Urinary Incontinence in Adults: Acute and Chronic Management

Urine travels down tubes called ureters into a muscular sac
called the urinary bladder, which stores the urine.

When you are ready to go to the bathroom,
your brain tells your system to relax.

Urine
travels out of your bladder through a tube called the urethra. You release
urine by relaxing the urethral sphincter and contracting the bladder muscles.
The urethral sphincter is a group of muscles that tightens to hold urine in and
loosens to let it out.

Purpose of This Booklet

Many people lose urine when they don’t want to. When this
happens enough to be a problem, it is called urinary incontinence.

Urinary incontinence is very common. But some people are too embarrassed to get
help. The good news is that millions of men and women are being successfully
treated and cured.

Reading this booklet will help you. But it is
important to tell your health care provider (such as a doctor or nurse) about
the problem. You may even want to bring this booklet with you to help you talk
about your incontinence.

Causes of Urinary Incontinence

Urinary incontinence is not a natural part of
aging. It can happen at any age, and can be caused by many physical
conditions. Many causes of incontinence are temporary and can be managed with
simple treatment. Some causes of temporary incontinence are:

• Urinary
  tract infection
• Vaginal infection or irritation
• Constipation
• Effects of medicine

Incontinence can be caused by
other conditions that are not temporary. Other causes of incontinence are:

• Weakness of muscles that hold the bladder in place
• Weakness of
  the bladder itself
• Weakness of the urethral sphincter muscles
• Overactive bladder muscles
• Blocked urethra (can be from prostate
  enlargement)
• Hormone imbalance in women
• Neurologic
  disorders
• Immobility (not being able to move around)

In
almost every case, these conditions can be treated. Your health care provider
will help to find the exact cause of your incontinence.

Types of Incontinence

There are also many different
types of incontinence. Some people have more than one type of incontinence. You
should be able to identify the type of incontinence you have by comparing it to
the list below.

Urge incontinence:

People with urge incontinence lose urine as soon as they feel a strong need
to go to the bathroom. If you have urge incontinence you may leak urine:

• When you can’t get to the bathroom quickly enough
• When you drink
  even a small amount of liquid, or when you hear or touch running water

You may also…

• Go to the bathroom very often; for
  example, every two hours during the day and night. You may even wet the bed

Stress incontinence:

People with stress incontinence lose urine when they exercise or move in a
certain way. If you have stress incontinence, you may leak urine:

• When
  you sneeze, cough, or laugh
• When you get up from a chair or get out of
  bed
• When you walk or do other exercise

You may
also…

• Go to the bathroom often during the day to avoid accidents

Overflow incontinence:

People with overflow incontinence may feel that they never completely empty
their bladder. If you have overflow incontinence, you may:

• Often lose
  small amounts of urine during the day and night
• Get up often during
  the night to go to the bathroom
• Often feel as if you have to empty
  your bladder but can’t
• Pass only a small amount of urine but feel as
  if your bladder is still partly full
• Spend a long time at the toilet,
  but produce only a weak, dribbling stream of urine

Some
people with overflow incontinence do not have the feeling of fullness, but they
lose urine day and night.

Finding the Cause of Urinary Incontinence

Once you tell your health care
provider about the problem, finding the cause of your urinary incontinence is
the next step.

Your health care provider will talk with you about your
medical history and urinary habits. You may be asked to keep a record of your
usual habits in a bladder record (see Sample Bladder Record at end of booklet). You probably will have a physical
examination and urine tests. You may have other tests, as well. These tests
will help find the exact cause of your incontinence and the best treatment for
you. The table at the end of this
booklet (Common Tests Used to Diagnose Urinary Incontinence) lists some of the tests you may be asked to take.

Treating Urinary Incontinence

Once the type and
cause of your urinary incontinence are known, treatment can begin. Urinary
incontinence is treated in one or more of three ways: behavioral techniques,
medication, and surgery.

Behavioral techniques:

Behavioral techniques teach you ways to control your own bladder
and sphincter muscles (see drawing at beginning of booklet). They are very
simple and work well for certain types of urinary incontinence. Two types of
behavioral techniques are commonly used —
bladder training and
pelvic muscle exercises. You may also be asked to change the amount of
liquid that you drink. You may be asked to drink more or less water depending
on your bladder problem.

