Urinary incontinence is the loss of voluntary bladder control leading to urine leakage. It can be temporary or long-lasting. Incontinence is a symptom, not a condition in and of itself.
The causes may vary with the type of incontinence. There may be several different causes. The cause may also be unclear.
Leakage may happen when you laugh, sneeze, lift heavy objects, or exercise. Activities like these can increase pressure on the bladder. The leakage may be caused by:
This is also known as overactive bladder. It is a loss of bladder control following a strong urge to urinate. You may not be able to hold urine long enough to make it to a toilet. It may be caused by:
This occurs when the bladder will not empty. As a result, the urine builds up. This will cause an overflow and leaking of urine. It may be caused by:
There is normal bladder control, but you are unable to reach the toilet in time. It may be a result of a condition like severe arthritis. Drugs which cause confusion or sedation can also cause functional incontinence.
These risk factors increase your chance of developing urinary incontinence:
Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.
Your doctor will ask about your symptoms and medical history. You will be asked about your urine leakage and how often you empty your bladder. A physical exam will be done to look for any physical causes, such as blockages or nerve problems. You will keep a diary of your bladder habits. You may be referred to a specialist. A urologist is a doctor who focuses on urinary issues.
Tests may include:
Treatments may include:
Behavioral therapy includes:
Losing weight may help to reduce the number of episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is right for you.
Medicines may be prescribed to relax the bladder muscles. These types of medicines, called anticholinergics, are often used in treating urge incontinence. Examples include:
In men, surgery may be done to relieve a physical blockage due to an enlarged prostate. Other procedures involve surgical repair or implants into the bladder sphincter. The sphincter is the gate that allows the urine to flow through.
To stimulate the nerves, there are devices like Urgent PC and Inter-Stim. The procedure may involve implanting a thin lead wire with a small electrode tip. In some cases, the tibial nerve, which extends down to the ankle, is stimulated. This electronic stimulation therapy can be done as a series of treatments in the doctor's office.
Absorbent diapers are often used by men with incontinence. Catheters are sometimes used to treat more severe cases. External (condom) or internal (Foley) catheters may also be used. Another option is a penile clamp. These clamps are padded and have a sleeve to absorb leakage.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases
http://www2.niddk.nih.gov/
UrologyHealth.org
http://www.urologyhealth.org/
CANADIAN RESOURCES:
Canadian Nurse Continence Advisors
http://www.cnca.ca/
Health Canada
http://www.hc-sc.gc.ca/
References:
American Foundation for Urologic Disease. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/ . Accessed September 14, 2009.
Controlling urinary incontinence. FDA Consumer Magazine, United States Food and Drug Administration website. Available at: http://www.fda.gov/fdac/features/2005/505_incontinence.html . Published September-October 2005. Accessed July 19, 2008.
Corcos J, Gajewski J, Heritz D, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol . 2006;13:3127-3138.
Occhino J, Siegel S. Sacral nerve modulation in overactive bladder. Curr Urol Rep. 2010;11(5):348-352.
Prevention of incontinence. Continence Foundation website. Available at: http://www.continence-foundation.org.uk/in-depth/prevention-of-incontinence.php . Published June 1997. Accessed August 4, 2010.
Subak L, Wing R, Smith West D, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481-490.
Urinary incontinence in men. National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uimen/#treated . Published June 2007. Accessed December 3, 2010.
Wein A, ed. Campbell-Walsh Urology . 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.
Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis, and management. J Urol . 2006;175:S5-10.
Yang C, Schwartz S, Anderson D, et al. A new, simple device to manage male urinary incontinence. International Continence Society website. Available at: http://www.icsoffice.org/publications/2005/pdf/0464.pdf . Accessed September 10, 2009.
12/3/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Cardozo L, Khullar V, Wang JT, Guan Z, Sand PK. Fesoterodine in patients with overactive bladder syndrome: can the severity of baseline urgency urinary incontinence predict dosing requirement? BJU Int. 2010;106(6):816-821.
Last reviewed September 2010 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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