Urinary (or bladder) incontinence
is when you are not able to keep urine from leaking from your urethra, the
tube that carries urine out of your body from your bladder. It can range
from an occasional leakage of urine, to a complete inability to hold any
The three main types of urinary incontinence are:
1. Stress incontinence -- occurs during certain activities like coughing,
sneezing, laughing, or exercise.
2. Urge incontinence -- involves a strong, sudden need to urinate followed
by instant bladder contraction and involuntary loss of urine. You don't have
enough time between when you recognize the need to urinate and when you
actually do urinate.
3. Overflow incontinence -- occurs when the bladder cannot empty completely,
which leads to dribbling.
4. Mixed incontinence -- involves more than one type of urinary
Incontinence is most common among
the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not considered incontinent, but merely untrained,
up to the time of toilet training. Occasional accidents are not unusual in
children up to age 6 years. Young (and sometimes teenage) girls may have
slight leakage of urine when laughing.
Nighttime urination in children is normal until the age of 5 or 6.
Normally, the bladder begins to fill with urine from the kidneys. The
bladder stretches to allow increasing amounts of urine.
The first urge to urinate occurs when around 200 mL (just under 1 cup) of
urine is stored in the bladder. A healthy nervous system will respond to
this stretching sensation by alerting you to the urge to urinate, while also
allowing the bladder to continue to fill.
The average person can hold around 350 to 550 mL (more than 2 cups) of
urine. Two muscles help control the flow of urine:
1. The sphincter (the circular muscles around the opening of the bladder)
must be able to squeeze to prevent urine from leaking.
2. The bladder wall muscle (detrusor) must stay relaxed so the bladder can
When it is time to empty the
bladder, the bladder wall (detrusor) muscle contracts or squeezes to force
urine out of the bladder. Before this muscle squeezes, your body must be
able to relax the sphincter to allow the urine to pass out of the body.
The ability to control urination depends on having normal anatomy, a
normally functioning nervous system, and the ability to recognize and
respond to the urge to urinate.
1. Problems with the anatomy
3. Brain or nerve problems
4. Nerve and muscle disorders (neuromuscular disorders)
5. Dementia or other psychological problems that affect the ability to
recognize and respond to the urge to urinate
Incontinence may be sudden and
temporary, or ongoing and long-term. Causes of sudden or temporary
1. Bedrest -- for example, when recovering from surgery
2. Certain medications (such as diuretics, antidepressants, tranquilizers,
some cough and cold remedies, and antihistamines for allergies)
3. Mental confusion
5. Prostate infection or inflammation
6. Stool impaction from severe constipation, causing pressure on the bladder
7. Urinary tract infection or inflammation
8. Weight gain
Causes that may be more long-term:
1. Alzheimer's disease
2. Bladder cancer
3. Bladder spasms
5. Large prostate in men
6. Neurological conditions such as multiple sclerosis or stroke
7. Nerve or muscle damage after pelvic radiation
8. Pelvic prolapse in women -- falling or sliding of the bladder, urethra,
or rectum into the vaginal space, often related to having had multiple
pregnancies and deliveries
9. Problems with the structure of the urinary tract
10. Spinal injuries
11. Weakness of the sphincter, the circular muscles of the bladder
responsible for opening and closing it; this can happen following prostate
surgery in men, or vaginal surgery in women
See your doctor for an initial
evaluation and to come up with a treatment plan. Treatment options vary,
depending on the cause and type of incontinence you have. Fortunately, there
are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic
1. Bladder retraining -- this involves urinating on a schedule,
whether you feel a need to go or not. In between those times, you try to
wait to the next scheduled time. At first, you may need to schedule 1-hour
intervals. Gradually, you can increase by 1/2-hour intervals until you are
only urinating every 3 - 4 hours without leakage.
2. Kegel exercises -- contract the pelvic floor muscles for 10
seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises
three times per day. You can do Kegel exercises any time, any place.
To find the pelvic muscles when you
first start Kegel exercises, stop your urine flow midstream. The muscles
needed to do this are your pelvic floor muscles. Do NOT contract your
abdominal, thigh, or buttocks muscles. And Do NOT overdo the exercises. This
may tire the muscles out and actually worsen incontinence.
Two methods called biofeedback and electrical stimulation can help you learn
how to perform Kegel exercises. Biofeedback uses electrodes placed on the
pelvic floor muscles, giving you feedback about when they are contracted and
when they are not. Electrical stimulation uses low-voltage electric current
to stimulate the pelvic floor muscles. It can be done at home or at a clinic
for 20 minutes every 1 - 4 days.
