Urinary incontinence is the loss of voluntary bladder control leading to the leakage of urine. It can be temporary or chronic. Incontinence is a symptom, not a condition in and of itself.
Causes
Temporary incontinence can be caused by:
More permanent urinary incontinence may be classified as one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. Sometimes the cause is unclear.
Stress Incontinence
This results when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise. This is the most common type of incontinence. It may be caused by:
Urge Incontinence
Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is unable to hold urine long enough to make it to a toilet. This is also known as overactive bladder. It may be caused by:
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Urinary tract infection
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Diabetes type 1 and 2
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Bladder irritation (stone, tumor)
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Drugs (eg, hypnotics, diuretics)
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Caffeine
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Alcohol
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Nerve damage due to:
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Overflow Incontinence
This occurs when the bladder will not empty completely. This causes an overflow and leaking of urine. It may be caused by:
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A bladder that is blocked
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Fecal impaction
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Drugs (eg, antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
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Vitamin B12 deficiency
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Prostate enlargement in men
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Weak bladder muscles
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Nerve damage due to:
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Functional Incontinence
Normal bladder control, but an inability to reach the toilet in time. Drugs which cause confusion or sedation could cause functional incontinence.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
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Sex: female
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Age: older than 65
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Multiparity (giving birth to more than one offspring at a time)
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Urinary tract infection
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Obesity
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Chronic lung disease
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Urethritis
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Previous hysterectomy or urethral syrgery
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Depression
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Dementia including Alzheimer’s disease
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Menopause
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Diabetes
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Enlarged prostate
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Dementia
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Stroke
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Multiple sclerosis
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Spinal cord injury or disease
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Use of certain substances/medications:
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Symptoms
Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You will be asked how often you empty your bladder and patterns of urine leakage. A physical exam will look for any physical causes such as blockages or nerve problems. You will be asked to keep a diary of your bladder habits. You may also be referred to a urologist or a urogynecologist.
Tests may include:
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Stress test–you relax, then cough as your doctor watches for loss of urine, confirming diagnosis of stress incontinence
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Urine tests
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Blood tests to detect diabetes and elevated calcium level
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Ultrasound–a test that uses sound waves to examine structures inside the body and to determine the residual urine volume after voiding
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Cystoscopy–a thin tube with a tiny camera inserted in the urethra to view the urethra and bladder
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Urodynamic Tests–used to measure the flow of urine and pressure in the bladder
Treatment
Treatment may include one or more of the following:
Behavioral Therapy
Behavioral therapy includes:
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Making muscles stronger by doing Kegel exercises. This strengthens the muscles that hold the bladder in place and those that control urine flow. Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence. .
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Bladder training can be done by setting a regular timed schedule for emptying your bladder and by drinking fewer liquids.
Medication
Medications may be prescribed to either strengthen muscles that control the flow of urine or to relax the bladder.
Surgery
In men, surgery may be performed to relieve a physical blockage due to an enlarged prostate. In women, surgery can help repair weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra, or surgical repair/implants into the bladder sphincter.
Devices
Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases. Alternatively, pessaries (devices that raise the uterus and decrease pressure on the bladder) may be used in women.
Prevention
Incontinence is really a symptom of another condition. There are several ways to help prevent incontinence including the following:
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Exercise. Women can decrease their chances of developing incontinence by doing Kegel exercises. This is especially helpful in women who have given birth because childbirth weakens muscles around the bladder.
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Quit smoking
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Reduce oral intake of substances which lead to incontinence (such as caffeine, alcohol, and drugs)
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Weight reduction
RESOURCES:
American Foundation for Urologic Disease
http://www.afud.org
National Association for Continence
http://www.nafc.org
References:
American Foundation for Urologic Disease website. Available at: http://www.afud.org.
Corcos J, Gajewski J, Heritz D, et al. Canadian urological Association guidelines on urinary incontinence. Can J Urol. 2006;13:3127-38.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www2.niddk.nih.gov/.
Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367(9504):57-67.
United States Food and Drug Administration website. Available at: http://www.fda.gov/.
Wein AJ, Rackley RR: Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175:S5-10.
