Urinary Incontinence
Urinary incontinence (UI) is the loss of bladder control. It is a common condition that involves the involuntary loss of urine. It may range in severity from occasionally leaking urine to a sudden urge to urinate that comes on very strongly. Although it is not usually a serious condition, UI can be embarrassing and affect a person's daily life. Urinary incontinence is most common in women, especially during and after pregnancy. It can, however, affect people of all ages. Being overweight or elderly may also increase the risk of urinary incontinence.
Causes of Urinary Incontinence
Urinary incontinence is often caused by a urinary tract infection or weak muscles in the urinary tract. Some medications may cause weak bladder muscles, thereby causing urinary incontinence. Weak muscles can prevent the closing off of the urethra, and doing certain activities may cause urine to leak. Other causes of urinary incontinence include the following:
- Pregnancy
- Childbirth
- Menopause
- Enlarged prostate
- Prostate cancer
- Neurological disorders
- Bladder obstruction
Normal urination involves emptying the bladder when the desire to urinate occurs, at which point the bladder contracts and urine flows out of the body. Once the bladder is empty, the muscles contract and urination stops. People with UI experience a disruption in this process that causes a loss of bladder control.
Symptoms of Urinary Incontinence
In addition to leaking urine, people with UI may also experience:
- Strong desire to urinate
- Pelvic pressure
- Frequent urination
- Nocturia (the need to urinate at night while sleeping)
- Painful urination
- Bed wetting
Some people may suffer from mixed incontinence and experience several different symptoms of UI.
Types of Urinary Incontinence
Urinary incontinence is classified, based on causes and symptoms, into three different types:
Urge
Urge incontinence is the most common type of incontinence. This type of incontinence involves urine leakage that occurs after a sudden urge to urinate, because the muscle wall of the bladder is overactive.
Stress
Stress incontinence is defined as urine leakage that occurs after an activity places pressure on the bladder. Activities may include coughing, laughing or sneezing.
Overflow
Overflow incontinence occurs as the result of an inactive bladder muscle that does not completely empty the bladder after urination. This is the least common of the types of incontinence.
Treatment for urinary incontinence varies, based on type.
Diagnosis of Urinary Incontinence
Urinary incontinence is diagnosed through a physical examination, a series of diagnostic tests, and an evaluation of the patient's medical history. Patients may also be asked to keep a bladder or urination diary to record the frequency and circumstances of their urination issues. Testing may begin with a pelvic exam to detect any physical abnormalities, and additional tests include:
- Blood tests
- Urinalysis
- Cystogram
- A stress test to determine if any urine leaks during physically stressful situations
After a diagnosis of UI, the physician may perform further testing to determine the cause of the condition, in order to recommend the most appropriate treatment approach.
Treatment of Urinary Incontinence
Treatment for urinary incontinence varies, depending on the severity of the condition. There are many effective treatment options, including the following:
- Bladder training
- Avoiding alcohol and caffeine
- Medication
- Electrical stimulation
- BOTOX® injections
- Nerve-stimulation implant
- Kegel exercises
For severe cases of UI in women, a medical device such as a urethral insert or pessary may be inserted through the vagina to prevent urine leakage. Surgery may be recommended to provide support to the bladder neck to relieve symptoms caused by UI. However, there are certain risks, including infection, bladder spasms and recurring incontinence, associated with surgery.
Prevention of Urinary Incontinence
Not all cases of urinary incontinence can be prevented, although the following recommendations may help in controlling urinary incontinence:
- Drinking less fluid
- Emptying the bladder regularly
- Avoiding caffeinated beverages
Kegel exercises may also be effective at strengthening the muscles of the pelvic floor, which can also help to prevent incontinence.