Urinary Incontinence Health Article

Definition

Urinary incontinence is unintentional loss of urine that is sufficient enough in frequency and amount to cause physical and/or emotional distress in the person experiencing it.

Description

Approximately 13 million Americans suffer from urinary incontinence. Women are affected by the disorder more frequently than are men; one in 10 women under age 65 suffers from urinary incontinence. A study published in late 2002 found that between 21% and 29% of adult women in the workforce reported at least one episode of urinary incontinence each month. Older Americans, too, are more prone to the condition. Twenty percent of Americans over age 65 are incontinent. In general, the condition is underrecognized and undertreated.

There are five major categories of urinary incontinence: overflow, stress, urge, functional, and reflex:

• Overflow incontinence. Overflow incontinence is caused by bladder dysfunction. Individuals with this type of incontinence have an obstruction to the bladder or urethra, or a bladder that doesn't contract properly. As a result, their bladders do not empty completely, and they have problems with frequent urine leakage.
• Stress incontinence. Stress incontinence occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (i.e., during exercise, sexual activity, sneezing, coughing, laughing, or hugging).
• Urge incontinence. Urge incontinence occurs when a person feels a sudden need to urinate and cannot control the urge to do so. As a consequence, urine is involuntarily lost before the individual can get to the toilet.
• Functional incontinence. Individuals who have control over their own urination and have a fully functioning urinary tract, but cannot make it to the bathroom in time due to a physical or cognitive disability, are functionally incontinent. These individuals may suffer from arthritis, Parkinson's disease, multiple sclerosis, or Alzheimer's disease.
• Reflex incontinence. Individuals with reflex incontinence lose control of their bladder without warning. They typically suffer from neurological impairment.

In some cases, an individual may develop short-term or acute incontinence. Acute incontinence may occur as a symptom or byproduct of illness, as a side effect of medication, or as a result of dietary intake. The condition is typically easily resolved once the cause is determined and addressed.

Causes & symptoms

Urinary incontinence can be caused by a wide variety of physical conditions, including:

• