Urinary Incontinence

What is urinary incontinence (UI)?

Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom. More than 13 million people in the United States experience incontinence and 85 percent are women. Urinary incontinence may be a temporary condition, resulting from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.

What causes urinary incontinence?

Incontinence is not an inevitable result of aging, but is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications, and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop incontinence either during pregnancy and childbirth, or after the hormonal changes of menopause, because of weakened pelvic muscles.

What are some of the different types of urinary incontinence?

• urge incontinence - the inability to hold urine long enough to reach a restroom. It is often found in people who have conditions such as diabetes, stroke, dementia, Parkinson's disease, and multiple sclerosis, but may be an indication of other diseases or conditions that would also warrant medical attention.

• stress incontinence - the most common type of incontinence that involves the leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder.

• functional incontinence - leakage due to a difficulty reaching a restroom in time because of physical conditions such as arthritis.

• overflow incontinence - leakage that occurs when the quantity of urine produced exceeds the bladder's capacity to hold it.

What are the symptoms of urinary incontinence?

The following are the most common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:

• inability to urinate

• pain related to filling the bladder and/or pain related to urination without a proven bladder infection

• progressive weakness of the urinary stream with or without a feeling of incomplete bladder emptying

• an increased rate of urination without a proven bladder infection

• needing to rush to the restroom and/or losing urine if you do not get to restroom in time

• abnormal urination or changes in urination related to a nervous system

• abnormality such as stroke, spinal cord injury, multiple sclerosis

• leakage of urine that prevents activities

• leakage of urine that began or continued after surgery

• leakage of urine that causes embarrassment 

• frequent bladder infections 

The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is urinary incontinence diagnosed?

For people with urinary incontinence, it is important to consult a physician for a complete physical examination that focuses on the urinary and nervous systems, reproductive organs, and urine samples. In many cases, patients will then be referred to a urologist, a physician who specializes in diseases of the urinary tract.

Treatment for urinary incontinence:

Specific treatment for urinary incontinence will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• behavioral therapies (to help people regain control of their bladder), including the following:
  
  
  • bladder training - teaches people to resist the urge to void and gradually expand the intervals between voiding.
    
    
  • toileting assistance - uses routine or scheduled toileting, habit training schedules, and prompted voiding to empty the bladder regularly to prevent leaking.

• pelvic muscle rehabilitation (to improve pelvic muscle tone and prevent leakage), including the following:
  
  
  • Kegel exercises
    Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence. This is particularly helpful for younger women. Should be performed 30-80 times daily for at least 8 weeks.
    
    
  • biofeedback
    Used in conjunction with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.
    
    
  • vaginal weight training
    Small weights are held within the vagina by tightening the vaginal muscles. Should be performed for 15 minutes, twice daily, for four to six weeks.
    
    
  • pelvic floor electrical stimulation
    Mild electrical pulses stimulate muscle contractions; should be performed in conjunction with Kegel exercises.

• medication (including specific drugs for incontinence as well as estrogen therapy, which may be helpful in conjunction with other treatments for postmenopausal women with UI)

• surgery (if the incontinence is related to structural problems such as an abnormally positioned bladder or a blockage)

• diet modifications (i.e., eliminating caffeine in coffee, soda, and tea, and/or eliminating alcohol)

Managing urinary incontinence:

Specifically designed absorbent underclothing is available - which is no more bulky than normal underwear and can be worn easily under everyday clothing. Also, incontinence may be managed by inserting a catheter into the urethra and collecting the urine into a container. Consult your physician with your questions regarding the management and treatment of urinary incontinence.

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