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14 / 12 / 2017
Urinary Incontinence
 
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Urinary incontinence - loss of bladder control

 
 
 
Urinary incontinence is the inability to control the release of urine from your bladder.

Although common, urinary incontinence isn't necessarily a normal part of aging or, in women, an inevitable consequence of childbirth or changes after menopause. It's a medical condition that can have many different causes, some relatively simple and temporary and others more involved and long term.

If you're having trouble with incontinence, don't hesitate to see your doctor. In many cases, incontinence can be eliminated. Even if it can't be completely eliminated, modern products and ways of managing urinary incontinence can ease your discomfort and inconvenience.

Signs and symptoms

Urinary incontinence is the inability to control the release of urine from your bladder. The problem has varying degrees of severity. Some people experience only occasional, minor leaks — or dribbles — of urine. Others wet their clothes frequently. For a few, incontinence means both urinary and fecal incontinence — the uncontrollable loss of stools.

Urinary incontinence is classified by your symptoms or the circumstances at the time you leak urine. The five main types of urinary incontinence and their characteristics are:

  • Stress incontinence. This is loss of urine when you exert pressure — stress — on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. It has nothing to do with psychological stress. The problem is especially noticeable when you let your bladder get too full. Stress incontinence is the most common type of incontinence, often affecting women. Physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to this type of incontinence.

  • Urge incontinence. This is a sudden, intense urge to urinate, followed by a loss of urine. Your body may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may need to urinate often. The urge to urinate may even wake you up several times a night. Some people with urge incontinence have a strong urge to urinate when they hear water running or after they drink only a small amount of liquid. Simply going from sitting to standing may even cause you to leak urine. Urge incontinence may be caused by a urinary tract infection or by anything that irritates the bladder. It can also be caused by bowel problems or damage to the nervous system associated with multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke or injury. In urge incontinence, the bladder is said to be "overactive" — it's contracting even when your bladder isn't full. In fact, urge incontinence is sometimes called overactive bladder or irritable bladder.

  • Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence. This is an inability to empty your bladder, so it overflows uncontrollably and you leak urine. With overflow incontinence, you may feel as if you never completely empty your bladder — or that you need to empty your bladder but can't. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence is common in people with a weak bladder or blocked urethra and in men with prostate gland problems. Nerve damage from diabetes also can lead to overflow incontinence. Some medications can cause or increase overflow incontinence.

  • Mixed incontinence. This means having more than one type of incontinence, typically stress incontinence and urge incontinence. Usually one type is more bothersome than the other is. The cause of the two forms may or may not be related.

  • Functional incontinence. Many older adults, especially those in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants in a hurry. Someone with Alzheimer's disease may not think well enough to plan a timely trip to the bathroom. This type of incontinence is called functional incontinence.

You may hear other terms to describe incontinence. Reflex incontinence occurs when people with neurologic injury — such as those with paralysis from a spinal cord injury that affects nerves that run to the bladder — experience urine loss without any sensation or warning at all. An abnormal opening (fistula) between the bladder and another structure or a leak in the urinary system also may cause incontinence.

Total incontinence is a term that's sometimes used to describe continuous leaking of urine, day and night, or periodic large volumes of urine and uncontrollable leaking. Some people have this type of incontinence because they were born with an anatomic defect. It can also be caused by a spinal cord injury or by injury to the urinary system from surgery.

Nocturnal enuresis is the medical term for nighttime bed-wetting. Some children, mainly boys, who are otherwise toilet-trained wet the bed at night for a variety of reasons. Adults can lose control of their bladder at night, too, possibly because of alcohol or medications. The aging bladder also is more likely to have difficulty storing urine at night because of an abnormally high production of urine during nighttime.

Urinary incontinence isn't a disease itself. It indicates some underlying problem or condition that likely can and should be treated. A thorough evaluation by your doctor can help determine what's behind your incontinence.

Causes

Your urinary tract collects, stores and eliminates urine from your body. When you eat and drink, your body absorbs liquid. Excess fluid and liquid waste accumulate in your bloodstream. Your kidneys — a pair of bean-shaped organs — filter your blood, removing liquid waste to make urine. Adult-sized kidneys eliminate about a quart and a half of urine each day.

