Urinary Incontinence

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Urinary incontinence is the uncontrollable leakage of urine. A closely related condition known as overactive bladder does not always produce leakage but causes frequent urination and an urgency to go to the bathroom.

Incontinence can be a mild bother—losing a few drops of urine while coughing, for example—or socially and emotionally debilitating, with the patient avoiding social gatherings out of fear of the involuntary release of large amounts of urine. It affects more than 30 million American adults—perhaps significantly more, because many people probably don't report it. It is more common in the U.S. population than asthma and diabetes.

Urinary incontinence is generally caused by problems with the nerves and muscles that assist in releasing or holding urine. Because of their pelvic anatomy and changes related to childbirth and menopause, women are three times as likely to suffer from it as men.

In both men and women, the incidence of urinary incontinence increases with age. However, it is not an inevitable part of aging. It is a medical condition with a variety of causes, and it can usually be effectively treated. Most patients who suffer from this condition could realize significant improvement if not complete resolution with the appropriate diagnosis and treatment. Patients who feel their symptoms affect their activities of daily living should seek medical advice on the range of treatment options.

Need-to-know anatomy

Urination involves the contraction and relaxation of different sets of muscles, guided by nerve signals to the brain.

The water and wastes that make up urine are stored in the bladder, a balloonlike organ that expands to take in urine, supported by contractions of the pelvic floor muscles. When your bladder is full, it sends a signal to your brain. When the time is appropriate, you relax your pelvic floor muscles and the bladder contracts, squeezing urine into a tube called the urethra. The muscles that were keeping the urethra shut now relax, and the urine flows out of the body.

Causes

Incontinence can be caused by weakened muscles, a sagging bladder that impinges on the urethra, damage to the nerves of the bladder, or injury to the spinal cord and the brain. Medications can lead to temporary incontinence, as can urinary infections and bladder irritations from dietary substances. Physical and mental disabilities can also cause incontinence by preventing a person from reaching a toilet in time.

Types

There are various types of urinary incontinence, with different treatments, so it is important for the patient to be correctly diagnosed. Approximately 90 percent of patients experiencing urinary incontinence will have either overactive bladder/urge incontinence, stress incontinence, or mixed incontinence. A small minority may have overflow incontinence, anatomic incontinence, or functional incontinence.

Overactive bladder


Previously known as urge incontinence, overactive bladder is a condition characterized by frequent urination and the sudden urge to urinate. Typically, patients complain of a need to urinate that is so sudden, they sometimes cannot make it to the bathroom in time to prevent leakage. They sometimes wet the bed at night. This condition is due to spontaneous bladder spasms. The spasms can result from:

  • Bladder stimulants such as caffeine or alcohol
  • Bladder irritants, including carbonated drinks, citrus fruits, and artificial sweeteners
  • Increased fluid intake
  • Medications, including sedatives, cold medicines, and high blood pressure medicines
  • Urinary tract infection
  • Urinary tract cancer
  • Nerve dysfunction (associated with nerve trauma, diabetes, multiple sclerosis, or spinal cord injury)
  • Stress urinary incontinence


    Stress urinary incontinence is one of the most common types of incontinence and is characterized by urinary leakage during activity including coughing, sneezing, exercising, lifting, and laughing. As the condition progresses, it can become severe enough to happen with simple acts such as bending and walking. This condition is due to a weakness of the muscles that are supposed to keep the urine sealed in during activity. SUI can result from a variety of conditions with a cumulative effect over the course of a woman's lifetime. They include:

    • Vaginal childbirth (with weakening of the pelvic floor muscles)
    • Menopause (the drop in estrogen affects muscles of bladder and urethra)
    • Obesity
    • Chronic constipation
    • Smoking
    • Aging
    • Mixed incontinence


      Mixed incontinence is a combination of the symptoms of overactive bladder and stress incontinence. Both sets of symptoms may be the result of a nerve problem, or it may be that the patient is intentionally urinating frequently to try to prevent stress-related leakage; that can have the result of shrinking the bladder so that it can't handle as much urine. It is important to determine which component is most bothersome and to treat that first. Other types of incontinence


      Other types of incontinence are relatively uncommon but are possible, especially in patients who have not improved with traditional therapies.

      • Overflow incontinence can occur when the patient fails to sense a full bladder because of nerve damage and thus does not empty the bladder. Risk factors include bladder injury, radical pelvic surgery, spinal cord injury, nerve damage from diabetes, or the use of certain drugs.
        • Anatomic incontinence typically occurs early in life or after surgical intervention and is caused by abnormalities that include ectopic ureter, urethral diverticulum, and urinary fistula.
          • Functional incontinence occurs when a patient doesn't reach a toilet in time because he has problems thinking, communicating, or moving. A person disabled by arthritis, for example, might be experience functional incontinence.
          • Last reviewed on 1/29/10

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