Urinary Incontinence

What is it and what causes urinary incontinence?

What Causes Urinary Incontinence?

Several muscles and nerves have to work right for you to have normal bladder control. 10 When the system is working normally, your body stores urine in the bladder, which is a balloon-like organ at the bottom of the pelvis.

The bladder is connected to the urethra, which is the tube that drains urine from your body.  A small ring-like muscle called the urethral sphincter stops urine from leaking by staying closed until you’re ready to go to the bathroom.1, 3,10

When your bladder is full, the receptors and nerves send signals to your brain and you will have an urge to urinate.  Then the bladder muscles squeeze to push the urine out through your urethra.  The sphincters open up and the bladder contracts.3,10

If the sphincter or other muscles around the bladder are weakened or otherwise working incorrectly, urine can leak.  There are many things that can interfere with the urinary system working correctly.  They include diseases like diabetes (a condition where blood sugar is too high), stroke, Multiple Sclerosis, and Parkinson’s disease.  Surgery, menopause and obesity can also cause incontinence.  There are many medicines that can cause you to lose bladder control or make incontinence worse: diuretics, sedatives, narcotics, antidepressants, antihistamines, calcium channel-blockers and alpha-blockers.2, 3,10,11

Urinary incontinence is more common in women than in men.  Pregnancy, childbirth and hormonal changes that come with aging can all make incontinence more likely.3  In men, the most common cause of incontinence is prostate surgery.2  For both men and women, injury to the nervous system, birth defects, and physiological problems associated with aging can cause incontinence.3,10,11

The older you are, the more likely you may experience incontinence.  It is a medical problem and your doctor can help you find a solution, often without surgery.3, 6,10,11

Incontinence can be a problem for children too.  Preschoolers by the age of 4 -6 years old should be completely trained during the day with occasional accidents.  Normal school age children should have normal daytime continence with few exceptions.  If this is not happening medical attention should be sought.  There are medical conditions that could be triggering this.  These include urinary tract infections, diabetes, kidney problems, nerve problems, constipation, obstructive sleep apnea (a condition in which breathing is interrupted during sleep, often because of inflamed or enlarged tonsils), obesity or a structural problem in the urinary tract. 7,10,11

There are three forms of urinary incontinence: 2, 3, 6,10,11

  • Stress incontinence is when an action like coughing, sneezing or lifting causes you to leak urine.  It happens because these activities put extra pressure on the muscles around your bladder. 
  • Urge incontinence (overactive bladder) is a urine leak that happens after you feel an overwhelming urge to urinate that cannot be stopped.  This is usually the result of an overactive bladder.
  • Overflow incontinence happens when the bladder is full.  You may experience constant dribbling and need to go to the bathroom often.  It is rare in women and more common if you are a man and have problems with your prostate.

Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.


How is Urinary Incontinence Diagnosed?

Your doctor will ask you questions about your medical history and give you a physical examination.

He/she may perform tests to find the cause of your urinary incontinence.1, 2, 6,10,11  You may need tests such as:

  • a cough stress test
  • urinalysis, which tests your urine sample to show the source of any problems
  • urodynamic testing, which includes several painless tests2 and helps your doctor understand how your urinary system is working.1,2

In some cases, your doctor may find causes of leakage that can be corrected.  Impacted stool, constipation, urinary tract infection and vaginal infection or irritation are some of these causes.  Medications you may be taking and restricted mobility are other causes that are not difficult to resolve.  Pads or diapers can prevent embarrassing leaks, but other treatment options may allow you to stop using them.2,10,11


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 


What are Your Treatment Options?

Your options for treatment depend on three things: what type of incontinence you have, how severe it is, and what’s causing it.

You may need more than one treatment.  It is likely your doctor will recommend the least invasive treatments first (listed below).  If these lifestyle changes do not work, your doctor may move on to other options.9,10

Managing What You Drink.  One method for reducing urinary incontinence is to keep track of the fluids you drink.  Drinks like fruit juices, and caffeine containing drinks such as colas, coffee and tea can irritate the bladder so your doctor may recommend limiting those.  Your doctor may also recommend drinking six to eight glasses of water per day, which can help reduce bladder irritation.2,10

Bladder Training.  Keeping track of how often you urinate, when you have leakage and what you’ve been drinking is the first step toward training your bladder.  Your doctor may recommend you keep a journal to record the details.  If you don’t usually urinate often enough, he or she may also recommend visiting the bathroom every one to two hours when you are awake.  By regularly emptying your bladder, leaking should become less of a problem, particularly with stress incontinence and urge incontinence.2, 3,10,11

Bladder Retraining.  With this technique, you may also use a journal to record the details of when you urinate.  The goal here is to reduce frequency.  Your doctor may suggest you slowly increase the time between bathroom visits by 15 to 30 minutes per week.  You try to extend the time between visits so that you are going only every two to four hours (while awake).  This can help reduce urgency and incontinence.2, 3,10,11

