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Urinary Incontinence - Tear Sheet Pad
 
Urinary Incontinence
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Urinary Incontinence - Tear Sheet Pad
Urinary Incontinence
by Julie Riley, MS, RD
Definition
Urinary incontinence is the loss of voluntary bladder control leading to the leakage of urine. It can be temporary or chronic. Incontinence is a symptom, not a condition in and of itself.

Causes
Temporary incontinence can be caused by:

Constipation
Endocrinological disorders (for example, diabetes)
Infection
Medications
Muscle weakness
Restricted mobility
More permanent urinary incontinence may be classified as one of four types. Some people have a mixture of these types. In some cases, incontinence may have several different causes. Sometimes the cause is unclear.

Stress Incontinence
This results when certain activities lead to increased pressure on the bladder. Triggers may be laughing, sneezing, lifting heavy objects, or exercise. This is the most common type of incontinence. It may be caused by:

Weakening of muscles that control the flow of urine
Weakening of the muscles that hold the bladder
Urge Incontinence
Urge incontinence is a loss of bladder control following a strong urge to urinate. The person is unable to hold urine long enough to make it to a toilet. This is also known as overactive bladder. It may be caused by:

Nerve damage due to:
Multiple sclerosis
Parkinson's disease
Spinal cord injury
Stroke
Urinary tract infection
Overflow Incontinence
This occurs when the bladder will not empty completely. This causes an overflow and leaking of urine. It may be caused by:

A bladder that is blocked
Nerve damage due to:
Diabetes
Other factors
Spinal cord injuries
Surgery
Prostate enlargement in men
Weak bladder muscles
Functional Incontinence
Normal bladder control, but an inability to reach the toilet in time. It can be caused by any mental or physical condition that slows a person's movement.

Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.

Age: older than 65
Aging
Childbirth
Dementia
Diabetes
Enlarged prostate
Menopause
Multiple sclerosis
Sex: female
Spinal cord injury or disease
Stroke
Use of certain substances/medications:
Alcohol
Alpha-agonists
Beta-blockers
Caffeine
Cholinergic agents
Cyclophosphamide
Symptoms
Urinary incontinence is a symptom of other conditions. Any loss of bladder control can be considered incontinence.

Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. You will be asked how often you empty your bladder and patterns of urine leakage. A physical exam will look for any physical causes such as blockages or nerve problems. You will be asked to keep a diary of your bladder habits. You may also be referred to a urologist or a urogynecologist.

Tests may include:

Blood tests
Cystoscopy – a thin tube with a tiny camera inserted in the urethra to view the urethra and bladder
Stress test – you relax, then cough as your doctor watches for loss of urine
Ultrasound – a test that uses sound waves to examine structures inside the body
Urine tests
Urodynamic tests – measure the flow of urine and pressure in the bladder
Treatment
Treatment may include one or more of the following:

Behavioral therapy
Behavioral therapy includes:

Bladder training. This can be done by setting a regular timed schedule for emptying your bladder and by drinking fewer liquids.
Making muscles stronger by doing Kegel exercises. This strengthens the muscles that hold the bladder in place and those that control urine flow. Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful for stress incontinence. Painless electrical stimulation is sometimes used to strengthen the muscles.
Medication
Medications may be prescribed to either strengthen muscles that control the flow of urine or to relax the bladder.

Surgery
In men, surgery may be performed to relieve a physical blockage due to an enlarged prostate. In women, surgery can help repair weakened muscles related to bladder function. Other procedures involve collagen injections into the urethra, or surgical repair/implants into the bladder sphincter.

Devices
Plugs and patches that hold urine in place are available for women. Catheters are sometimes used to treat more severe cases. Alternatively, pessaries (devices that raise the uterus and decrease pressure on the bladder) may be used in women.

Prevention
Incontinence is really a symptom of another condition. It cannot always be prevented. Women can decrease their chances of developing incontinence by doing Kegel exercises. This is especially helpful in women who have given birth, because childbirth weakens muscles around the bladder.

Last reviewed: July 2004 by Jeff Andrews, MD.

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