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Urinary Incontinence

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.

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 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. 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.

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. 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.

*Catheters and pads are not the first and only treatment for incontinence. They should only be used to make other treatments more effective or when other treatments have failed.

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

...and remember, incontinence is not a natural part of aging. In most cases, it can be successfully treated and reversed.

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.

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