From your kidneys, urine travels down a pair of long tubes called ureters and empties into your bladder — a muscular, balloon-like sac that stores urine. Connected to the bottom (neck) of your bladder is a short tube called the urethra. Urine exits your body through the urethra. In women, the urethral opening is located just above the vagina. In men, the urethral opening is at the tip of the penis.

When you urinate, several things happen. First the pelvic floor muscles relax, allowing urine to pass out of your body easily. Then your bladder muscle (detrusor muscle) contracts, pushing urine out of your bladder and through the urethra. Between episodes of urination, your bladder muscle relaxes, allowing urine to be stored in your bladder. At the same time, the pelvic floor muscles lightly contract, holding in the urine and supporting your bladder from underneath.

Nerves that run from your spinal cord to your bladder coordinate the action of these muscles. When you feel the urge to urinate, nerves in your bladder have sent a signal to your brain that your bladder is full. Your brain is responsible for keeping your bladder from contracting without your permission. But certain neurologic conditions such as Alzheimer's or stroke may impair the brain's ability to keep the bladder from firing and causing leakage.

The bottom line is that good bladder control isn't simple. You learn how to hold on until you get to the bathroom as a child. But urination is a complex process that involves relaxing part of the pelvis while contracting another part. The many organs, tubes, muscles and nerves in your urinary system must work together. If any part malfunctions, incontinence can result.

Urinary incontinence has many possible causes. Some causes are temporary and can be managed with simple treatment. Examples include:

  • Consuming alcohol to excess. Alcohol is a diuretic. It causes your bladder to fill quickly, triggering an urgent and sometimes uncontrollable need to urinate. In addition, alcohol can temporarily impair your ability to recognize the need to urinate — and act on that need in a timely manner.

  • Drinking a lot of fluid. Drinking a lot of water or other beverages, particularly in a short period of time, increases the amount of urine your bladder has to deal with and may result in an occasional accident.

  •  Not drinking enough fluid. If you have urge incontinence, you may try to limit your fluids to reduce the number of trips to the bathroom. However, if you don't consume enough liquid to stay hydrated, your urine can occasionally become overconcentrated. This collection of concentrated salts can irritate your bladder and worsen your urge incontinence.

  • Overdoing the caffeine. Caffeine also is a diuretic. It causes your bladder to fill more quickly than usual so that you suddenly and perhaps uncontrollably need to urinate.

  • Consuming foods and beverages that irritate your bladder. Carbonated drinks, tea and coffee — with or without caffeine — may irritate your bladder and cause episodes of urge incontinence. Citrus fruits and juices and artificial sweeteners also can be sources of aggravation.

  • Taking certain medications. Sedatives, such as sleeping pills, can sometimes interfere with your ability to control bladder function. Other medications — including water pills (diuretics), muscle relaxants and antidepressants — can cause or increase incontinence. Some high blood pressure drugs, heart medications and cold medicines also can affect bladder function. After surgery, some people experience temporary overflow incontinence from the lingering effects of anesthesia.

  • Urinary tract infection. This very common condition can cause bladder irritation and ultimately incontinence. This infection involves your urinary tract, usually your bladder — in which case it's called a bladder infection (cystitis). Germs from the outside enter your urethra and bladder, then start to multiply. The resulting infection irritates your bladder, causing you to experience strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.

  • Constipation. The rectum is located near the bladder and shares many of the same nerves. Unmoved stools in your rectum cause these nerves to be overactive, causing you to leak urine.

More often, urinary incontinence is a persistent condition caused by some underlying physical problem — weakened muscles, nerve problems or an obstruction in your urinary tract. Factors that can lead to chronic incontinence include:

  • Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of childbirth can weaken the pelvic floor muscles and the ring of muscles that surrounds the urethra (urinary sphincter). The result is often stress incontinence — urine escapes past the weakened muscles whenever pressure is placed on your bladder. The stress of childbearing also can damage bladder nerves or lead to a dropped (prolapsed) bladder — a cystocele. With a cystocele, your bladder gets pushed out of position and protrudes into your vagina. Signs and symptoms include the feeling of a protrusion in your vagina and often incontinence. Incontinence related to childbirth may develop right after delivery or not until many years later.