Bladder training is used for urge
incontinence, and may also be used for stress incontinence. Both men and women
can benefit from bladder training. People learn different ways to control the
urge to urinate. Distraction (thinking about other things) is just one example.
A technique called prompted voiding — urinating on a schedule — is also used.
This technique has been quite successful in controlling incontinence in nursing
home patients.

Pelvic muscle exercises called Kegel exercises
are used for stress incontinence. The Kegel exercises help to strengthen weak
muscles around the bladder.

Medication:

Some people need to take medicine to treat conditions that cause
urinary incontinence. The most common types of medicine treat infection,
replace hormones, stop abnormal bladder muscle contractions, or tighten
sphincter muscles. Your health care provider may recommend medication for your
condition. You will be taught how and when to take it.

Surgery:

Surgery is sometimes needed to help treat
the cause of incontinence. Surgery can be used to:

• Return the bladder
  neck to its proper position in women with stress incontinence
• Remove
  tissue that is causing a blockage
• Correct severely weakened pelvic
  muscles
• Enlarge a small bladder to hold more urine

There are many different surgical procedures that may be used to treat
incontinence. The type of operation you may need depends on the type and cause
of your incontinence. Your doctor will discuss the specific procedure you
might need.

Other Measures and Supportive Devices

Some other products can be
used to help manage incontinence. These include pads and catheters. Catheters
are used when a person cannot urinate. A catheter is a tube that is placed in
the bladder to drain urine into a bag outside the body. The catheter usually is
left inside the bladder, but some catheters are not left in. They are put in
and taken out of the bladder as needed to empty it every few hours. Condom
catheters (mostly used in men) attach to the outside of the body and are not
placed directly in the bladder. Specially designed pads are available to help
men and women with incontinence.

What To Do Next

Your health
care provider will tell you about the type of incontinence you have and will
recommend a treatment. While you are being treated, be sure to:

• Ask
  questions
• Follow instructions
• Take all of your medicine
• Report side effects of your medicine, if any
• Report any
  changes, good and bad, to your health care provider

Risks and Benefits of Treatment

Three types of
treatment are recommended for urinary incontinence:

• Behavioral
  techniques
• Medicine
• Surgery

How well each
of these treatments works depends on the cause of the incontinence and, in some
cases, patient effort. The risks and benefits described below are based on
current medical knowledge and expert opinion. How well a treatment works may
also depend on the individual patient. A treatment that works for one patient
may not be as effective for another patient. Therefore, it is important to talk
with a health care provider about treatment choices.

Behavioral
techniques.There are no risks for this type of treatment.

Medicine. As with most drugs, there is a risk of having a side effect. If
you are taking medicine for other conditions, the drugs could react with each
other. Therefore, it is important to work with the health care provider and
report all of your medicines and any side effects as soon as they happen.

Surgery. With any surgery there is a possibility of a risk or
complication. It is important to discuss these risks with your surgeon.

Coping with Incontinence

Several
national organizations help people with urinary incontinence. They may be able
to put you in touch with local groups that can give you more information,
ideas, and emotional support in coping with urinary incontinence.

Alliance for Aging Research (information on bladder training program)

2021 K Street, N.W.

Suite 305

Washington, DC 20006

(202) 293-2856

Bladder Health Council

c/o American
Foundation for Urologic Disease

300 West Pratt Street, Suite 401

Baltimore, MD 21201

(800) 242-2383

(410) 727-2908

National Association for Continence

(formerly Help for
Incontinent People)

P.O. Box 8310

Spartanburg, SC 29305

(864) 579-7900

(800) BLADDER or (800) 252-3337

International Continence Society

The Continence Foundation

2
Doughty Street

London WC1N 2PH

44-714046875

Simon Foundation for Continence

Box 835

Wilmette, IL 60091

(800) 23-SIMON

(708) 864-3913

For Further Information

The information in this booklet
was taken from the Clinical Practice
Guideline Update on Urinary Incontinence in Adults: Acute and Chronic
Management. The guideline was developed by an expert panel of
doctors, nurses, other health care providers, and consumers sponsored by the
Agency for Health Care Policy and Research. Other guidelines on common health
problems are being developed and will be released in the near future. For more
information about the guidelines or to receive additional copies of this
booklet, contact: Agency for Health Care Policy and Research, Publications
Clearinghouse, Post Office Box 8547, Silver Spring, MD 20907. (800) 358-9295