Urinary Incontinence
Are you reluctant
to talk to your doctor about your bladder control problem? Don’t be.
There is help.
Loss
of bladder control is called urinary incontinence. It can happen to
anyone, but is very common in older people. At least 1 in 10 people
age 65 or older has this problem. Symptoms can range from mild leaking
to uncontrollable wetting. Women are more likely than men to have
incontinence.
Aging does not
cause incontinence. It can occur for many reasons. For example,
urinary tract infections, vaginal infection or irritation, constipation,
and certain medicines can cause bladder control problems that last
a short time. Sometimes incontinence lasts longer. This
might be due to problems such as:
- weak bladder muscles,
- overactive bladder muscles,
- blockage from an enlarged
prostate,
- damage to nerves that
control the bladder from diseases such as multiple sclerosis or
Parkinson’s disease, or
- diseases such as arthritis
that can make walking painful and slow.
Many people with
bladder control problems hide the problem from everyone, even from
their doctor. There is no need to do that. In most cases urinary
incontinence can be treated and controlled, if not cured. If you
are having bladder control problems, don’t suffer in silence. Talk
to your doctor.
Bladder Control
The body stores
urine in the bladder. During urination, muscles in the bladder contract
or tighten. This forces urine out of the bladder and into a tube called
the urethra that carries urine out of the body. At the same time,
muscles surrounding the urethra relax and let the
urine pass through. Spinal nerves control how these muscles move.
Incontinence occurs if the bladder muscles contract or the muscles
surrounding the urethra relax without warning.
Diagnosis
The first step
in treating a bladder control problem is to see a doctor. He or she
will give you a physical exam and take your medical history. The doctor
will ask about your symptoms and the medicines you use. He or she
will want to know if you have been sick recently or had surgery. Your
doctor also may do a number of tests. These might include:
- urine and blood tests
and
- tests that measure how
well you empty your bladder.
In addition, your
doctor may ask you to keep a daily diary of when you urinate and when
you leak urine. Your pattern of urinating and urine leakage may suggest
which type of incontinence you have.
Types of Incontinence
There are several
different types of urinary incontinence:
- Stress incontinence
happens when urine leaks during exercise, coughing, sneezing,
laughing, lifting heavy objects, or other body movements that
put
pressure on the bladder. It is the most common type of bladder
control problem in younger and middle-age women. In some cases
it is related to childbirth. It may also begin around the time
of menopause.
- Urge incontinence
happens when people can’t hold their urine long enough to get
to the toilet in time. Healthy people can have urge incontinence,
but it is often found in people who have diabetes, stroke, Alzheimer’s
disease, Parkinson’s disease, or multiple sclerosis. It is also
sometimes an early sign of bladder cancer.
- Overflow incontinence
happens when small amounts of urine leak from a bladder that is
always full. A man can have trouble emptying his bladder if an
enlarged prostate is blocking the urethra. Diabetes and spinal
cord injury can also cause this type of incontinence.
- Functional incontinence
happens in many older people who have normal bladder control.
They just have a hard time getting to the toilet in time because
of arthritis or other disorders that make moving quickly difficult.
Treatment
Today there are
more treatments for urinary incontinence than ever before. The choice
of treatment depends on the type of bladder control problem you have,
how serious it is, and what best fits your lifestyle. As a general
rule, the simplest and safest treatments should be tried first.
Bladder
Control Training
Your
doctor may suggest you try to get back control of your bladder through
training. With bladder training you can change how your bladder stores
and empties urine. There are several ways to do this:
- Pelvic muscle exercises
(also known as Kegel exercises) work the muscles that you
use to stop urinating. Making these muscles stronger helps you
hold urine in your bladder longer. These exercises are easy to
do. They can lessen or get rid of stress and urge incontinence.
| Kegel Exercises
The muscles you want to
exercise are your pelvic floor muscles. These are the ones
you use to stop the flow of urine or to keep from passing
gas. Often doctors suggest that you squeeze and hold these
muscles for a certain count, and then relax them. Then you
repeat this a number of times. You will probably do this
several times a day. Your doctor will give you exact
directions. |
-
Biofeedback
helps you become more aware of signals from your body. This
may help you regain control over the muscles in your bladder and
urethra. Biofeedback can be used to help teach pelvic muscle exercises.
-
Timed
voiding and bladder training also can help you control
your bladder. In timed voiding, you keep a chart of urination
and leaking to determine the pattern. Once you learn that, you
can plan to empty your bladder before you might leak. When combined
with biofeedback and pelvic muscle exercises, these methods may
help you control urge and overflow incontinence.
Management
Besides bladder
control training, there are several other ways to help manage incontinence:
- Sometimes doctors suggest
a small, throwaway patch; a small, tampon-like urethral
plug; or a vaginal insert called a pessary for women
with stress incontinence.
- A doctor can prescribe
medicines to treat incontinence. Some drugs prevent unwanted
bladder contractions. Some relax muscles, helping the bladder
to empty more fully during urination. Others tighten muscles in
the bladder and urethra to cut down leakage. These drugs can sometimes
cause side effects such as dry mouth, eye problems, or urine buildup.
Vaginal estrogen may be helpful in women after menopause. Talk
with your doctor about the benefits and side effects of using
any of these medicines for a long time.
- A doctor can inject an
implant into the area around the urethra. The implant adds
bulk. This helps close the urethra to reduce stress incontinence.
Injections may have to be repeated after a time because your body
slowly gets rid of these substances.
- Sometimes surgery can
improve or cure incontinence if it is caused by a problem such
as a change in the position of the bladder or blockage due to
an enlarged prostate. Common surgery for stress incontinence involves
pulling the bladder up and securing it. When stress incontinence
is serious, the surgeon may use a wide sling. This holds up the
bladder and narrows the urethra to prevent leakage.
- You can now buy special
absorbent underclothing. It is not bulky and can be worn easily
under everyday clothing.
If you suffer
from urinary incontinence, tell your doctor. Remember, under a doctor’s
care, incontinence can be treated and often cured. Even if treatment
is not fully successful, careful managing can help you feel more relaxed
and comfortable.
Resources
You are not alone.
There are people who can answer your questions and give you information
about urinary incontinence. To learn more, contact:
National Association
for Continence
P.O. Box 8306
Spartanburg, SC 29305-8306
1-800-BLADDER (1-800-252-3337)
www.nafc.org
Simon Foundation
for Continence
P.O. 835-F
Wilmette, IL 60091
1-800-237-4666
www.simonfoundation.org
National Institute
of Diabetes and Digestive and Kidney Diseases
National Kidney and
Urologic Diseases Information
Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
301-654-4415
www.niddk.nih.gov
For a list of
free publications on health and aging from the National Institute
on Aging (NIA), contact:
NIA Information
Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
www.nia.nih.gov
National Institute
on Aging
U. S. Department of Health and Human Services
National Institutes of Health
August 2002.
