Urinary Incontinence - The "Leaky Plumbing" Problem

Incontinence, or the involuntary loss of urine, can be a symptom of several conditions.  Learn what causes incontinence, and the common treatments for it.

by Donald Feeney, MD

Urinary incontinence can be defined as the involuntary loss of urine. The urinary bladder, which stores urine until the patient voluntary empties its content, is a reservoir in the lower abdomen whose walls are a muscle that is supplied with nerve fibers. When the patient desires to empty their bladder, this muscle contracts forcing the urine out of the exit tube. There is a circular muscle surrounding its exit tube called the urinary sphincter. The muscular sphincter opens to allow for emptying of the urine, remaining closed most of the time to keep the urine stored in the bladder.

Urinary incontinence is a common problem, perhaps more common in women than men, and may be temporary or chronic. Temporary urinary incontinence is loss of urine caused by another condition and disappears when the causative disease is no longer present.  Examples of temporary incontinence would be acute bladder infection, loss of consciousness, or because of a reaction to a medication.

Long-standing or chronic urinary incontinence is a much more complex problem and there are several types, each with its own cause.

OVERFLOW INCONTINENCE is mainly a problem seen in older men.  This involuntary loss of urine occurs when there is an obstruction to the outflow of urine and the bladder becomes completely full, leading to the overflow and leakage.    Benign enlargement of the prostate or carcinoma of that gland, which surrounds the drainage tube (urethra), are the most common causes in middle-aged and older men.  Scarring of this urine outflow tube from infection or injury is another cause occurring in younger men.  Treatment of this retention and overflow leakage is usually the surgical removal of the obstructing prostate tissue or incising the scar in the outflow urine tube.  Mild to moderate prostate enlargement symptoms can be now treated by a variety of medications before complete obstruction and leakage develops.

URGENCY INCONTINENCE (also referred to as "over-active bladder") mostly affects women.  In this condition, the muscle of the bladder wall spontaneously contracts on its own, creating a sense of urgency to void and often leakage of urine. The cause is unknown. The treatment starts with behavioral modification, specifically teaching the woman to void on a set time schedule and gradually increasing the time between voiding.  There are also medications that tend to reduce the bladder muscle wall contractions.

STRESS INCONTINENCE occurs almost exclusively in women. It is the loss of urine when the patient increases intra abdominal pressure by coughing, sneezing, or exercising.  It is caused by laxity or weakness of the pelvic muscles supporting the bladder and adjacent uterus, vagina and lower rectum.  It tends to be more common in women who have given birth multiple times. Mild cases can be helped by exercises of voluntary contracting the pelvic muscles (Kegel Exercises).  Most cases however require surgical correction of the lax muscles often in conjunction with removal of the uterus.

NEUROGENIC BLADDER INCONTINENCE is leakage that is the result of disease or injury to the central nervous system (brain and spinal cord).  Diseases or injuries that affect the spinal cord, the brain or nerves going to the bladder may result in the bladder muscle or the sphincter mechanism at the outflow tube malfunctioning with resultant leakage.  Examples would be spinal core injury from accidents, multiple sclerosis, and stokes. Either overactive bladder or complete retention with overflow incontinence can develop depending on the specifics nervous system malfunction.  Treatment options also depend on the specific disease present.  If treatment options are not available or fail, the patient with this type of urinary incontinence may have to have a permanent tube place in their bladder to control the incontinence.

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