  • Hormonal changes following menopause. After menopause, a woman's body produces less of the hormone estrogen. This drop in estrogen can contribute to incontinence. In women, estrogen helps keep the lining of the bladder and urethra healthy. With less estrogen, these tissues lose some of their ability to close — meaning that your urethra can't hold back urine as easily as before. Meanwhile, aging of the bladder muscle affects both men and women, leading to a decrease in the bladder's capacity to store urine.

  • Hysterectomy. In women, the bladder and uterus (womb) lie close to one another and are supported by the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — runs the risk of damaging muscles or nerves of the urinary tract, which can lead to incontinence.

  • Interstitial cystitis. This inflammation of the bladder wall is a cause of painful and frequent urination, and possibly incontinence. This chronic condition usually affects women. Its cause isn't clear.

  • Prostatitis. In rare cases, this common condition in men can cause incontinence. Prostatitis is inflammation of the prostate gland — an organ about the size and shape of a walnut located just below the bladder. The prostate, which produces seminal fluid, actually surrounds the urethra. If it becomes infected or inflamed, it can occasionally swell and constrict the urethra. This can block normal urine flow, leading to urinary urgency and frequency. Rarely, this also causes incontinence.

  • Enlarged prostate. In older men, incontinence often stems not from irritation but from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH). Around age 40 in men, the prostate begins to enlarge slightly. As the gland enlarges, it can constrict the urethra and block the flow of urine. For some men, this problem results in urge or overflow incontinence.

  • Prostate cancer. In men, incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments (surgery or radiation) for prostate cancer.

  • Bladder cancer. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer. Other signs and symptoms of bladder cancer include blood in the urine and pelvic pain.

  • Neurologic disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal cord injury can damage the nerves of your bladder, your nervous system and muscles.

  • Obstruction. A tumor anywhere along your urinary tract can obstruct the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage.

Obesity is another risk factor for incontinence, especially for women. Being overweight puts constant and higher pressure on your bladder and surrounding muscles, weakening them and allowing urine to leak out when you cough or sneeze.

A chronic cough can cause episodes of incontinence or aggravate incontinence with other causes. Constant coughing puts stress on your urinary sphincter. Longtime smokers often experience stress incontinence for this reason.

High-impact sports — such as running, basketball or gymnastics — can cause episodes of incontinence in otherwise healthy women. These vigorous activities put sudden, strong pressure on your bladder, allowing urine to leak past your urinary sphincter. However, no data links high-impact sports to an increased risk of chronic stress incontinence.

Any illness, injury or disability that keeps you from getting to the toilet in time also is a potential cause of incontinence.

In children, urinary incontinence may have several causes. Children who wet the bed at night may be slower to develop the brain control needed to allow storage of urine all night. These children may also produce more urine at night or their brains may lack the ability to recognize that the bladder is overfilled when they're asleep. Most children naturally outgrow nighttime incontinence. Children who experience daytime incontinence should undergo evaluation as they may have a urinary tract infection or a developmental abnormality. Some children simply may hold their urine longer than they should.

Risk factors

With so many possible causes, it's not surprising that incontinence is common.

Women are twice as likely as men are to have incontinence. Pregnancy and childbirth, menopause, and the structure of the female anatomy account for this difference. Men with prostate gland problems are at increased risk of incontinence. Bed-wetting in children can run in families.

Age is a risk factor for loss of bladder control. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold. However, that doesn't mean that you'll have incontinence just because you're getting older. Incontinence isn't normal at any age — except during infancy.

Other risk factors for incontinence include kidney disease, obesity, diabetes, smoking and the use of certain medications.

When to seek medical advice

You may feel uncomfortable discussing incontinence with your doctor. But seeking medical advice for incontinence is important for several reasons.

First, incontinence may indicate a more serious underlying condition, such as cancer or a nerve disorder. Second, incontinence may be causing you to restrict your activities and limit your social interactions to avoid embarrassment. In addition, urinary incontinence may increase the risk of falls in older adults as they rush to make it to the bathroom.

A few isolated incidents of incontinence don't necessarily require medical attention. But if incontinence is frequent or affecting your quality of life, talk to your doctor.

Screening and diagnosis

The first step in diagnosing urinary incontinence is to see your doctor for a complete medical exam.

