What is urinary incontinence?
Urinary incontinence occurs when you’ve lost some control over your bladder and can’t help passing urine. This may happen because the surrounding muscles in your pelvic floor are weak, or because your bladder and other organs sag. It can also result from overactive bladder muscles or from weakness in the ring of muscles that holds the bladder closed.
If you suffer from incontinence, you have plenty of company. About one-third of Americans over the age of 60 have experienced the condition. Every year 50,000 men in the United States develop some degree of incontinence after prostate surgery. And nearly one in four women between the ages of 30 and 60 has had at least one bout of urinary incontinence.
Since incontinence is embarrassing, however, you may feel uncomfortable seeing a doctor about it. Some people suffer in silence, cutting out activities they love for fear of an accident. They may feel a loss of self-esteem or become isolated and depressed. The fact is that incontinence isn’t a normal consequence of aging; it’s a disorder that in most cases is completely treatable and curable. And it should be treated as a medical problem like any other.
Are there different kinds of incontinence?
Yes, there are three main types. If you’ve noticed that you’re leaking a little urine or have to go too frequently, these descriptions may help you identify the kind of incontinence you have.
- Stress incontinence is the most common form affecting women. It occurs when there’s a sudden rise in pressure within the abdomen. This may happens when you cough, laugh, sneeze, lift, exercise, or do anything else that puts a strain on the bladder. It generally results from pelvic-floor muscles that have been weakened by pregnancy and vaginal delivery. Diabetes, frequent urinary-tract infections, changes in hormone production, and excess body fat may also contribute to stress incontinence.
- Urge incontinence occurs when the urge to urinate is so strong and comes on so suddenly that there’s often no time to make it to the toilet. It often results from an underlying health problem, such as Parkinson’s disease, stroke, multiple sclerosis, or an undiagnosed tumor. Medications such as diuretics, antihistamines, or antidepressants can also play a role.
- Overflow incontinence is most common in older men. Bladder stones can cause it, but it usually results from an enlargement of your prostate gland, which lies at the base of your bladder. When the prostate gets bigger, it can squeeze your urethra and make urination more difficult. The bladder may then get overfilled, a condition that leads to near-constant dribbling.
You can also have more than one type of urinary incontinence at a time. There are other kinds, too, caused by abnormalities in the urethra, spinal-cord injury, or difficulty in getting to the toilet (the last, known as functional incontinence, is common among people with arthritis or Alzheimer’s).
What are the symptoms?
If you suffer from incontinence, you probably have two or more of the following symptoms:
- Involuntary loss of urine or a continuous leakage of urine from the bladder
- A frequent and urgent need to urinate
- A feeling that your bladder is constantly full, or that it isn’t empty after you’ve urinated
- Difficulty urinating even if you have the urge
- Releases of urine triggered by movement or by coughing, sneezing, or laughing
- The need to get up repeatedly at night to urinate (this may not be a symptoms of incontinence, since it’s common for older people to need to urinate at night)
- A start-and-stop stream during urination
How is it diagnosed?
Your medical history serves as a guide. Your doctor should first find out whether you have an underlying condition or health problem, such as diabetes, constipation, a urinary-tract infection, or an enlarged prostate gland that needs treatment. The doctor may test your urine as well, to see whether you have an infection in your urinary tract, which could cause temporary incontinence.
If a diagnosis isn’t possible from your medical history, your doctor will perform a more in-depth exam or refer you to a urologist, who specializes in incontinence and other bladder problems. You will probably receive a rectal exam, which can help pinpoint muscle or nerve involvement and potential blockages. If you’re a woman, your doctor will do a pelvic exam to check on the condition of your pelvic muscles; if you’re postmenopausal, he or she will also look for thinning tissue.
Two procedures, a bladder stress test and a Bonney test, can determine whether stress incontinence is the problem. In one of these, the doctor will have you cough to see if that makes you release some urine. He or she may also perform other urine tests to find out the following:
- Whether there’s a problem with the flow of urine
- Whether the stream is steady or interrupted
- Whether there’s a pause or hesitation before you urinate
- How much urine remains in your bladder after urination
These tests are generally enough for a diagnosis. If not, the doctor may suggest additional ones.
Keeping a three-day urination diary can help your doctor diagnose the problem and decide what solutions to recommend. Note when you urinated, how much urine you released each time, whether you were able to make it to the toilet, and if not, approximately how much leakage took place.
How is urinary incontinence treated?
The treatment depends on the type (or types) of incontinence you have. Some of the most popular methods include:
- Behavior modification: In this highly effective treatment, you and the doctor outsmart the condition by setting up a urination schedule to prevent accidents. If you have an episode of incontinence about every three hours, for example, you can set a watch alarm or other timer to sound every two hours and remind you to empty your bladder.
If you have urge incontinence, your doctor may also suggest “bladder training” to help you develop more control. You might begin by urinating at intervals of an hour or so; if you stay dry, you can try waiting longer. Continue the process until you can wait several hours.
- Exercise: If the muscles of your pelvic floor are weak, your doctor may teach you how to do Kegel exercises, which strengthen those muscles. (Make sure you’re doing them correctly, though, because they can make the incontinence worse if you aren’t.) Many women have used this method with great success.
- Medication: Your doctor may prescribe medication to relax your bladder muscles — or, if you’re male and have an enlarged prostate, to shrink the gland. Medication can also be used to tighten the ring of muscles that surrounds the opening of the bladder. If you’re a postmenopausal woman, your doctor may prescribe estrogen therapy.
- Devices: A pessary, a device similar to the outer ring of a diaphragm used for birth control, can be inserted into a woman’s vagina to support the pelvic muscles and organs. Similarly, a device like a condom can be fitted over a man’s penis to collect urine.
Newer devices to relieve stress incontinence in women include a urethral plug. This is a small balloon-tipped cylinder that’s inserted into the urethra with an applicator; the tiny balloon fills with air and blocks any leakage. To urinate, you pull a string to deflate the balloon and take out the device. (There’s at least one drawback: Urinary-tract infections are more frequent than normal until women learn how to use the device correctly, reports the manufacturer.)
- Surgery: Doctors often perform surgery to reduce the size of an enlarged prostate, but otherwise this method is generally used only if other treatments don’t work.
What else can I do to take care of myself?
- If you sneeze or cough, cross your legs. This is a safe, reliable method that may lessen or eliminate episodes of stress incontinence, according to a recent study.
- Cut out foods and beverages that contain caffeine, like coffee, tea, and chocolate.
- Reduce your intake of alcohol and carbonated drinks, since these can irritate the bladder.
- Drink one to two quarts of water a day.
- Add fiber to your diet if you have trouble with constipation.
- Go to the bathroom frequently, even if you don’t feel like it.
- If you smoke, quit. Smoking can make you cough, triggering urine leaks.
- If you have mobility problems, make sure there’s a clear path to the bathroom. Wear clothes that you can take off easily too.
- Use absorbent pads for security, and change them regularly.
- Keep a night light on to help you get to the toilet more easily at night.
- Urinate before you leave the house or go to bed; this will reduce the chance of accidents.
References
Urinary Incontinence. MayoClinic.com
Urinary Incontinence in Women. National Kidney and Urologic Diseases Information Clearinghouse.
What I Need to Know About Bladder Control for Women. National Kidney and Urologic Disease Information Clearinghouse.
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