Urinary incontinence is the inability of the bladder to retain urine. Incontinence is seen mostly among the elderly and among women who have had children. It is rare in children.
Incontinence is usually a symptom of an underlying disorder and, if treated properly, can be improved or cured. If left untreated, it can lead to bladder infections or urinary tract infections. Also, skin that is exposed to leaked urine can develop an uncomfortable rash or other disorder.
Approximately 10 million American adults are incontinent. Women are more likely to suffer from this disorder for biological reasons. Women who have multiple vaginal births experience weakening in their pelvic floor. Weakening of this group of muscles and tissues can lead to leakage. In addition, the distance from the bladder to where urine actually leaves the body is shorter in women than in men.
During normal urination, the bladder fills and then sends a message to the nerves in the spinal cord. These nerves then begin the voiding reflex, or contraction of the bladder muscles that sends urine into the urethra and out of the body.
Incontinence is grouped into three major categories: stress incontinence, urge incontinence, and overflow incontinence. All three of these can occur when normal urinary control is disrupted.
Stress incontinence is defined by a weakening of the muscles surrounding the urethra. The muscles cannot handle an increase in bladder pressure, usually leading to a small amount of leakage. Coughing, sneezing, laughing, and exercising can exert extra pressure on the bladder.
Urge incontinence means that the bladder contracts when it is full; the person has little or no control over the urge to void. This is a common form of incontinence among people with illnesses involving the central nervous system, such as stroke, Alzheimer’s disease, and multiple sclerosis.
Overflow incontinence means that a person’s bladder is always partially full—excess urine only spills out in small amounts. Overflow incontinence is usually associated with diabetes, an enlarged prostate that blocks urine flow (in men), or a fibroid or ovarian tumor (in women).
Other causes of incontinence are: surgery on or near the urinary tract, pregnancy, childbirth, and a slipped spinal disk that presses on the nerves. Incontinence may be a side effect of medications such as diuretics, sedatives, antidepressants, and antihistamines. Consulting a doctor and switching medication may alleviate the problem.
Incontinence can usually be treated and cured, or at least improved. Women who suffer from stress incontinence can do Kegel exercises to strengthen their pelvic floor muscles. These muscles support the uterus and bladder and tend to weaken with pregnancy and age. Kegel exercises require a woman to slowly contract her pelvic floor muscles while urinating in order to stop urine flow. The exercises can also be done at other times; the more a woman performs these, the stronger the muscles will be.
Biofeedback is another popular non-medical approach used to improve incontinence. The purpose of biofeedback is to teach a patient how to monitor his or her body and use muscle relaxation or guided imagery to alter the body’s responses. Biofeedback should be used only after consultation with a doctor, and under the care of a biofeedback expert. The guide teaches a person to monitor his or her own physiological responses so that eventually the patient can monitor them without a guide.
Another behavior modification exercise that may treat incontinence is bladder retraining. The patient writes down liquid intake, frequency of urination, and quantity of urination for one week; then he or she is advised to urinate at scheduled intervals. Over a period of a few weeks, the length of time between trips to the bathroom increases.
A doctor may also choose to prescribe medication for incontinence. Different ones are available depending on the type of incontinence. Some women with stress incontinence use a device called a pessary. Pessaries fit into the vagina to support the pelvic muscles, much like tampons.
Surgery is recommended only in extreme cases. For women who are incontinent due to childbirth, surgery can be effective to repair damaged muscles and ligaments. If incontinence cannot be controlled, it can be managed with absorbent underwear or devices that capture urine in plastic bags.
Avoid constipation, as the straining that accompanies it can weaken bladder muscles. Try to keep body weight down—excess weight puts pressure on bladder muscles as well. Alcohol, caffeine, sugar, and spicy foods can irritate the bladder.
