Urinary incontinence

What is urinary incontinence?

Incontinence is an uncontrollable and involuntary loss of bladder control.

Who is affected?

It is most common in the elderly because the efficiency of the sphincter muscles (which act like a valve, regulating outflow) surrounding the urethra (the tube by which urine is excreted from the bladder) declines with age. Women are more affected than men.

Are there different types of urinary incontinence?

  • Stress incontinence — an involuntary escape of a small amount of urine when a person sneezes, coughs, laughs, or strains to pick up a heavy object. It is common in women, particularly following childbirth when the sphincter muscles are stretched.
  • Urge incontinence — an urgent need to pass urine is accompanied by an inability to control the bladder as it contracts. Once urination starts it continues until the bladder is empty. It is often triggered by a sudden change in position.
  • Total incontinence — complete lack of bladder control caused by complete absence of sphincter activity.
  • Overflow incontinence — occurs in chronic urinary retention (the individual is unable to empty the bladder normally, often because of an obstruction such as an enlarged prostate gland). The bladder is always full, so there is constant dribbling of the overflow of urine.

What causes urinary incontinence?

  • Disorders of the urinary tract — for example, infections or bladder stones).
  • In women, prolapse (displacement from its normal position) of the uterus or vagina.
  • Damage to the brain or spinal cord.
  • Feelings of anxiety, stress or anger.
  • A fractured pelvis or weak pelvic muscles.
  • Irritable bladder — the bladder muscle contracts intermittently and increases the pressure in the bladder to push urine out of the urethra, causing an intense desire to pass urine.
  • Central nervous system disorders — for example, stroke or Parkinson's disease.

How is urinary incontinence diagnosed?

  • Urinalysis (examination of the urine) — this is carried out to eliminate the possibility of infection, inflammation, diabetes mellitus or protein loss.
  • Ultrasound and x-ray — these are used to investigate the possibility of an obstruction.
  • Cystometry (measure of the pressure in the bladder) — checks whether the bladder is operating normally or whether there are any abnormalities of the nerves supplying the bladder.
  • Cytoscopy (examination of the urethra and bladder through a viewing instrument) — checks for the presence of bladder stones, or cysts.

How is urinary incontinence treated?

  • If weak pelvic muscles are the cause, then pelvic floor exercises may help to restore sphincter muscle — in some cases an operation may be performed to tighten or lengthen the urethra.
  • Anticholinergic drugs may be used to relax the bladder muscle if irritable bladder is found to be the cause.
  • Special incontinence underwear (with an internal pad to absorb the urine) may be used if normal bladder control cannot be restored. Men can wear a penile sheath that leads into a tube connected to a portable urine bag.
  • In severe cases where all other treatments have failed, your doctor may suggest urinary catheterisation (a tube inserted into the bladder to drain the urine) or a urinary diversion operation (to bypass the bladder).

What can I do?

  • Don't hold urine — go when you feel the need.
  • Practice good genital hygiene.
  • Get a portable urinal or bedside commode.
  • Plan a schedule for emptying the bladder.
  • Keep a daily diary of fluid intake and urination.
  • Lose weight if you are overweight.
  • Don’t drink a lot of fluids in situations where access to bathroom facilities is limited.

What is the outlook?

The majority of people with incontinence can be helped and even chronic cases can often be cured.

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