Urinary Incontinence
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Urinary Incontinence

(Incontinence, Urinary; Incontience, Stress; Incontinence, Urge; Incontinence, Overflow; Incontinence, Functional; Stress Incontinence; Urge Incontinence; Overflow Incontinence; Functional Incontinence; Overactive Bladder)

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Definition

Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or chronic. Incontinence is a symptom, not a condition in and of itself.

Causes

Temporary incontinence can be caused by:

  • Medications
  • Constipation
  • Infection
  • Muscle weakness
  • Restricted mobility
  • Endocrinological disorders (for example, diabetes)

More permanent urinary incontinence may be one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. The cause may also be 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:

  • Weakening of the muscles that suspend the bladder
  • Weakening of muscles that control urine flow

Muscles Involved in Incontinence in Women

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© 2008 Nucleus Medical Art, Inc.

Urge Incontinence

Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is not able to hold urine long enough to make it to a toilet. This is also known as overactive bladder. It may be caused by:

Overflow Incontinence

This occurs when the bladder will not empty. Urine builds up, and this causes an overflow and leaking of urine. It may be caused by:

  • A bladder that is blocked, such as by a scar in the urethra (stricture)
  • Fecal impaction
  • Drugs (eg, antidepressants, hypnotics, antipsychotics, beta-blockers, antihistamines, calcium channel blockers)
  • Vitamin B12 deficiency
  • Prostate enlargement in men
  • Weak bladder muscles
  • Nerve damage due to:
    • Surgery
    • Diabetes
    • Spinal cord injuries
    • Other factors

Functional Incontinence

This occurs when there is normal bladder control, but an inability to reach the toilet in time. An example would be severe arthritis. Drugs which cause confusion or sedation can also cause functional incontinence.

Risk Factors

These risk factors increase your chance of developing urinary incontinence. Tell your doctor if you have any of these risk factors:

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. You will be asked how often you empty your bladder and patterns of urine leakage. Your doctor will perform a physical exam to look for any physical causes, such as blockages or nerve problems. You will keep a diary of your bladder habits. You may be referred to a urologist or a urogynecologist.

Tests may include:

  • Stress test—You relax then cough as your doctor watches for loss of urine. This will cofirm if you have stress incontinence.
  • Urine tests
  • Blood tests to detect diabetes
  • Ultrasound—a test that uses sound waves to examine structures inside the body to determine the residual urine volume after voiding
  • Cystoscopy—a thin tube with a tiny camera is inserted in the urethra to view the urethra and bladder
  • Urodynamic tests—tests used to measure the flow of urine and pressure in the bladder

Treatment

Treatments may include:

Behavioral Therapy

Behavioral therapy includes:

  • 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.
  • Bladder training
    • This 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 urine flow or relax the bladder.

Surgery

In men, surgery may be done to relieve a physical blockage due to an enlarged prostate. In women, surgery can repair weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra, or surgical repair/implants into the bladder sphincter.

Devices

Absorbent diapers are often used by men and women with incontinence.

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.

External (condom) or internal (Foley) catheters may be used for men. Penile clamps are sometimes used.

Prevention

Incontinence is really a symptom of another condition. There are several ways to prevent incontinence:

  • Exercise—Women can decrease their chance of developing incontinence by doing Kegel exercises. This is very helpful for women who have given birth, because childbirth weakens muscles around the bladder.
  • Reduce your intake of substances which lead to incontinence (such as caffeine, alcohol, and certain drugs).
  • Lose weight.
  • Avoid and treat constipation.

RESOURCES:

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
http://www.niddk.nih.gov/

National Kidney Foundation
http://www.kidney.org/

UrologyHealth.org
http://www.urologyhealth.org/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

American Foundation for Urologic Disease. American Foundation for Urologic Disease website. Available at: http://www.auafoundation.org/. Accessed July 19, 2008.

Controlling urinary incontinence. FDA Consumer Magazine, United States Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/505_incontinence.html. Published September-October 2005. Accessed July 19, 2008.

Corcos J, Gajewski J, Heritz D, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol. 2006;13:3127-3138.

Norton P, Brubaker L. Urinary incontinence in women. Lancet. 2006;367:57-67.

Sobhgol SS, Charandabee SM. Related factors of urge, stress, mixed urinary incontinence, and overactive bladder in reproductive age women in Tabriz, Iran: a cross-sectional study. Int Urogynecol J Pelvic Floor Dys Function. 2008 Mar;19(3):367-73.

Urinary incontinence in women. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/. Published October 2007. Accessed July 19, 2008.

Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol. 2006;175:S5-10.



Last reviewed January 2008 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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