Urinary Incontinence

Last Updated: July 1, 2003

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
• 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.

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.

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.

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.

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.

Source: National Institute on Aging

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