Your doctor will ask about your symptoms and medical history. How often do you need to urinate? When do you leak urine? Do you have trouble emptying your bladder? Are you experiencing any symptoms in addition to incontinence? Your answers to these questions will help your doctor determine what type of incontinence you have.

A complete physical examination, focusing on your abdomen and genitals also may give clues to your incontinence. Your doctor will look for reasons for your incontinence, such as a urinary tract infection, mass, hernia or compacted stool. If the reason for your incontinence is harder to find, your doctor may want to do some tests. These include:

  • Bladder diary. Your doctor may go over a bladder diary that he or she has asked you to complete at home over several days. You simply record how much you drink, when you urinate, the amount of urine you produce, whether you had an urge to urinate and the number of incontinence episodes. To measure your urine, your doctor may give you a pan that fits over your toilet rim. The pan has markings like a measuring cup.

  • Urinalysis. A sample of your urine is sent to a laboratory, where it’s checked for signs of infection, traces of blood or other abnormalities. For the sample to be collected, you're asked to urinate into a container. A urine culture is a lab test that specifically checks for signs of infection in your urine. A urine cytology involves a check of your urine for cancer cells.

  • Blood test. Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.

If further testing is needed, you'll likely be referred to a doctor who specializes in urinary disorders in men and women (urologist). Women might also be referred to a doctor who focuses on urologic problems in women (urogynecologist). At the specialist's office, you may undergo additional testing such as:

  • Postvoid residual (PVR) measurement. This test helps your doctor determine whether you have difficulty emptying your bladder. For the procedure, you're asked to urinate (void) into a funnel-like container that allows your doctor to measure your urine output. Then your doctor checks the amount of residual urine in your bladder using a catheter — a thin, soft tube that's inserted into your urethra and bladder to drain any remaining urine — or an ultrasound device. For the ultrasound test, a wand-like device is placed over your abdomen. The device sends sound waves through your pelvic area. A computer transforms these sound waves into an image of your bladder, so your doctor can see how full or empty it is. A large amount of leftover (residual) urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

  • Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

  • Stress test. For this test, you're asked to cough vigorously or bear down as your doctor examines you and watches for loss of urine.

  • Urodynamic testing. These are tests that measure pressure in your bladder both at rest and when filling. A doctor or nurse inserts a catheter into your urethra and bladder. The catheter is used to fill your bladder with water. As your bladder fills, pressure within your bladder is recorded. Normally, pressure increases by only very small amounts during filling. However, in some people with incontinence, the bladder goes into spasms as it fills. This test also helps your doctor measure the strength of your bladder muscle.

  • Cystogram. In this special X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, your doctor injects a fluid containing a special dye. As you urinate this fluid back out of your body, images show up on a series of X-rays. These images help reveal problems with your urinary tract.

  • Cystoscopy. In this procedure, a thin tube with a tiny lens (cystoscope) that allows your doctor to see the inside of your urethra and bladder is inserted into your urethra. With the aid of this device, your doctor can check for — and potentially remove — abnormalities in your urinary tract, such as bladder stones.

Complications

Urinary incontinence can cause rashes, skin infections and sores from constantly wet skin. Incontinence can also contribute to repeat urinary tract infections. But more distressing than these physical problems may be the effect incontinence can have on your quality of life.

Urinary incontinence may keep you from participating in activities. You may stop exercising, quit attending social gatherings or even refrain from laughing because you're afraid of an accident. You may even reach a point where you stop traveling or venturing out of familiar areas where you know the locations of toilets.

Urinary incontinence may negatively affect your work life. Your urge to urinate may keep you away from your desk or cause you to have to get up often during meetings. The problem may be so distressing that it disrupts your concentration at work. Urinary incontinence may also keep you up at night, so you're tired most of the time.

Perhaps most distressing is the impact incontinence can have on your personal life. Your family may not understand changes in your behavior or may grow frustrated at your many trips to the bathroom. You may avoid sexual intimacy because of embarrassment caused by urine leakage. It's not uncommon to experience anxiety and depression along with incontinence.

Treatment

Treatment for urinary incontinence depends on the type of incontinence, the severity of your problem and the underlying cause. Your doctor will recommend the approaches that are best suited to your condition. Often a combination of treatments is used. Most people treated for urinary incontinence see a dramatic improvement in their symptoms.

