Urinary incontinence

Definition

Urinary incontinence is a condition characterized by the involuntary loss of bladder control.

Description

Urinary incontinence, the inability to keep urine in the bladder, is a problem of the urinary tract, the organs of the body that produce and discharge urine from the body. They include the kidneys, ureters, bladder, and urethra. A circular muscle system, called the urethral sphincter, controls the retention and release of urine from the bladder. As the bladder fills with urine, the sphincter expands to accommodate the increasing urine volume and holds the urine in the bladder without leakage. When the bladder is full, the brain signals the sphincter and the muscles at the base of the pelvis that support the bladder (pelvic floor muscles) to contract and expel urine through the urethra and out of the body. When the urinary muscle system malfunctions, incontinence can result, almost always due to an underlying medical condition. There are different types of urinary incontinence:

• Stress incontinence. This type of incontinence is due to a weakened sphincter muscle and occurs when pressure is exerted on the bladder for example by coughing, sneezing, laughing, or lifting something heavy.
• Urge incontinence. This type of incontinence, also called “overactive bladder,” is characterized by a sudden urge to urinate, and the need to urinate often. Affected persons often also awaken during the night to urinate (nocturia).
• Overflow incontinence. This type of incontinence is an inability to empty the bladder, leading to overflow and leakage. Affected persons often dribble urine and feel as if their bladder cannot be emptied.
• Functional incontinence. People suffering from this type of incontinence have a physical or mental impairment that prevents them from reaching the bathroom in time.

Demographics

According to the National Association for Continence (NAFC), urinary incontinence affects 200 million people worldwide and some 25 million adult Americans. NAFC estimates that 75–80% of those affected are women, 9–13 million of whom have severe symptoms. 33% of people aged 30–70 years have also experienced loss of bladder control during their adult lives. In this age group, more than 33% who experience nocturia get up twice or more per night, and one in eight persons report that they sometimes lose urine on the way to the bathroom. On average, women wait on average 6.5 years from the first time they experience incontinence to obtain a diagnosis for their bladder control problem. The condition is highly prevalent in the 70–79 age group. At least 50% of all nursing home residents are urine incontinent and many also experience loss of bowel control.

Causes and symptoms

Urinary incontinence is an under-diagnosed and under-treated condition that is falsely thought to be a normal consequence of aging. In fact, it is almost always indicative of some underlying medical condition that can be treated. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, and urinary tract infections. For example, urge incontinence may be caused by multiple sclerosis , Parkinson's disease, Alzheimer's disease, or stroke . Overflow incontinence occurs in people with a damaged bladder or blocked urethra, or with nerve damage resulting from diabetes, and in men with prostate problems.

Symptoms of urinary incontinence may include:

• Leakage of urine impacting on activities
• Leakage of urine causing embarrassment
• Urgent need to urinate with loss of urine before reaching the bathroom
• Frequent bladder infections
• Urinating more frequently than usual
• Pain related to filling the bladder and during urination
• Inability to urinate (urinary retention)

Diagnosis

Diagnosis includes a complete medical history and a thorough physical examination to determine the cause of the incontinence. Tests may include x rays, blood analysis, urine analysis, and special tests to determine bladder capacity, sphincter condition, and urethral pressure. A cystoscopic examination may also be performed. In this test, a tube with a small camera on the end (cystoscope) is inserted through the urethra into the bladder to visualize possible abnormalities.

QUESTIONS TO ASK YOUR DOCTOR

• What causes my urinary incontinence?
• Can it be cured?
• What does treatment involve?
• Are medications effective?
• Can exercise help?

Treatment

Since urinary incontinence is a condition and not a disease, treatment depends on diagnostic results to clarify the type of incontinence and its underlying cause. Treatment commonly involves a combination of medications, behavioral techniques, and pelvic muscle exercises. Behavioral techniques include prompting the incontinent person to visit the bathroom every 2–4 hours, and bladder retraining that gradually increases the length of time between bathroom trips.

For patients whose incontinence cannot be cured, devices and products are available to help manage incontinence, including catheters, pelvic organ support devices, urethral plug inserts, external collection systems, and absorbent products.

Nutrition/Dietetic concerns

Including more fiber in the diet has been shown to prevent constipation , a risk factor for urinary incontinence. Avoiding or limiting certain foods and drinks that may irritate the bladder, such as coffee, may also reduce urinary incontinence.

Therapy

Drug therapy can be used for incontinence. Medications are available to help control an overactive bladder , such as olterodine (Detrol), oxybutynin (Ditropan), solifenacin (Vesicare) and darifenacin (Enablex). Imipramine (Tofranil) is occasionally prescribed in combination with other medications to relax the bladder muscle. Antibiotics may also be prescribed if the incontinence results from a urinary tract infection or an inflamed prostate gland (prostatitis).

KEY TERMS

Alzheimer's disease —Degenerative brain disease resulting in progressive mental deterioration with disorientation, memory disturbance and confusion.

Bladder —Elastic, muscular pouch in which urine collects before being discharged from the body through the urethra.

Catheter —A hollow flexible tube for insertion into a body cavity, duct, or vessel to allow the passage of fluids or distend a passageway.

Cystoscope —Specialized endoscope, a tube with a small camera on the end, inserted through the urethra into the bladder to visualize the inside of the bladder and urethra.

Diuretics —Medications that help the body get rid of excess water and salt.

