Urinary Incontinence

Incontinence, the involuntary release of urine, is a medical condition that is well-known but rarely discussed. Although it becomes more common as people age, it is not a normal part of aging. Because it can be socially embarrassing and is not life-threatening, many people with incontinence avoid mentioning the condition to their physicians. Their silence is unfortunate because incontinence can be improved with a variety of treatments,

Incontinence takes several forms: stress, urge, reflex, overflow, and functional.

• Stress incontinence, the most common form, refers to urine that leaks following activities like exercise, coughing, laughing, or sneezing.
• Urge incontinence is the frequent, sudden, and uncontrollable urge to urinate.
• Reflex incontinence refers to leaking urine without realizing it. People with this disorder usually do not sense that their bladder is full.
• Overflow incontinence results from an inability to completely empty the bladder. A person may frequently feel the urge to urinate but void only a small amount of urine.
• Functional incontinence refers to the inability to physically get to a toilet.

Each form of incontinence has specific causes and risk factors.

• Stress incontinence arises when the bladder sags because the pelvic muscles are weak. It most often strikes women, whose risk factors include childbirth, menopause, age, and obesity. Prostate surgery can increase a man's risk for stress incontinence.
• Urge incontinence typically appears in older women who have a hyperactive bladder (a bladder that contracts uncontrollably). Other causes include anxiety, infections, nerve damage, neurological diseases such as multiple sclerosis and Parkinson's, and in men, prostate surgery.
• Reflex incontinence causes include diabetes, neurological diseases, or stroke.
• Overflow incontinence is common in men who have an enlarged prostate. Other causes include constriction of the urethra, inflammation, nerve damage, and tumors.
• Functional incontinence occurs when a debilitating disease like arthritis, Alzheimer's disease, or severe depression prevents a person from physically getting to a toilet. People with this condition may have normal bladder control and urination.

To determine the type of incontinence a patient has, a physician may order one of the following tests:

• Bladder diary: The patient records day-to-day information like fluid intake and frequency of urination.
• Post-void residual urine volume: The physician measures the urine left in the bladder after voiding.
• Urodynamic testing: A series of tests measure the bladder's ability to retain urine, the nerve activity of pelvic muscles, and other factors.
• Bladder stress test (Marshall test) used to diagnose stress incontinence. This test involves filling the bladder, asking the patient to cough forcefully, and looking for leakage.

Treatment for incontinence depends on the type of incontinence and can be mild to invasive. Therapies include:

• Kegel exercises (identifying and squeezing the muscles that stop urination)
• Vaginal cones (weights that improve pelvic muscle tone)
• Biofeedback
• Urinating on a schedule
• Barriers or pads (such as pessaries, patches, or urethral plugs)
• Catheters
• Medications such as calcium channel blockers, estrogen, or some decongestants
• Surgery

Managing incontinence also means making lifestyle changes. These include:

• Limiting consumption of alcohol and caffeine, which spur urination
• Spacing drinks throughout the day
• Maintaining an appropriate weight
• Exercising regularly
• Avoiding smoking