Treatment options for urinary incontinence fall into four broad categories — behavioral techniques, medications, devices and surgery.

Behavioral techniques
Behavioral techniques and lifestyle changes work well for certain types of urinary incontinence. They may be the only treatment you need.

  • Bladder training. Your doctor may recommend bladder training — alone or in combination with other therapies — to control urge and other types of incontinence. Bladder training involves learning to delay urination after you get the urge to go. You may start by trying to hold off for 10 minutes every time you feel an urge to urinate. Then try upping the waiting period to 20 minutes. The goal is to lengthen the time between trips to the toilet until you're urinating every two to four hours.

Bladder training may also involve double voiding — urinating, then waiting a few minutes and trying again. This exercise can help you learn to empty your bladder more completely to avoid incontinence. In addition, bladder training may involve learning to control urges to urinate. When you feel the urge to urinate, you're instructed to relax — breathe slowly and deeply — or to distract yourself with an activity.

Nighttime bladder training may be reinforced with devices such as moisture alarms, which wake you up when you begin to urinate. They are particularly helpful for children who wet the bed at night. The devices consist of a fluid-sensitive pad worn in pajamas, a wire connecting to a control, and an alarm that sounds or vibrates when moisture is first detected. Moisture alarms help children learn to awaken when their bladder is full, in time to go to the bathroom.

  • Scheduled toilet trips. This means timed urination — going to the bathroom according to the clock rather than waiting for the need to go. Following this technique, you go to the toilet on a routine, planned basis, usually every two to four hours.

  • Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises three or four times a day to treat your incontinence. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegels), imagine that you're trying to stop from passing gas. Squeeze the muscles you would use and hold for a count of three. Relax, count to three again, then repeat. You can do these exercises almost anywhere — while you're driving, watching television or sitting at your desk at work.

With Kegels, it can be difficult to know whether you're contracting the right muscles. In general, if you sense a pulling feeling when you squeeze, you're using the right muscles. Men may feel their penis pull in slightly toward their body. To double-check that you're contracting the right muscles, try the exercises in front of a mirror. Your abdominal, buttock or leg muscles shouldn't tighten if you're isolating the muscles of the pelvic floor. You can also test yourself by trying to stop your urine midstream, although most people with incontinence can't stop their urine midstream, so don't lose hope if you can't. Another way to be sure you're doing Kegels correctly is a simple finger test. Place a finger in your anus or vagina (for women). Then squeeze around your finger. The muscles you contract are your pelvic floor muscles.

If you're still not sure whether you're contracting the right muscles, you can ask your doctor for help. Your doctor can refer you to a physical therapist for biofeedback techniques that will help you identify and contract the right muscles.

After several months of doing pelvic floor muscle exercises correctly, you should notice improvement in your urinary control. To further strengthen their urinary and pelvic floor muscles, women can use "vaginal weights." These are tampon-shaped cones of increasing weight that women can insert into their vaginas and try to hold in place.

  • Electrical stimulation. In this procedure, electrodes are temporarily inserted into your rectum or vagina to stimulate and strengthen pelvic floor muscles. Gentle electrical stimulation can be effective for stress incontinence and urge incontinence, but it takes several months and multiple treatments to work.

  • Fluid and diet management. In some cases, you can simply modify your daily habits to regain control of your bladder. You may need to cut back on or avoid alcohol or caffeine, if either cause you incontinence. If acidic foods irritate your bladder, cutting back on such triggers may rid you of your problem. For some people, reducing liquid consumption before bedtime is all that's needed. Losing weight also may eliminate the problem.

  • Other techniques. For stress incontinence, contracting your urinary muscles to hold urine in or crossing your legs at certain times — such as when you feel a sneeze coming — may help significantly.

Medications
Many times, urinary incontinence can be corrected with the help of medication. Drugs commonly used to treat incontinence include:

  • Anticholinergic (antispasmodic) drugs. These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence. Examples include tolterodine (Detrol), oxybutynin (Ditropan) and hyoscyamine (Levsin). These drugs can be very effective at controlling incontinence, but a side effect is dry mouth. To combat dry mouth, you may be tempted to drink more water. But that may not help your incontinence. Your doctor may recommend that you suck on a piece of candy or chew gum instead to produce more saliva.

