What is Urinary Incontinence

Urinary Incontinence refers to a condition in which a person is unable to control where and when to pass urine. A person with this condition will urinate when he or she does not mean to (involuntarily).

What are the causes?

This condition may be caused by:

• Medicines.
• Infections.
• Constipation.
• Overactive bladder muscles.
• Weak bladder muscles.
• Weak pelvic floor muscles. These muscles provide support for the bladder, intestine, and, in women, the uterus.
• Enlarged prostate in men. The prostate is a gland near the bladder. When it gets too big, it can pinch the urethra. With the urethra blocked, the bladder can weaken and lose the ability to empty properly.
• Surgery.
• Emotional factors, such as anxiety, stress, or post-traumatic stress disorder (PTSD).
• Pelvic organ prolapse. This happens in women when organs shift out of place and into the vagina. This shift can prevent the bladder and urethra from working properly.

What increases the risk?

The following factors may make you more likely to develop this condition:

• Older age.
• Obesity and physical inactivity.
• Pregnancy and childbirth.
• Menopause.
• Diseases that affect the nerves or spinal cord (neurological diseases).
• Long-term (chronic) coughing. This can increase pressure on the bladder and pelvic floor muscles.

What are the signs or symptoms?

Symptoms may vary depending on the type of urinary incontinence you have. They include:

• A sudden urge to urinate, but passing urine involuntarily before you can get to a bathroom (urge incontinence).
• Suddenly passing urine with any activity that forces urine to pass, such as coughing, laughing, exercise, or sneezing (stress incontinence).
• Needing to urinate often, but urinating only a small amount, or constantly dribbling urine (overflow incontinence).
• Urinating because you cannot get to the bathroom in time due to a physical disability, such as arthritis or injury, or communication and thinking problems, such as Alzheimer disease (functional incontinence).

How is this diagnosed?

This condition may be diagnosed based on:

• Your medical history.
• A physical exam.
• Tests, such as:
  • Urine tests.
  • X-rays of your kidney and bladder.
  • Ultrasound.
  • CT scan.
  • Cystoscopy. In this procedure, a health care provider inserts a tube with a light and camera (cystoscope) through the urethra and into the bladder in order to check for problems.
  • Urodynamic testing. These tests assess how well the bladder, urethra, and sphincter can store and release urine. There are different types of urodynamic tests, and they vary depending on what the test is measuring.

To help diagnose your condition, your health care provider may recommend that you keep a log of when you urinate and how much you urinate.

How is this treated?

Treatment for this condition depends on the type of incontinence that you have and its cause. Treatment may include:

• Lifestyle changes, such as:
  • Quitting smoking.
  • Maintaining a healthy weight.
  • Staying active. Try to get 150 minutes of moderate-intensity exercise every week. Ask your health care provider which activities are safe for you.
  • Eating a healthy diet.
    • Avoid high-fat foods, like fried foods.
    • Avoid refined carbohydrates like white bread and white rice.
    • Limit how much alcohol and caffeine you drink.
    • Increase your fiber intake. Foods such as fresh fruits, vegetables, beans, and whole grains are healthy sources of fiber.
• Pelvic floor muscle exercises.
• Bladder training, such as lengthening the amount of time between bathroom breaks, or using the bathroom at regular intervals.
• Using techniques to suppress bladder urges. This can include distraction techniques or controlled breathing exercises.
• Medicines to relax the bladder muscles and prevent bladder spasms.
• Medicines to help slow or prevent the growth of a man’s prostate.
• Botox injections. These can help relax the bladder muscles.
• Using pulses of electricity to help change bladder reflexes (electrical nerve stimulation).
• For women, using a medical device to prevent urine leaks. This is a small, tampon-like, disposable device that is inserted into the urethra.
• Injecting collagen or carbon beads (bulking agents) into the urinary sphincter. These can help thicken tissue and close the bladder opening.
• Surgery.

Follow these instructions at home:

Lifestyle

• Limit alcohol and caffeine. These can fill your bladder quickly and irritate it.
• Keep yourself clean to help prevent odors and skin damage. Ask your doctor about special skin creams and cleansers that can protect the skin from urine.
• Consider wearing pads or adult diapers. Make sure to change them regularly, and always change them right after experiencing incontinence.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Use the bathroom about every 3–4 hours, even if you do not feel the need to urinate. Try to empty your bladder completely every time. After urinating, wait a minute. Then try to urinate again.
• Make sure you are in a relaxed position while urinating.
• If your incontinence is caused by nerve problems, keep a log of the medicines you take and the times you go to the bathroom.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that gets worse.
• Your incontinence gets worse.

Get help right away if:

• You have a fever or chills.
• You are unable to urinate.
• You have redness in your groin area or down your legs.

Summary

• Urinary incontinence refers to a condition in which a person is unable to control where and when to pass urine.
• This condition may be caused by medicines, infection, weak bladder muscles, weak pelvic floor muscles, enlargement of the prostate (in men), or surgery.
• The following factors increase your risk for developing this condition: older age, obesity, pregnancy and childbirth, menopause, neurological diseases, and chronic coughing.
• There are several types of urinary incontinence. They include urge incontinence, stress incontinence, overflow incontinence, and functional incontinence.
• This condition is usually treated first with lifestyle and behavioral changes, such as quitting smoking, eating a healthier diet, and doing regular pelvic floor exercises. Other treatment options include medicines, bulking agents, medical devices, electrical nerve stimulation, or surgery.