What Is Urinary Incontinence?
Urinary incontinence is the inability to control urination causing involuntary leakage. It is a very common problem in older women ranging as high as 50% or more. Even in younger women the prevalence can be 30 to 40%. Incontinence is not, however, an inevitable consequence of aging; it is typically caused by an underlying disorder. There are different types of incontinence: stress, urge, overflow, and mixed. Stress and urge incontinence are two of the most common.
Stress incontinence occurs when some activity (coughing, laughing, or lifting, for example) temporarily increases the pressure on the bladder, causing urine to be released. Urge incontinence (also referred to as overactive bladder) occurs when a sudden need to urinate is accompanied by an inability to control the bladder, sometimes releasing small to large amounts of urine.
Incontinence can cause embarrassment, depression, and social isolation, markedly decreasing quality of life. Patients are often reluctant to discuss incontinence with their doctors.
Specific treatment and the degree of success achieved with them depend on the underlying cause. But in most instances, incontinence can at least be controlled if not eliminated.
Who Gets Urinary Incontinence?
About 25 million American adults experience transient or chronic urinary incontinence. It is twice as common in women as in men. Less than half of these women have discussed their symptoms with a health care provider. The prevalence increases with age and is extremely common in women in nursing homes (more than 50%). Up to 60% of women may experience urinary incontinence during pregnancy. The incidence by race has been variable.
- Urine leakage when coughing or during lifting or other activities that increase pressure on the bladder.
- Partial or complete inability to control the bladder.
- Dribbling of urine.
- Strong, imminent urge to urinate.
Nocturia: increased urination at night.
- Increasing age.
- Abnormalities of the bladder muscle, which contracts to force urine out of the bladder.
- Weakness, due to childbirth, of the muscles of the pelvic floor that support the bladder and control urine flow (i.e., pelvic organ prolapse).
- Age-related changes in the urinary tract, such as bladder shrinkage.
- Atrophy of the urethra due to decreased estrogen production in postmenopausal women.
- Medications, including diuretics, sleeping pills, and tranquilizers.
- Poorly controlled diabetes mellitus (sugar in the urine creates large amounts of urine to be voided).
- Urinary tract infections.
- Damage to the nerves that control bladder function, causing either excessive bladder contraction or loss of sensation governing the urge to urinate (for example, from multiple sclerosis, stroke, or Parkinson’s disease).
- Surgery or radiation therapy of the pelvic area.
- Obstruction of the flow of urine—for example, due to an enlarged prostate or urethral stricture.
- Psychological disorders, including depression.
What If You Do Nothing?
In most cases, ignoring symptoms of incontinence just makes the problem worse and can also lead to complications. For example, what begins as occasional stress incontinence may become more frequent and associated with other activities over time. Being damp, even if absorbable pads are used, can cause skin irritation and ulcerative breakdown. There is also an increased risk of developing a urinary tract infection or pyelonephritis (kidney infection). In addition, untreated incontinence can lead to social isolation because of embarrassment about odor or anxiety about not being close to a toilet and the potential for accidents.
- Patient history and physical examination, including a review of your medications to determine if any may be contributing to incontinence.
- An “incontinence chart” or voiding diary that contains the time, amount, and circumstances of urination.
- Catheterization of the bladder to measure amount of urine remaining in the bladder after urination.
- Urodynamic studies.
- Microscopic examination and culture of urine.
- Education is important. Sometimes mere interpretation of the incontinence chart will lead to complete or greatly improved bladder control.
- In many cases a loss of bladder control due to urge incontinence can be regained with a technique known as bladder training. Bladder training begins by scheduling a bathroom visit every two hours, whether the patient needs to go or not. The interval is gradually increased by a half hour at a time, toward a goal of four-hour intervals. In many cases the body adapts to this schedule, eliminating incontinence.
- For improvement of both urge and stress incontinence, Kegel exercises are highly effective at strengthening the pelvic muscles that support the bladder. They involve repetitive contractions that are easy to do and can be performed anywhere.
- Biofeedback—a technique using electronic equipment that provides visual and auditory feedback to increase patient awareness and control of the bladder muscles—may improve or even cure incontinence in certain patients.
- Antimuscarinic medication (oxybutynin) combats urge incontinence or overactive bladder by blocking the neurotransmitter acetylcholine, which trigger bladder muscle contractions. The antidepressant imipramine also relaxes bladder muscles.
- Some women with overactive bladder are treated with estrogen cream or suppository.
- Antibiotics may be prescribed to treat an associated bacterial infection.
- Adult diapers and pads may actually promote complications, so they are not recommended for anything but very short-term use unless otherwise advised by a doctor.
- Avoid drinking excess fluids for two to three hours prior to going to bed.
- Surgery is an option for persistent stress incontinence. There are two main types of surgery: sling procedures (which create support under the urethra) and bladder neck suspension procedures (which reinforce the urethra and bladder neck so they do not prolapse). One such procedure is called a Monarch sling. Always carefully discuss the benefits and risks of any procedure with your doctor.
- In rare, severe cases, an indwelling catheter or suprapubic tube may be indicated.
- Regular exercise—both a general exercise routine as well as Kegel exercises to strengthen pelvic muscles—can help prevent incontinence.
- Hormone therapy may be prescribed for postmenopausal women. Treatment with female hormones can have a number of benefits, including improved muscle tone,
When To Call Your Doctor
- Call a doctor if you experience any bladder control problems.
Reviewed by Thomas Moran, M.D., obstetrician-gynecologist in private practice, Springfield, MA.