Incontinence is a common condition that involves the involuntary loss of urine. Although it is not usually a serious condition, incontinence can be embarrassing and affect a person's daily life. Incontinence is more common in women, especially during and after pregnancy, but can affect people of all ages.
Normal urination involves emptying the bladder when the desire to urinate occurs, at which point the bladder contracts and urine flows out of the body. Once the bladder is empty, the muscles contract and urination stops. People with incontinence experience a disruption in this process, which results in a loss of bladder control.
Causes of Incontinence
Incontinence is often caused by a urinary tract infection or weak muscles in the urinary tract. Some medications may cause weak bladder muscles, therefore causing urinary incontinence. Weak muscles may prevent the closing off of the urethra, and performing certain activities may cause urine to leak.
In some cases, urinary incontinence may be a symptom of a bladder or pelvic floor disorder.
Pelvic Organ Prolapse
Pelvic organ prolapse is the bulging, sagging or falling of pelvic organs such as the bladder, uterus, rectum or intestine. Pressure from these organs against the bladder may result in incontinence.
Urinary Tract Infection
The urinary tract includes the bladder and the urethra, and a bacterial infection can develop in either of these areas. Symptoms of a urinary tract infection include burning when urinating, frequent urge to urinate, pelvic pain and fever.
Interstitial Cystitis
Interstitial cystitis is an inflammation or irritation of the bladder wall. It can cause chronic pain, stiffening and scarring of the bladder, a decrease in the amount of urine the bladder can hold, painful sexual intercourse and a frequent need to urinate.
Bladder Cancer
The most telling sign of bladder cancer is blood in the urine. Other symptoms of bladder cancer include pain when urinating, frequent need to urinate and an unproductive urge to urinate.
Symptoms of Incontinence
In addition to leaking urine, people with incontinence may also experience the following symptoms:
- Strong desire to urinate
- Pelvic pressure
- Frequent urination
- Nocturia
- Painful urination
A symptom of incontinence may also be bed-wetting or nocturia.
Types of Incontinence
There are three main types of urinary incontinence.
Urge
Urge incontinence is most common and involves urine leakage that occurs after a sudden urge to urinate because the muscle wall of the bladder is overactive.
Stress
Stress incontinence is urine leakage that occurs after an activity such as coughing, laughing or sneezing places pressure on the bladder.
Overflow
Overflow incontinence occurs as the result of an inactive bladder muscle that does not completely empty the bladder after urination. This is the least common form of incontinence.
Diagnosis of Incontinence
Patients exhibiting the symptoms of incontinence should see their doctor to determine the cause, type and severity of their condition. Doctors can diagnose urinary incontinence through a series of tests and an evaluation of the patient's medical history. Patients may also be asked to keep a bladder or urination diary to record the frequency and circumstances of their urination. Testing may begin with a pelvic exam to detect any physical abnormalities, and may also include the following diagnostic tests:
- Blood tests
- Urinalysis
A pad test or dye test, which helps to determine urine leakage during stressful situations, may also be performed.
Treatment of Incontinence
There are many different treatment options available for patients with urinary incontinence, depending on the severity of their condition. Conservative treatments are often effective, and may include the following:
- Bladder training
- Avoiding alcohol and caffeine
- Medication to control pelvic muscle spasms.
- Kegel exercises to strengthen the pelvic floor muscles and prevent urine leakage
For more severe cases of incontinence, a medical device or surgery may be used to relieve symptoms. One option includes the insertion of a pessary or urethral insert to prevent urine leakage. Surgery may also be recommended to provide support to the bladder neck. It may be performed through the abdomen or vagina, or using minimally invasive techniques.
Prevention of Incontinence
Not all cases of urinary incontinence can be prevented, however the following recommendations may help in controlling incontinence in some people:
- Drinking less fluids
- Emptying the bladder regularly
- Avoiding alcohol and caffeinated beverages
- Kegel exercises