Kegel Exercises.  The pelvic floor muscles support the bladder neck, rectum and vagina.  Dr. Kegel in 1948 suggested using exercises to strengthen the pelvic floor.  Like any exercise, they must be done regularly to remain effective.  With this technique, you contract or tighten the pelvic floor muscles, which are the same muscles you use to hold urine or stop urine flow.  Hold the muscles tight for two seconds and then relax for two.  If this is easy, try holding for five seconds and relaxing for five.  Repeat this cycle ten times and do this three times per day.  If you have trouble figuring out how to tighten these muscles, your doctor can help.2, 3,10,11

If none of these therapies help, your doctor may recommend other treatments as well.  These include:

Medications.  Some drugs help with incontinence by either tightening the bladder neck or allowing the bladder muscle to relax.  If you are a women who has become incontinent after menopause, hormone treatments may help.  All drugs carry risks and possible side effects, so your doctor will need to guide you to the right choice.2, 3,10,11

Medical Devices.  There are devices designed for women with incontinence that can bring you relief.  Some options include a urethral insert which is temporary and acts as a plug to prevent leakage or a pessary which is worn all day.  It helps support your bladder to prevent leakage.3, 9,10

Interventional Therapies.  Some examples include injections of bulking material to help keep the urethra closed and reduce leaking.  Botox and nerve stimulators which may help some people by activating nerves to control urge incontinence.3, 9,10

Surgery.  There are also surgical options if other treatments don’t work for you.  These include the use of slings to create more support for the urethra and bladder and/or the use of inserted devices to control the flow of urine.3, 9,10,11

Other Options.  Absorbent pads are often no more bulky than regular underwear and are very effective at capturing leaks.  If you are incontinent because your bladder does not empty properly, you may need to learn to use a catheter.  Your doctor will show you how to insert this soft tube into your urethra to drain your bladder.1, 3, 9,10

If you and your doctor have tried medical treatments but haven’t been able to stop your incontinence, there are other products you may wish to try.  Ask your doctor to discuss the risks and benefits of any of these treatments mentioned above with you and help you find the appropriate treatment for you.

Left untreated, urinary incontinence is a condition that can be upsetting and isolating.  If you’re suffering from leakage, be sure to visit your doctor.  He or she can work with you to find the treatment that will allow you to resume your normal activities.2


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional.


Resources and References

There are a number of places you can find more information.  Click here to find some help or to view all the references from the article above.

Here are a few places you can go to get additional information.

Urology Care Foundation’s pamphlet: Loss of Bladder Control/Urinary Incontinence
US Dept. of Health and Human Services - How to Do Kegel Exercises
US Dept. of Health and Human Services - Urinary Incontinence in Women
US Dept. of Health and Human Services - Urinary Incontinence in Men


Please note that this information provided by Liberator Medical is not intended to be used in place of a visit, consultation, or advice of a medical professional. 

References

  1. Urology Care Foundation – Neurogenic Bladder Symptoms https://www.urologyhealth.org/urology/index.cfm?article=9#SymptomNB May 2014
  2. Urology Care Foundation – Loss of Bladder Control/Urinary Incontinence https://www.urologyhealth.org/_media/_pdf/AUA2014_BladderIncontinence_web.pdf 2014
  3. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) – Urinary Incontinence in Women https://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.aspx September 2013
  4. Cleveland Clinic, Diseases and Conditions – Neurogenic Bladder https://my.clevelandclinic.org/disorders/neurogenic_bladder/hic-neurogenic-bladder.aspx - Nov 2012
  5. Urology Care Foundation – Neurogenic Bladder Fact Sheet https://www.urologyhealth.org/_media/_pdf/BH_NeurogenicBladder_FactSheet_2014.pdf 2014
  6. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) – Urinary Incontinence in Men https://kidney.niddk.nih.gov/KUDiseases/pubs/uimen/index.aspx June 2012
  7. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) – Urinary Incontinence in Children https://kidney.niddk.nih.gov/KUDiseases/pubs/uichildren/index.aspx#6 June 2012
  8. Urology Care Foundation – Neurogenic Bladder https://www.urologyhealth.org/urology/index.cfm?article=9&display=1   May 2014
  9. Mayo Clinic - Urinary Incontinence, Treatment and Drugs https://www.mayoclinic.org/diseases-conditionsurinary-incontinence/basics/treatment/con-20037883 Aug. 2014
  10. Slack A, Newman D, Wein A, Fast Facts: Bladder Disorders, Health Press, Oxford UK, 2011
  11. Urinary Incontinence , Pat D O’Donnell MD, Mosby Ltd, St Louis, 1997

Information is as of 12/2014. Please check references for updated information. 

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