Overview
What Is Urinary Incontinence (UI) ?
Urinary incontinence (UI) is the loss of urine control, or the inability to hold your urine until you can reach a restroom. More than 13 million men and women in the United States experience incontinence. UI can strike at any age. Women over age 50 are the most likely to develop UI. Urinary incontinence may be a temporary condition, resulting from an underlying medical condition. It can range from the discomfort of slight losses of urine to severe, frequent wetting.
Causes Of Urinary Incontinence
- For women, thinning and drying of the skin in the vagina or urethra, especially after menopause
- For men, enlarged prostate gland or prostate surgery
- Weakened and stretched pelvic muscles after childbirth
- Certain medicines
- Build-up of stool in the bowels
- Overweight and obesity, which increases pressure on the bladder and muscles that control the bladder
- Urinary tract infections
- Vascular disease
- Diseases such as diabetes, Alzheimer's disease and multiple sclerosis
Are There Different Types Of Incontinence ?
Yes. There are 5 types of urinary incontinence. A brief explanation of each follows :
Stress Incontinence
Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth or surgery. Stress incontinence is common in women.
Urge Incontinence
This occurs when the need to urinate comes on very suddenly, often before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of a urinary tract infection or an overactive bladder.
Overflow Incontinence
This type of incontinence is the uncontrollable leakage of small amounts of urine. It's caused by an overfilled bladder. You may feel like you can't empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking the urinary flow, such as an enlarged prostate gland or tumor. Diabetes or certain medicines may also cause the problem.
Functional Incontinence
This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.
Mixed Incontinence
This type involves more than one of the types of incontinence listed above.
Prostate Symptom Scores
If your prostate could be involved in your incontinence, your health care provider may ask you a series of standardized questions, either the International Prostate Symptom Score or the American Urological Association (AUA) Symptom Scale.
Some of the questions you will be asked for the AUA Symptom Scale will be the following:
- Over the past month or so, how often have you had to urinate again in less than 2 hours?
- Over the past month or so, from the time you went to bed at night until the time you got up in the morning, how many times did you typically get up to urinate?
- Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
- Over the past month or so, how often have you had a weak urinary stream?
- Over the past month or so, how often have you had to push or strain to begin urinating?
Your answers to these questions may help identify the problem or determine which tests are needed. Your symptom score evaluation can be used as a baseline to see how effective later treatments are at relieving those symptoms.
How Is UI Treated ?
No single treatment works for everyone. Your treatment will depend on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options. Many men regain urinary control by changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. If these behavioral treatments do not work, you may choose to try medicines or a continence device—either an artificial sphincter or a catheter. For some men, surgery is the best choice.
Overactive Bladder
Overactive bladder occurs when abnormal nerves send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. Voiding up to seven times a day is normal for many women, but women with overactive bladder may find that they must urinate even more frequently.
Specifically, the symptoms of overactive bladder include :
- Urinary Frequency—bothersome urination eight or more times a day or two or more times at night
- Urinary Urgency—the sudden, strong need to urinate immediately
- Urge Incontinence—leakage or gushing of urine that follows a sudden, strong urge
- Nocturia—awaking at night to urinate
Behavioral Treatments
For some men, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom—a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips. Bladder training also includes Kegel exercises to strengthen the pelvic muscles, which help hold urine in the bladder. Extensive studies have not yet conclusively shown that Kegel exercises are effective in reducing incontinence in men, but many clinicians find them to be an important element in therapy for men.
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