Definition and Overview

Urinary incontinence is a medical condition where the patient loses control over his bladder and experiences involuntary urination or leaking of the urine. This is a common condition among the elderly, since the muscles in the bladder weaken as a person ages. It is twice as common in women than in men and is believed to be caused by weakening of the muscles of the pelvis due to childbirth.

Types of Urinary Incontinence

  • Stress incontinence is a kind of incontinence that happens when the patient engages in certain physical activities that increase intraabdominal pressure, such as lifting and exercising.

  • Urge incontinence is a type of incontinence wherein the patient suddenly experiences an urge to urinate and then experiences leaking of urine right after. In urge incontinence, patients are unable to get to the bathroom on time.

  • Overflow incontinence, also known as dribbling, is a form of incontinence wherein the patient is unable to empty the bladder completely. Thus, the patient experiences leakage of urine even after urinating. Some patients experience a combination of these different types of incontinence.

Approximately 35% of people older than 60 are incontinent. Affecting about 600,000 men, more than half of the admissions to nursing homes and other assisted living facilities are related to this condition. Incontinence may result in social stigma and hygiene problems.

Cause of Condition

Normal continence involves proper functioning of various components of the renal, excretory and nervous systems. Urine produced by the kidneys is stored in the bladder, which stretches during filling. The nervous system conducts the signals, facilitating urination. During urination, the sphincter muscle, which keeps the urine inside the bladder, relaxes while the detrusor muscle contracts. These facilitate the passage of the urine from the bladder to the urethra and out of the body.

Urinary incontinence occurs when there is a problem in any of these components. Stress incontinence is caused by problems with the pelvic muscles, such as weakness of the sphincter muscle. This usually happens when as a person gets older. It may also occur when the muscles get damaged during surgery. In women, this usually happens during childbirth or surgery of the uterus. In men, urinary incontinence commonly occurs after they undergo surgical removal of the prostate gland.

Urge incontinence, meanwhile, is usually due to overactivity of the detrusor muscle. Also called overactive bladder, this condition is typically observed in older patients with certain diseases, such as diabetes, Alzheimer's disease, and stroke. It may also be due to an inherent bladder muscle problem, called detrusor instability.

Finally, overflow incontinence is usually associated with bladder outlet obstruction, or a blockage in urinary flow. This is common in men with benign prostatic enlargement. It can also occur in patients with bladder stones and those with urethral strictures.

Incontinence may be induced or aggravated by several factors. These include drinking certain beverages, namely caffeine or alcohol; intake of certain medications, such as diuretics or sedatives; and the presence of a urinary tract infection.

Key Symptoms

Urinary incontinence involves the leakage of variable amounts of urine. Straining, even just a little, can result in leakage. Urgency or the need to urinate immediately, may also occur. Some patients who are incontinent are unable to reach the toilet in time. Some patients also complain of a weak stream of urine. Intermittency, wherein a patient urinates in several short segments during one trip to the bathroom, can also occur. Patients can also experience frequent urination and nocturia, or waking up at night with an urgent need to urinate, as well as a sensation of retention, or feeling that the bladder is not completely emptying.

Who to See and Types of Treatments Available

Incontinence of any kind should prompt you to seek consult. It could potentially be a symptom of an underlying disease or problem, which requires medical attention. Your physician will obtain your complete medical history focusing on your specific symptoms. He will also perform a comprehensive physical examination. You may be asked to undergo several laboratory tests, such as a urinalysis, to examine the contents of your urine. For more complex conditions, you will be referred to a urologist for cystoscopy and further evaluation. Cystoscopy involves direct visualization and examination of the bladder by inserting a scope with a camera. Aside from this, additional studies can be performed, such as urodynamic tests.

The management of urinary incontinence varies, depending on the condition causing the symptom. In general, patients are advised to avoid alcoholic drinks and coffee. Drinking before bedtime is also discouraged. You will be taught Kegel exercises, which helps strengthen the muscles of your pelvic floor. This can train you to develop more control and keep urine in. Management of incontinence may also include the use of absorbent underwear and diapers. Collecting and occluder devices are options for incontinent males. Sometimes, intermittent or prolonged catheterization may have to be performed. Therapy using electrical stimulation is also an option. This attempts to re-train and improve the function of urinary muscles and the bladder using electrical current.

Several medications, such as oxybutinin, may be used to treat incontinence. Some drugs can reduce urinary frequency, while other medications can decrease bladder tone and increase its capacity. If the incontinence is caused by prostatic enlargement and obstruction, medications like 5-alpha reductase inhibitors can help make the prostate gland smaller. Medical devices, such as the artificial sphincter, are also available to prevent or minimize leakage of urine from the urethra. Surgery is usually the last option as treatment for urinary incontinence. A bulbourethral sling may be inserted, which serves as an additional support for the urethra to improve a person's bladder control.

References:

  • Urology Care Foundation. www.urologyhealth.org
  • National Association for Continence. www.nafc.org
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