves that control the bladder
    • Movement of the urethra and bladder during pregnancy
    • An episiotomy
  • Changes with aging
  • Hysterectomy
  • Painful bladder syndrome (interstitial cystitis)
  • Prostatitis (swelling and inflammation of the prostate gland)
  • Enlarged prostate
  • Prostate cancer
  • Bladder cancer or bladder stones
  • Neurological disorders such as multiple sclerosis, Parkinson’s disease, stroke, a brain tumor or a spine injury.
  • Obstruction including a tumor along the urinary tract or urinary stones.

 

Symptoms

Stress Incontinence

A variable amount of urine escapes suddenly with an increase in intra-abdominal pressure, such as when an individual sneezes, laughs or stands up from a seated position.

Urge Incontinence

  • Feeling the intense need to urinate, but being unable to hold back the urine
  • Uncontrolled urine loss of the entire contents of the bladder
  • Frequent urination
  • Urgency
  • Nocturia (needing to wake up at night to go to the bathroom)

Mixed Incontinence

Includes the symptoms of stress and urge incontinence together.

Reflex Incontinence

The same symptoms as those of urge incontinence, but they occur in people with neurological disorders.

Overflow Incontinence

  • Symptoms are similar to those of mixed incontinence
  • There may be a feeling like the bladder does not empty completely, urine flows out slowly and/or that urine dribbles out after voiding.

Functional incontinence

Relative normal bladder function and control with other conditions (musculoskeletal, neurological or thinking/communication problems) hindering them from reaching the toilet in time.

 

Diagnosis

Common diagnostic tests and processes can include:

  • Bladder diary
  • Urinalysis
  • Blood Test

If necessary, additional testing may include:

  • Postvoid residual (PVR) measurement. The amount of leftover urine in the bladder (after voiding) is checked using a catheter or ultrasound.
  • Pelvic ultrasound to view other parts of the urinary tract or genitals to check for abnormalities.
  • Stress test in which a patient is asked to cough vigorously or bear down as the doctor does an examination and watches for loss of urine.
  • Urodynamic testing to measure pressure in the bladder when it is at rest and when it is filling.
  • Cystogram (an X-ray of the bladder)
  • Cystoscopy. A thin tube with a tiny lens is inserted into the urethra to check for abnormalities in the urinary tract.