Urinary Incontinence

What is urinary incontinence?

Urinary incontinence is uncontrollable leaking of urine from the bladder. When the bladder is functioning normally, it does not empty without your awareness and control.

Urinary incontinence becomes more common as people get older. It is an embarrasing problem for as many as one in three Americans age 60 or older. The condition is at least twice as common among women as men.

How does it occur?

There are several different types of incontinence: stress, urge, overflow, and functional.

The most common kind of urinary incontinence in women is stress incontinence, in which urine leaks during lifting, exercise, coughing, sneezing, or laughing. It is caused by relaxed pelvic muscles that may have been stretched or torn during child-bearing.

Urge incontinence is an inability to hold the urine once the urge to urinate occurs. You are unable to get to the bathroom in time. If often occurs with Parkinson's disease, stroke, or multiple sclerosis. It can occur in healthy people, too.

Incontinence may be caused or made worse by a simple underlying problem that can be corrected. Examples of such problems include:

constipation
irritation due to infection
a stone in the bladder
use of diurectics ("water pills")
thinning of tissue due to lack of estrogen (especially after menopause), which may weaken urethral muscle.

Functional incontinence occurs with normal bladder control, but you may have arthritis or another condition that makes it hard to reach the toilet in time.

What are the symptoms?

Symptoms include:

leakage of urine during exercise, laughing, coughing, sneezing, or lifting
urine leaks in frequent dribbles
inability to hold urine long enough to get to the toilet
urine continues to dribble after urinating
embarrassing smell on clothes and in the house.

How is it diagnosed?

Your health care provider will take a careful history and examine you to see if the incontinence is caused by an underlying condition that can be corrected. Your blood and urine will be checked for infection or other abnormalities.

You may be referred to a urologist or gynecologist for further investigation and treatment. (A urologist is a doctor who specializes in disorders of the urinary tract in both men and women and in the reproductive tract of men. A gynecologist specializes in women's health care and especially in disorders of the reproductive tract of women.)

How is it treated?

Treatment depends on the type of incontinence and the cause of the problem. Treatment for urinary incontinence can include:

Kegel exercises to strengthen weak pelvic muscles. The muscles can also be tightened by surgery.
Medicine that tightens the urethral muscle, stimulates the bladder to empty, relaxes an irritable bladder, or treats infection.
Bladder training, which teaches you to empty the bladder on schedule rather than waiting until you feel the urge.
A pessary, which is similar to the outer ring of a diaphragm. This is inserted up around a woman's cervix, where it gives support to the pelvic muscles and helps prevent stress incontinence. Your health care provider may advise a pessary to support lax pelvic muscles if this is contributing to the incontinence.
Incontinence pads, available in all sizes and degrees of absorbency, to decrease chances of accidents.
Catheters inserted into the bladder so that it can be mechanically drained on schedule. This is usually done only as a last resort.
Surgery.

Can urinary incontinence be prevented?

You may not be able to prevent urinary incontinence before it occurs because it is a symptom of several possible underlying problems, rather than a condition with a single cause. This is why it is important to discuss incontinence with your health care provider.

Many people may benefit from exercises known as Kegel exercises that strengthen the pelvic floor muscles. To do these, you might find that it helps to pretend you are stopping a flow of urine or trying to stop from passing gas. Tighten these muscles and hold the contraction for 4 seconds. Do this 10 to 20 times. Allow the muscles to relax completely between contractions. Do these sets of contractions 10 times a day. Performing fewer repititions than this will lower the effectiveness of the exercises. You can do Kegel exercises anywhere: while sitting at a desk, waiting for a bus, washing dishes, driving a car, waiting in line, or watching television. No one will know you are doing them. do not do these exercises while you are urinating.

If you have urge incontinence, bladder training can make all the difference in your life. Instead of waiting for your bladder to signal the need to urinate (which is too late for many people), set a schedule for emptying your bladder. Use the toilet 20 to 30 minutes after each meal, at least twice between meals, and before you go to bed. You can set a timer to remind you. Adjust the schedule as you learn the frequency that best meets your needs. Use incontinence pads if you need to. Change them regularly.

Arrange your life so you stay within easy reach of a bathroom. Have a night-light in your bathroom. Don't try to hold your urine, and be willing to ask where the toilet is when you are away from home.

Drink plenty of fluids. Don't try to control incontinence by cutting back on fluids. It won't help and may even be harmful to you.

How can I take care of myself?

Consult your health care provider if you begin to have urinary incontinence. Follow his or her advice for correcting or managing your incontinence.
Limit drinking carbonated, caffeinated, or alcoholic beverages.
Decrease intake of tomatoes, fruit juices, dairy products, spicy foods, sugar, and artificial sweeteners. These things in larger quantities can irritate the bladder.
Drink 8 to 12 eight ounce glasses of liquid each day to avoid concentrated urine that leads to urgency.
Drink liquids throughout waking hours, but limit fluids 3 hours before usual bedtime. Be sure to empty your bladder every 2 to 4 hours and before going to bed.
If you have stress incontinence, do Kegel exercises regularly.
Train your bladder as far as possible to empty on a regular schedule.
Use incontinence pads to prevent wetting of clothing. (The pads are expensive.) Be sure to change the pads regularly.
Keep your groin area as clean and as dry as possible.

For more information visit http://www.nafc.org and http://www.simonfoundation.org.

You may also go to our downloads and print the "Incontinence Questionnaire". Be sure to complete and bring this with you to your next visit.