Urinary incontinence — the loss of bladder control
— is a common and often embarrassing problem. The severity of urinary
incontinence ranges from occasionally leaking urine when you cough or sneeze to
having an urge to urinate that's so sudden and strong you don't get to a toilet
in time.
If urinary incontinence affects your day-to-day
activities, don't hesitate to see your doctor. In most cases, simple lifestyle
changes or medical treatment can ease your discomfort or stop urinary
incontinence.
Symptoms
Urinary incontinence is the inability
to control the release of urine from your bladder. Some people experience
occasional, minor leaks — or dribbles — of urine. Others wet their clothes
frequently.
Types of urinary incontinence include:
- Stress incontinence:sphincter muscle of the bladder is weakened. In women, physical changes resulting from pregnancy, childbirth and menopause can cause stress incontinence. In men, removal of the prostate gland can lead to stress incontinence.
- Urge incontinence. This is a sudden, intense urge to urinate, followed by an involuntary loss of urine. Your bladder muscle contracts and may give you a warning of only a few seconds to a minute to reach a toilet. With urge incontinence, you may need to urinate often, including throughout the night. Urge incontinence may be caused by urinary tract infections, bladder irritants, bowel problems, Parkinson's disease, Alzheimer's disease, stroke, injury or nervous system damage associated with multiple sclerosis. If there's no known cause, urge incontinence is also called overactive bladder.
- Overflow incontinence. If you frequently or constantly dribble urine, you may have overflow incontinence, which is an inability to empty your bladder. Sometimes you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine. This type of incontinence may occur in people with a damaged bladder, blocked urethra or nerve damage from diabetes, multiple sclerosis or spinal cord injury. In men, overflow incontinence can also be associated with prostate gland problems.
- Mixed incontinence. If you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence, you have mixed incontinence.
- Functional incontinence. Many older adults, especially people in nursing homes, experience incontinence simply because a physical or mental impairment keeps them from making it to the toilet in time. For example, a person with severe arthritis may not be able to unbutton his or her pants quickly enough. This is called functional incontinence.
- Total incontinence. This term is sometimes used to describe continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volumes of urine
· Causes:
Urinary incontinence isn't a disease, it's a
symptom. It can be caused by everyday habits, underlying medical conditions or
physical problems. A thorough evaluation by your doctor can help determine
what's behind your incontinence.
Causes of temporary urinary incontinence:
Certain foods, drinks and medications can cause temporary urinary incontinence. A simple change in habits can bring relief.
- Alcohol. Alcohol acts as a bladder stimulant and a diuretic, which can cause an urgent need to urinate.
- Over hydration. Drinking a lot of fluids, especially in a short period of time, increases the amount of urine your bladder has to deal with.
- Caffeine. Caffeine is a diuretic and a bladder stimulant that can cause a sudden need to urinate.
- Bladder irritation. Carbonated drinks, tea and coffee — with or without caffeine — artificial sweeteners, corn syrup, and foods and beverages that are high in spice, sugar and acid, such as citrus and tomatoes, can aggravate your bladder.
- Medications. Heart medications, blood pressure drugs, sedatives, muscle relaxants and other medications may contribute to bladder control problems.
Easily treatable medical conditions also may be
responsible for urinary incontinence.
- Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate. These urges may result in episodes of incontinence, which may be your only warning sign of a urinary tract infection. Other possible signs and symptoms include a burning sensation when you urinate and foul-smelling urine.
- Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency. In addition, compacted stool can sometimes interfere with the emptying of the bladder, which may cause overflow incontinence.
Urinary incontinence can also be a persistent
condition caused by underlying physical problems or changes, including:
- Pregnancy and childbirth. Pregnant women may experience stress incontinence because of hormonal changes and the increased weight of an enlarging uterus. In addition, the stress of a vaginal delivery can weaken muscles needed for bladder control. The changes that occur during childbirth can also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, your bladder, uterus, rectum or small bowel can get pushed down from the usual position and protrude into your vagina. Such protrusions can be associated with incontinence.
- Changes with aging. Aging of the bladder muscle leads to a decrease in the bladder's capacity to store urine and an increase in overactive bladder symptoms. Risk of overactive bladder increases if you have blood vessel disease, so maintaining good overall health — including stopping smoking, treating high blood pressure and keeping your weight within a healthy range — can help curb symptoms of overactive bladder.
After menopause women produce less estrogen, a
hormone that helps keep the lining of the bladder and urethra healthy. With
less estrogen, these tissues may deteriorate, which can aggravate incontinence.
- Hysterectomy. In women, the bladder and uterus lie close to one another and are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system — for example, removal of the uterus (hysterectomy) — may damage the supporting pelvic floor muscles, which can lead to incontinence.
- Painful bladder syndrome (interstitial cystitis). This chronic condition causes painful and frequent urination, and rarely, urinary incontinence.
- Prostatitis. Loss of bladder control isn't a typical sign of prostatitis, which is inflammation of the prostate gland — a walnut-sized organ located just below the male bladder. Even so, urinary incontinence sometimes occurs with this common condition.
- Enlarged prostate. In older men, incontinence often stems from enlargement of the prostate gland, a condition also known as benign prostatic hyperplasia (BPH).
- Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. However, more often, incontinence is a side effect of treatments — surgery or radiation — for prostate cancer.
- Bladder cancer or bladder stones. Incontinence, urinary urgency and burning with urination can be signs and symptoms of bladder cancer or bladder stones. Other signs and symptoms include blood in the urine and pelvic pain.
- Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.
- Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine and cause incontinence, usually overflow incontinence. Urinary stones — hard, stone-like masses that can form in the bladder — may be to blame for urine leakage. Stones can be present in your kidneys, bladder or ureters.
Risk factors
These factors increase your risk of
developing urinary incontinence:
- Sex. Women are more likely than men are to have stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy account for this difference. However, men with prostate gland problems are at increased risk of urge and overflow incontinence.
- Age. As you get older, the muscles in your bladder and urethra lose some of their strength. Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release. However, getting older doesn't necessarily mean that you'll have incontinence. Incontinence isn't normal at any age — except during infancy.
- Being overweight. Being obese or overweight increases the pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
- Smoking. A chronic cough associated with smoking can cause episodes of incontinence or aggravate incontinence that has other causes. Constant coughing puts stress on your urinary sphincter, leading to stress incontinence. Smoking may also increase the risk of overactive bladder by causing bladder contractions.
- Other diseases. Kidney disease or diabetes may increase your risk for incontinence.
Complications
Complications of chronic urinary incontinence include:
- Skin problems. Urinary incontinence can lead to rashes, skin infections and sores (skin ulcers) from constantly wet skin.
- Urinary tract infections. Incontinence increases your risk of repeated urinary tract infections.
- Changes in your activities. Urinary incontinence may keep you from participating in normal activities. You may stop exercising, quit attending social gatherings or even stop venturing away from familiar areas where you know the locations of toilets.
- Changes in your work life. Urinary incontinence may negatively affect your work life. Your urge to urinate may cause you to have to get up often during meetings. The problem may disrupt your concentration at work or keep you awake at night, causing fatigue.
- Changes in your personal life.Perhaps most distressing is the impact incontinence can have on your personal life. Your family may not understand your behavior or may grow frustrated at your many trips to the toilet.