  • Imipramine (Tofranil). This antidepressant may be used to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.

  • Pseudoephedrine. In the past, some doctors recommended medications that contain pseudoephedrine (Dimetapp, Sudafed) to treat mild to moderate stress incontinence. These cold medications slightly tighten the urinary sphincter. However, these products can cause dangerous, rapid heartbeats, so they're no longer used for incontinence.

  • Hormone replacement therapy. After menopause, a woman's body produces less of the hormone estrogen. This drop in estrogen can contribute to changes in the skin lining the urethra and vagina, which can contribute to the development of incontinence in some women. Applying estrogen in the form of a vaginal cream, ring or patch may help relieve some of the symptoms of incontinence in these women. Oral estrogen may not have the same benefits as topical creams and ointments. Taking HRT as a combination therapy — estrogen plus progestin — can result in serious side effects and health risks. Work with your doctor to evaluate the options and decide what's best for you.

In children, nighttime incontinence may be due to a shortage of the nighttime production of a hormone called antidiuretic hormone (ADH). This hormone slows the making of urine. The body normally produces more ADH at night, so the need to urinate is lower. If a child doesn't produce enough ADH at night, the making of urine doesn't slow down and the bladder overfills. If the child doesn't sense the bladder filling and awaken to urinate, he or she wets the bed. A synthetic version of ADH — known as desmopressin (DDAVP) —is available as a nasal spray or pill for children to use before bedtime.

  • Antibiotics. If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.

  • Others. Your doctor may prescribe drugs that actually relax your urinary sphincter or make your bladder contract more, depending on the underlying cause of your incontinence.

If you're a man with incontinence caused by an enlarged prostate gland, your doctor may prescribe medications or other therapies to treat your condition. The goal may be to relax muscles around your urethra so that you can urinate with more control or to shrink the size of your prostate.

Drugs can be effective at treating urinary incontinence. But they may have side effects. Ask your doctor about what to expect from a treatment.

If a medication you're taking — such as a sedative — is the cause of incontinence, your doctor may lower the dosage or change the medication to relieve that side effect.

Medical devices
Several medical devices are available to help treat incontinence. They're designed specifically for women and include:

  • Urethral inserts. These are small, tampon-like disposable devices or plugs that a woman inserts into her urethra — the tube where urine exits the body — to prevent urine from leaking out. Urethral inserts aren't for everyday use. They work best for women who have predictable incontinence during certain activities, such as while playing tennis. The device is inserted before the activity. Whenever the woman needs to urinate, she simply removes the device. Urethral inserts are available by prescription.

  • Pessary. Your doctor may prescribe a pessary — a stiff ring that you insert into your vagina and wear all day. The device helps hold up your bladder, which lies near the vagina, to prevent urine leakage. You need to regularly remove the device to clean it. You may benefit from a pessary if you have incontinence due to a dropped (prolapsed) bladder or uterus.

Surgery
If other treatments aren't working, there are nearly 100 variations of surgical procedures used to fix problems that cause urinary incontinence. In men, surgery may be necessary to remove an enlarged prostate gland that's constricting the urethra. Surgical removal of a tumor in the bladder or a uterine fibroid also may eliminate incontinence.

If your bladder or uterus has slipped out of position, a surgeon can put the structure back in place with a variety of techniques. Rarely, surgery to treat urinary incontinence may involve enlarging the bladder or correcting a birth defect. Or surgery may be needed to bolster weakened urinary sphincter muscles.

Some of the more common procedures include:

  • Artificial urinary sphincter. This small device is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland, and it's rarely used for women with stress incontinence. Shaped like a doughnut, the device is implanted around the neck of your bladder. The fluid-filled ring keeps your urinary sphincter shut tight until you're ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine from your bladder to be released. This surgery can cure or greatly improve incontinence in more than 70 percent to 80 percent of men with incontinence. Complications include malfunction of the device — which means the surgery will need to be repeated — and infection, but infection is uncommon.

  • Bulking material injections. Some women with stress incontinence benefit from urethral injections of bulking agents. This procedure involves injecting bulking materials — usually animal or human collagen — into the tissue surrounding the urethra or the skin next to the urinary sphincter. The injection tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. It usually needs to be repeated every six to 18 months, because the bulking agents that are currently available don't remain effective over time. There is a risk of rejection or infection, and the procedure is generally not as effective as open surgery.