Kidneys —Pair of bean—shaped organs located below the ribs toward the middle of the back that clean the blood, regulate acid concentration and maintain water balance in the body by excreting urine.

Multiple sclerosis —A chronic degenerative disease of the central nervous system.

Nocturia —Excessive urination at night.

Pelvic floor muscles —Muscles at the base of the pelvis that support the bladder and rectum, and the uterus and vagina in women.

Parkinson's disease —Chronic, progressive disorder of the nervous system.

Ureters —Tubes from the kidneys to the bladder that drain urine.

Urethra —The tube leading from the bladder to discharge urine outside the body. In males, the urethra travels through the penis, and in females, it is shorter than in the male and emerges above the vaginal opening.

Urethral sphincter —The muscle system that controls the retention and release of urine from the bladder.

Urinary incontinence —Inability to keep urine in the bladder.

Urinary retention —Inability to urinate.

Urinary tract —The organs of the body that produce and discharge urine. They include the kidneys, ureters, bladder, and urethra.

Urinary tract infection —Bacterial infection that occurs in any part of the urinary tract.

Urine —Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.

Prognosis

According to the NAFC, approximately 80% of those affected by urinary incontinence can be cured or improved. However, people wait on average some seven years before seeking treatment for their incontinence problem, and only one out of every twelve people affected seeks help. Recent surveys performed by the NAFC seem to contradict the 80% improvement rate: after receiving treatment, more people rated their incontinence as “unchanged” or “worse” after treatment than “improved” or “cured.”

Prevention

Prevention of incontinence is centered on maintaining a healthy lifestyle since the condition almost always results from an underlying medical disorder. Maintaining a healthy weight, and regular physical exercise have been shown to lower the risk of developing incontinence.

Caregiver concerns

Two—thirds of men and women in the 30–70 age group have never discussed bladder health with their physician. Men are also less likely to be diagnosed than women. In women over the age of 60, the high prevalence of urinary incontinence has been associated with a three—fold increase in nursing home admissions, social isolation , and psychological distress. This suggests that urinary incontinence should be routinely and more pro—actively evaluated in this age group.

Resources

BOOKS

Ellsworth, Pamela. 100 Questions and Answers about Overactive Bladder and Urinary Incontinence. Sudbury, MA: Jones and Bartlett Publishers, 2005.

Genadry, Rene, and Jacek L. Mostwin. A Woman's Guide to Urinary Incontinence. Baltimore, MD: Johns Hopkins University Press, 2007.

Kaschak Newman, Diane. Managing and Treating Urinary Incontinence. Baltimore, MD: Health Professions Press, 2002.

Safir, Michael H., Caly N. Boyd, and Tony E. Pinson. Overcoming Urinary Incontinence: A Woman's Guide to Treatment. Omaha, NE: Addicus Books, 2008.

PERIODICALS

Charles, J., et al. “Urinary incontinence in the older patient.” Australian Family Physician 37, no. 3 (March 2008): 105.

Chiaffarino, F., et al. “Impact of urinary incontinence and overactive bladder on quality of life.” European Urology 43, no. 5 (May 2003): 535–538.

Couture, J. A., and L. Valiquette. “Urinary incontinence.” Annals of Pharmacotherapy 34, no. 5 (May 2000):646–65.

Jackson, R. A., et al. “Urinary incontinence in elderly women: findings from the Health, Aging, and Body Composition Study.” Obstetrics & Gynecology 104, no. 2 (August 2004): 301–307.

Ko, Y., et al. “The impact of urinary incontinence on quality of life of the elderly.” American Journal of Managed Care 11, no. 4 (July 2005): S103–S111.

Lusky, K. F. “Real treatment options for incontinence. Condition is no longer a given in the aging process.” Provider 44, no. 6 (June 1998): 42–47.

MacDonald, C. D., and L. Butler. “Silent no more: elderly women's stories of living with urinary incontinence in long—term care.” Journal of Gerontological Nursing 33, no. 1 (January 2007): 14–20.

Wagg, A. “Continence, incontinence and the aging male.” Aging Male 3, no. 3 (September 2000): 143–154.

OTHER

Controlling Urinary Incontinence. FDA, Consumer Magazine (March 20, 2008) http://www.fda.gov/fdac/features/2005/505_incontinence.html

Urinary Incontinence. National Institute on Aging, Age Page (March 20, 2008) http://www.niapublications.org/agepages/urinary.asp

Urinary Incontinence: Embarrasing but Treatable. American Academy of Family Physicians, Family Doctor Information Page (March 20, 2008) http://familydoctor.org/online/famdocen/home/women/gen-health/189.printerview.html

Your Body's Design for Bladder Control. NKUDIC, Information Page (March 20, 2008) http://kidney.niddk.nih.gov/kudiseases/pubs/bodydesign_ez/index.htm

ORGANIZATIONS

American Urological Association (AUA), 1000 Corporate Blvd., Linthicum, MD, 21090, (410)689-3700, (866) 746-4282, (410)689-3800, aua@auanet.org, http://www.auanet.org.

National Association For Continence (NAFC), POB 1019, Charleston, SC, 29402-1019, (843)377-0900, (800) BLADDER, http://www.nafc.org.

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), 3 Information Way, Bethesda, MD, 20892–3580, (800)891-5390, (703) 738-4929, nkudic@info.niddk.nih.gov, http://kidney.niddk.nih.gov.

Monique Laberge Ph.D.