Urinary Incontinence

If you have urinary incontinence, you suffer from a loss of bladder control or your bladder fails to retain urine properly. As a result, you can’t keep from passing urine, even though you may try to hold it in. Urinary incontinence is not a normal part of aging, but often affects older persons because the sphincter muscles that open the bladder into the urethra become less efficient with aging.

Although you might feel embarrassed if you have urinary incontinence, you should nevertheless let your doctor know about it. It could be a symptom of a disorder that could lead to more trouble if not treated.

Causes


In most cases, the problem is curable and treatable.

Two categories of urinary incontinence are acute incontinence and persistent incontinence.

The acute form is generally a symptom of a new illness or condition (e.g., bladder infection, inflammation of the prostate, urethra or vagina, and constipation).

Side effects of some medications, such as water pills, tranquilizers, and antihistamines can also result in acute urinary incontinence.

Acute urinary incontinence comes on suddenly. It is often easily reversed when the condition that caused it is treated.

Persistent incontinence comes on gradually over time. It lingers or remains, even after other conditions or illnesses have been treated. There are many types of persistent incontinence. The 3 types that account for 80 percent of cases are:

• Stress Incontinence – Urine leaks out when there is a sudden rise in pressure in the abdomen (belly). The amount ranges from small leaks to large spills. This usually happens with coughing, sneezing, laughing, lifting, jumping, running, or with straining to have a bowel movement. Stress incontinence is more common in women than in men.
• Urge Incontinence – This inability to control the bladder when the urge to urinate occurs comes on suddenly, so there is often not enough time to make it to the toilet. This type typically results in large accidents. It can be caused by a number of things, including an enlarged prostate gland, a spinal cord injury, multiple sclerosis, or Parkinson’s disease.
• Mixed Incontinence – This type has elements of both stress and urge incontinence.

Other types of persistent incontinence are:

• Overflow Incontinence – Constant dribbling of urine occurs because the bladder overfills. This may be due to an enlarged prostate, diabetes, or multiple sclerosis.
• Functional Incontinence – With this, a person has trouble getting to the bathroom fast enough, even though he or she has bladder control. This can happen in a person who is physically challenged.
• Total Incontinence – In this rare type, with complete loss of bladder control, urine leakage can be continual.

Treatment


Care and treatment for urinary incontinence will depend on the type and cause(s). The first step is to find out if there is an underlying problem and to correct it. Treatment can also include pelvic floor exercises, called Kegel exercises, and other self-care measures (see Self-Care Tips in this section on pages 172-173). Medication, collagen injections (for a certain type of stress incontinence), or surgery to correct the specific problem may be needed.

Your primary doctor may evaluate and treat your incontinence or send you to a urologist, a doctor who specializes in treating problems of the bladder and urinary tract.

Questions to Ask

Have you lost control of your bladder after an injury to your spine or back?
Do you have these problems? Fever and shaking chills Back pain (sometimes severe) in one or both sides of the lower back or just at your midline Nausea and vomiting
Does your loss of bladder control come with any of these symptoms? Loss of consciousness Inability to speak or slurred speech Loss of sight, double or blurred vision Sudden, severe headaches Paralysis, weakness, or loss of sensation in an arm or leg and/or the face on the same side of the body Change in personality, behavior, and/or emotions Confusion and dizziness
Is the loss of bladder control more than temporary after surgery or an abdominal injury?
Do you have any of these problems? Burning Frequent urination Blood in the urine or cloudy urine Abdominal or low back pain
With the loss of bladder control, do you have diabetes or any of these symptoms of diabetes? Extreme thirst Unusual hunger Excessive loss or gain in weight Blurred vision Easy fatigue, drowsiness Slow healing of cuts and/or infections
If you are a man, do you have any of these problems? Dribbling urine and/or feeling the need to urinate again after you have finished urinating Voiding small amounts of urine often during the day The need to urinate while sleeping An intense and sudden need to urinate often A slow, weak, or interrupted stream of urine
Do you leak urine when you cough, sneeze, laugh, jump, run, or lift heavy objects?
Did you lose some bladder control only after taking a new medicine or after taking a higher dose of a medicine you were already taking?

• Avoid or limit drinks, foods, and medicines that have caffeine (e.g., coffee, tea, colas, chocolate, and No-Doz).
• Limit carbonated drinks, alcohol, citrus juices, greasy and spicy foods, and items that have artificial sweeteners. These can irritate the bladder.
• Drink 1–2 quarts of water throughout the day.
• Go to the bathroom often, even if you don’t feel the urge. When you urinate, empty your bladder as much as you can. Relax for a minute or two and then try to go again. Keep a diary of when you have episodes of incontinence. If you find that you have accidents every 3 hours, for example, empty your bladder every 21/2 hours. Use an alarm clock or wristwatch with an alarm to remind you.
• Wear clothes you can remove quickly and easily when you use the bathroom. Examples are elastic-waist bottoms and items with velcro closures or snaps instead of buttons and zippers. Also, look for belts that are easy to undo, or don’t wear belts at all.
• Wear absorbent pads or briefs.
• Ask your doctor if you would benefit from using self-catheters. A self-catheter is a clear, straw-like device, usually made of flexible plastic, that you insert into the opening of the urethra; it helps you empty your bladder completely. Your doctor will need to show you how to use one. You need a prescription for self-catheters.
• Empty your bladder before you leave the house, take a nap, and go to bed.
• Keep the pathway to your bathroom free of clutter and well lit. Make sure the bathroom door is left open until you use it.
• Use an elevated toilet seat and grab bars if these will make it easier for you to get on and off the toilet.
• Keep a bedpan, plastic urinal (for men), or portable commode chair near your bed. You can get these at medical supply stores and drugstores.

Kegel Exercises


To strengthen your pelvic floor muscles, do Kegel exercises . They can help treat or cure stress incontinence. Even elderly women who have leaked urine for years can benefit greatly from these exercises. Here’s how to do them:

• First, identify where your pelvic floor muscles are. One way to do this is to start to urinate, then hold back and try to stop. If you can slow the stream of urine, even a little, you are using the right muscles. You should feel muscles squeezing around your urethra and anus.
• Next, relax your body, close your eyes and just imagine that you are going to urinate and then hold back from doing so. You should feel the muscles squeeze like you did in the step before this one.
• Squeeze the muscles for 3 seconds and then relax them for 3 seconds. When you squeeze and relax, count slowly. Start out doing this 3 times a day. Gradually work up to 3 sets of 10 contractions, holding each one for 10 seconds at a time. You can do them in lying, sitting, and/or standing positions.
• Women can also use pelvic weights prescribed by their doctor. A woman inserts a weighted cone into the vagina and squeezes the correct muscles to keep the weight from falling out.
• When you do these exercises:
  • Do not tense the muscles in your belly or buttocks.
  • Do not hold your breath, clench your fists or teeth, or make a face.
  • If you are not sure you’re doing the exercise right, consult your doctor.
• Squeeze your pelvic floor muscles right before and during whatever it is (coughing, sneezing, jumping, etc.) that causes you to lose urine. Relax the muscles once the activity is over.
• It may take several months to benefit from pelvic floor exercises and you have to keep doing them daily to maintain their benefit.