Biofeedback and electrical stimulation will no longer be necessary once you
have identified the pelvic floor muscles and mastered the exercises on your
Vaginal cones enhance the performance of Kegel exercises for women.
For leakage, wear absorbent pads or
undergarments. There are many well designed products that go completely
unnoticed by anyone but you.
Other measures include:
1. Regulate your bowels to avoid constipation. Try increasing fiber in your
2. Quit smoking to reduce coughing and bladder irritation. Smoking also
increases your risk of bladder cancer.
3. Avoid alcohol and caffeinated beverages, particularly coffee, which can
overstimulate your bladder.
4. Lose weight if you need to.
5. Avoid foods and drinks that may irritate your bladder, like spicy foods,
carbonated beverages, and citrus fruits and juices.
6. Keep blood sugar under good control if you have diabetes.
Your doctor may recommend
medication or surgery, especially if home care measures are not helping or
if your symptoms are getting worse.
Medications that may be prescribed include drugs that relax the bladder,
increase bladder muscle tone, or strengthen the sphincter.
Surgery may be required to relieve an obstruction or deformity of the
bladder neck and urethra.
If you have overflow incontinence or cannot empty your bladder completely, a
catheter may be recommended. But using a catheter exposes you to potential
Performing Kegel exercises while you are pregnant and soon after delivery
may help prevent incontinence related to childbirth.
When to Contact a
Discuss incontinence with your
doctor. Gynecologists and urologists are the specialists most familiar with
this condition. They can evaluate the causes and recommend treatment
Call your local emergency medical number or go to an emergency room if any
of the following accompany a sudden loss of urine control:
1. Difficulty talking, walking, or speaking
2. Sudden weakness, numbness, or tingling in an arm or leg
3. Loss of vision
4. Loss of consciousness or confusion
5. Loss of bowel control
Call your doctor if:
1. You have been constipated for more than 1 week
2. You have difficulty starting your urine flow, dribbling, nighttime
urination, pain or burning with urination, increased frequency or urgency,
or cloudy or bloody urine
3.You are taking medications that may be causing incontinence -- do NOT
adjust or stop any medications without talking to your doctor.
4. You are over 60 years old and your incontinence is new, especially if you
are also having trouble with your memory or caring for yourself
5. You have the urge to go often, but are only passing small amounts of
6. Your bladder feels full even after you have just urinated
7. Incontinence persists for more than 2 weeks even with exercises to
strengthen your pelvic muscles
What to Expect at
Your Office Visit
Your doctor will take your medical
history and perform a physical examination, with a focus on your abdomen,
genitals, pelvis, rectum, and neurologic system.
Medical history questions may include:
- How long has incontinence been a problem for you?
- How many times does this happen each day?
- Are you aware of the need to urinate before you leak?
- Are you immediately aware that you have passed urine?
- Are you wet most of the day?
- Do you wear protective garments in case of accidents? How often?
- Do you avoid social situations in case of accidents?
- Have you had urinary tract infections in the past? Do you think that you
may have one now?
- Is it more difficult to control your urine when you cough, sneeze, strain,
- Is it more difficult to control your urine when running, jumping, or
- Is your incontinence worse when sitting up or standing?
- Are you constipated? For how long?
- Is there anything you do to reduce or prevent accidents?
- Have you ever been treated for this condition before? Did it help?
- Have you tried pelvic floor exercises (Kegel)? Do they help?
- What procedures, surgeries, or injuries have you had?
- What medications do you take?
- Do you drink coffee? How much?
- Do you drink alcohol? How much?
- Do you smoke? How much each day?
- Do you have diabetes or a family history of diabetes?
- Do you have any other symptoms?
Diagnostic tests that may be
2. Urine culture to check for infection, if indicated
3. Cystoscopy (inspection of the inside of the bladder)
4. Urodynamic studies (tests to measure pressure and urine flow)
5. Uroflow (to measure pattern of urine flow)
6. Post void residual (PVR) to measure amount of urine left after urination
Other tests may be performed to
rule out pelvic weakness as the cause of the incontinence. One such test is
called the Q-tip test. This test involves measurement of the change in the
angle of the urethra when it is at rest and when it is straining. An angle
change of greater than 30 degrees often indicates significant weakness of
the muscles that support the bladder.
Loss of bladder control;
Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary
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