Urinary Incontinence
What is it?
Urinary incontinence, the partial or complete inability to control the urge to urinate, is a very common problem in older people (and twice as common in women). Incontinence is not, however, an inevitable consequence of aging; it is caused by some underlying disorder. There are different types of incontinence: 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 a small amount of urine to be released. Urge incontinence occurs when a sudden need to urinate is accompanied by an inability to control the bladder, sometimes releasing large amounts of urine. Incontinence causes embarrassment, depression, and social isolation, and is often the final reason why people are placed in nursing homes. 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.
What Causes It?
- 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.
- 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.
- 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.
Prevention
- Hormone replacement therapy may be prescribed for postmenopausal women.
Diagnosis
- Patient history and physical examination.
- An "incontinence chart" or voiding record of the time, amount, and circumstances of urination.
- Catheterization of the bladder to measure amount of urine remaining in the bladder after urination.
- Observation of the effects of filling the bladder using a catheter.
- Microscopic examination and culture of urine.
How to Treat It
- Education is important. Sometimes mere interpretation of the incontinence chart will lead to complete or greatly improved bladder control.
- In many cases bladder control can be regained with techniques known as bladder training (for urge incontinence) and Kegel exercises (for stress incontinence). 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. Kegel exercises involve repetitive contractions of the pelvicfloor muscles to strengthen them and prevent stress incontinence.
- 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.
- Anticholinergic drugs (which block the neurotransmitter acetylcholine), imipramine, and estrogen are sometimes helpful in treating incontinence.
- Antibiotics may be prescribed to treat an associated bacterial infection.
- Your doctor should be consulted if you think that any medications may be contributing to incontinence.
- 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.
- A bedside toilet may help with nighttime urgency. Avoid drinking excess fluids for two to three hours prior to going to bed.
- Surgery may be used to relieve pressure on bladder nerves, reduce blockage of the urethra, or repair damaged muscles or other structures.
- In rare, severe cases, an indwelling catheter or suprapubic tube may be indicated.
When to Call a Doctor
- Call a doctor if you experience any bladder control problems.
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Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.