  • Sacral nerve stimulator. This small device acts on nerves that control bladder and pelvic floor contractions. The device, which resembles a pacemaker, is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve — an important nerve in bladder control that runs from your lower spinal cord to your bladder. Through the wire, the device emits electrical pulses that stimulate the nerve and help control the bladder. The pulse doesn't cause pain and may improve or cure 50 percent to 75 percent of people with tough-to-treat urge incontinence or urinary retention leading to overflow incontinence. Possible complications include infection, but the device can be removed.

  • Sling procedure. The most popular surgery for women with stress incontinence is the sling procedure. During this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra. Or the surgeon may use a strip of synthetic material or a strip of tissue from a donor or cadaver. These strips act like a hammock, compressing the urethra to prevent leaks that occur with the activities of daily living.

The success of your treatment depends on the right diagnosis. Talk to your doctor about the specifics and possible complications of any treatment. Ask questions and express concerns to help find out which treatment is right for you.

Absorbent pads and catheters
If medical treatments can't completely eliminate your incontinence — or you need help until a treatment starts to take effect — you can try products that help ease the discomfort and inconvenience of leaking urine.

Various absorbent pads are available to help you manage urine loss. Most products are no more bulky than normal underwear and can be worn easily under everyday clothing. Men who have problems with dribbles of urine can use a drip collector — a small pocket of absorbent padding that's worn over the penis and held in place by closefitting underwear. Men and women can wear panty liners or pads in their underwear to collect urine. Adult diapers are available in both disposable and reusable forms and come in a variety of sizes. Some people find wearing plastic underwear over their regular underwear helps keep them dry. Others opt for washable underwear and briefs with waterproof panels. Incontinence products can be purchased at drugstores, supermarkets and medical supply stores.

If you're incontinent because your bladder doesn't empty properly, your doctor may recommend that you learn to insert a soft tube (catheter) into your urethra several times a day to drain your bladder. This may give you more control, especially if you suffer from overflow incontinence.

In some cases people have to keep a catheter in constantly. The catheter is connected to an external bag to hold urine. As needed, the bag is emptied.

Prevention

Incontinence may or may not be something you can prevent. Oftentimes the cause of incontinence is out of your control.

However, you may be able to decrease your risk of urinary incontinence by taking good care of yourself and keeping or getting your weight under control. Because pregnancy and childbirth can weaken the urinary sphincter and pelvic floor muscles, doctors may advise pregnant women to do Kegel exercises during pregnancy as a preventive step.

Avoiding or limiting certain foods and drinks may help prevent incontinence. For example, if you know that drinking more than two cups of coffee makes you have to urinate uncontrollably, cutting back to one cup of coffee or forgoing caffeine may be all that you need to do.

Including more fiber in your diet or taking fiber supplements can help prevent constipation, which can be a cause of incontinence. Your doctor may recommend that you drink more or less water as a preventive measure, depending on your bladder problem.

Self-care

Problems with urine leakage may require you to take extra care to keep your skin clean and dry. You may need to use a washcloth to clean and dry yourself. Products such as powders, moisturizers and deodorizing tablets are available that can help you feel clean and eliminate urine odor.

Coping skills

People cope with urinary incontinence in a variety of ways. Some people choose to wear absorbent pads and never mention the problem to anyone. Perhaps you cope by always carrying an extra set of clothes with you, in case of an accident. Or you manage by staying at home or only going to places that have easily accessible toilets. You may even cut back on drinking liquids — and risk dehydration — to avoid wetting episodes.

But there are better ways to manage urinary incontinence, and new treatments for incontinence are continually being discovered. That's why it's important to see your doctor.

Many people feel embarrassed about incontinence. But it's a common problem. And fortunately, the stigma surrounding this condition is slowly eroding. Many people are discussing it with more openness. Pharmaceutical companies are now advertising medications for overactive bladder on television, increasing awareness of the problem.

Talk to your doctor about treatments for incontinence. You'll be on your way to regaining an active and confident life — and control of your bladder.

Urinary incontinence - loss of bladder control > 1 > 2 > 3 > 4

 
 
 
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