Urinary Incontinence

Urinary incontinence is the involuntary leakage of urine; in simple terms, it means a person urinates when they do not want to. Control over the urinary sphincter is either lost or weakened.

Symptoms of urinary incontinence

The main symptom is the unintentional release (leakage) of urine. When and how this occurs will depend on the type of urinary incontinence.

Stress incontinence

This is the most common kind of urinary incontinence, especially among women who have given birth or gone through the menopause.

In this case "stress" refers to physical pressure, rather than mental stress. When the bladder and muscles involved in urinary control are placed under sudden extra pressure, the person may urinate involuntarily.

The following actions may trigger stress incontinence:

A sudden cough

Sneezing

Laughing

Heavy lifting

Exercise

Urge Incontinence (effort incontinence)

Also known as reflex incontinence or "overactive bladder," this is the second most common type of urinary incontinence. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes an urge to urinate that cannot be stopped.

When the urge to urinate comes, the person has a very short time before the urine is released, regardless of what they try to do. The urge to urinate may be caused by:

. A sudden change in position

. The sound of running water (for some people)

. Sex (especially during orgasm)

Bladder muscles can activate involuntarily because of damage to the nerves of the bladder, the nervous system, or to the muscles themselves.

Overflow Incontinence

This is more common in men with prostate gland problems, a damaged bladder, or a blocked urethra. An enlarged prostate gland can obstruct the bladder.

The bladder cannot hold as much urine as the body is making and/or the bladder cannot empty completely, causing small amounts of urinary leakage. Often, patients will need to urinate frequently, and they may experience "dribbling" or a constant dripping of urine from the urethra.

Mixed Incontinence

This is where a patient experiences both stress and urge incontinence at the same time.

Functional Incontinence

With functional incontinence, the person knows there is a need to urinate, but cannot make it to the bathroom in time due to a mobility problem.

Common causes of functional incontinence include:

Confusion

. Dementia

Poor eyesight

Poor mobility

Poor dexterity (cannot unbutton pants in time)

Depression, anxiety, or anger (unwilling to go to the toilet)

Functional incontinence is more prevalent among elderly people and is common in nursing homes.

Gross Total Incontinence

This either means that the person leaks urine continuously, or has periodic uncontrollable leaking of large amounts of urine.

The patient may have a congenital problem (born with a defect), there may be an injury to the spinal cord or urinary system, or there may be a hole (fistula) between the bladder and, for example, the vagina.

Causes of urinary incontinence

We will divide the causes up between the four types of incontinence:

Causes of stress incontinence

Pregnancy

Childbirth (labor)

Menopause - when estrogen levels drop the muscles may get weaker

A hysterectomy - surgical removal of the uterus (womb)

Some other surgical procedures

Age

Obesity

Causes of urge incontinence

The following causes of urge incontinence have been identified:

Cystitis - inflammation of the lining of the bladder

CNS (central nervous system) problems - examples are multiple sclerosis, stroke, and Parkinson's disease

An enlarged prostate - the bladder may drop, and the urethra could become irritated

Causes of overflow incontinence

This happens when there is an obstruction or blockage to the bladder. The following may cause an obstruction:

An enlarged prostate gland

A tumor pressing against the bladder

Urinary stones

Constipation

Urinary incontinence surgery which went too far

Causes of total incontinence

The following can cause total incontinence:

An anatomical defect the person has had from birth

A spinal cord injury which messes up the nerve signals between the brain and the bladder

A fistula - a tube (channel) develops between the bladder and a nearby area, most typically the vagina

Other causes of urinary incontinence:

Some medications - especially some diuretics, antihypertensive drugs, sleeping tablets, sedatives, and muscle relaxants

Alcohol

Urinary tract infection

Diagnosis of urinary incontinence

Ways to diagnose urinary incontinence include:

A bladder diary - the doctor may ask the patient to record how much they drink, when urination occurs, how much urine is produced, and the number of episodes of incontinence.

Physical exam - the doctor may examine the vagina and check the strength of her pelvic floor muscles. If the patient is male, the doctor may examine his rectum to determine whether the prostate gland is enlarged.

Urinalysis - tests for signs of infection and abnormalities.

Blood test - to assess kidney function.

PVR (postvoid residual) measurement - measures how much urine is left in the bladder after urinating.

Pelvic ultrasound.

Stress test - the patient will be asked to apply sudden pressure while the doctor looks out for loss of urine.

Urodynamic testing - determines how much pressure the bladder and urinary sphincter muscle can withstand.

Cystogram - X-ray procedure to visualize the bladder.

Cystoscopy - a cystoscope (a thin tube with a lens at the end) is inserted into the urethra. The doctor can view abnormalities in the urinary tract.