Also called: loss of bladder control
Urinary incontinence is an involuntary loss of urine or the inability to control urination. People with urinary incontinence lose urine when they do not want to and this can cause emotional as well as physical problems. Many people who experience loss of bladder control tend to isolate themselves, because they are afraid of being ridiculed, and may have low self-esteem.
Types
There are four different types of urinary incontinence:
- stress incontinence
- Stress incontinence is the leaking of urine during certain activities (such as lifting, sneezing, coughing, laughing or exercise) that increase pressure within the abdomen. Leaking of urine occurs because the pressure in the bladder is greater than the pressure made by the pelvic muscles at the lower end of the bladder and around the top of the urethra (urethral sphincter).
- urge incontinence
- Urge incontinence is a loss of urine associated with a strong need to urinate (urgency). A person with urge incontinence is aware of the urge to urinate, but is not able to prevent the bladder from emptying before reaching a toilet. It is usually associated with frequent urination during the day and night and is also called overactive bladder.
- overflow incontinence
- Overflow incontinence is a loss of urine because the bladder becomes too full or overdistended. It may be caused by a blockage at the lower part or neck of the bladder (bladder neck obstruction) or a weak bladder muscle. Symptoms of overflow are frequent urination with difficulty starting to urinate, a slow stream and a feeling that the bladder has not completely emptied. Bladder neck obstruction can be caused by a narrow or blocked urethra or a sagging bladder (bladder prolapse).
- functional incontinence
- Functional incontinence occurs in people who can control urination, but factors such as problems with mobility, poor hand function or problems with thinking or communicating (cognitive impairment), prevents them from getting to a toilet in time.
Causes
Urinary incontinence can be due to a number of factors:
- urinary tract infection can cause frequent urination and urge incontinence
- infection or inflammation of the prostate gland in men can lead to frequent urination, urgency and difficulty urinating
- enlargement of the prostate gland can lead to bladder neck obstruction and overflow incontinence
- damage to the nerves or muscles that control bladder function or the release of urine (after prostate or vaginal cancer surgery or radiation therapy, for example)
- pelvic radiation can cause irritation of the lining of the bladder resulting in frequent urination and urgency
- weak pelvic muscle tone can contribute to stress and urge incontinence
- caffeine, alcohol and low fluid intake can result in bladder irritation and bladder spasm
- many medications can cause a person to retain urine, interfere with bladder contractions, increase the amount of urine made, relax bladder and urethra muscles, or affect a person's mobility that can lead to overflow, stress, urge or functional incontinence
- sometimes cancer can lead to urinary incontinence
- Bladder cancer can cause urge incontinence and bladder spasms or some brain or spinal cord tumours can cause urge or overflow incontinence.
Urinary incontinence experienced after some cancer treatments may be temporary and gradually get better as the body recovers. Sometimes it is permanent.
Diagnosis
Tests may be done to find the cause of urinary incontinence. Some of these include:
- urinalysis or urine culture to check for infection
- measuring how much urine is left in the bladder right after urinating (called residual urine) to see how well the bladder empties
- cystoscopy to look inside the bladder
- urodynamic studies, which are a series of different tests or imaging studies (such as x-rays or ultrasound) used to measure bladder pressure, bladder capacity and the flow of urine
Management
Management of urinary incontinence will depend on the cause and type of incontinence.
Irritating foods and drinks
Avoid alcohol and caffeinated beverages that can overstimulate the bladder and lead to urge incontinence. Also avoid spicy foods, carbonated drinks, citrus fruits and juices, all of which can irritate the bladder.
Bladder retraining
Bladder retraining involves emptying the bladder frequently or on a schedule. Gradually, the time period between urination can be increased. Bladder retraining is useful for urge or functional incontinence.
Pelvic muscle exercises or Kegels (Kegals)
The pelvic floor muscles support the bladder neck and help maintain continence. Kegel exercises can help strengthen the pelvic muscles and restore continence. Kegel exercises are useful for stress or urge incontinence.
- To locate the correct muscles, tighten or squeeze the muscles around the anus as if trying to prevent gas from passing.
- Try not to contract the abdominal, back or thigh muscles or hold your breath.
- Hold the squeeze for a count of 3, then release slowly for a count of 3.
- Repeat this 10 times for one set and try to do 5 sets of 10 Kegel exercises a day, for a total of 50.
Kegel exercises can be done in a sitting, lying or standing position. Use memory triggers to help remember to do the exercises, such as doing them while watching television, during commercials, at red lights when driving or while waiting in a lineup.
Talk to the healthcare team if you are having problems doing Kegel exercises properly. Sometimes biofeedback or electrical stimulation is used to help people who have difficulty locating the correct muscles and to teach them the proper technique to use to control pelvic floor muscles and improve bladder control. Biofeedback can involve the use of special devices like sensors or electrodes placed on the skin of the abdomen or pelvic floor muscles, in the vagina or anus, to monitor muscle contraction. Electrical stimulation uses a low-voltage electric current to stimulate the pelvic floor muscles. Once the person masters the exercises on their own, biofeedback and electrical stimulation can be stopped.
Medications
Different medications may be used to treat incontinence and the kinds of medications used may be tailored to the type of incontinence. Some medications relax the bladder muscle, some block nerve signals that can cause bladder spasms or stop contractions of an overactive bladder. Others increase bladder muscle tone and bladder capacity or strengthen the urethral sphincter – the muscle that holds urine in.
Other medications (such as antibiotics to treat infections) may be used depending on the cause of incontinence.
Injections
Special substances (usually collagen) can be injected into the tissues around the urethra. This adds bulk to the urethra and forces it to narrow, which helps control urine leakage due to stress incontinence. More than one injection is usually needed because the body slowly gets rid of the substance. This procedure only works temporarily for some people, while others may have long-term results.
Surgery
If other treatments do not work, surgery may be needed to manage urinary incontinence. The type of surgery will depend on gender and reasons for urinary incontinence. Surgery may involve:
- a procedure that pulls up the bladder and urethra to a more normal position within the pelvis (pelvic or bladder suspension)
- securing the bladder and urethra with a sling
- a "sling" is made by taking a piece of abdominal tissue (fascia) or a piece of synthetic mesh material, which is placed below the bladder and around the urethra and is used to compress the urethral sphincter and prevent leakage
- is used to treat women with stress incontinence caused by weak urethral sphincter muscles and is sometimes done in men
- implanting an artificial urinary sphincter
- a fluid-filled, synthetic cuff is placed around the urethra
- when the cuff is filled with fluid, it closes the urethra and prevents urine loss
- when the person needs to urinate, they release the control valve that causes the cuff to deflate and urine passes out from the bladder
- used mostly in men and is rarely used in women
Urinary catheter
Sometimes a person may have to have a urinary catheter, a rubber tube inserted into the bladder through the urethra to drain the bladder. A catheter may be inserted several times a day or the catheter may be left in place and connected to a drainage bag. This type of management may be useful for people who cannot empty their bladder completely and this leads to overflow incontinence.
A catheter requires special care because it can be a source of infection.
Protective products
Absorbent pads or liners have been designed specially for urine loss and may be used to protect clothing. When choosing an incontinence product, keep in mind the amount of activity and how much urine might be lost. Products can be bought at most drug and grocery stores and some products are different for men and women. Urine is irritating to the skin so change soiled pads frequently. Wash the skin with a mild soap and rinse well. A hair dryer can be used to dry the skin after washing.
External collection products
Special condoms (called condom catheters) are a type of external collection product that fits over a man's penis and is held in place with adhesive, small straps or rings. The end of the condom is attached to a bag secured to the leg, which collects the urine.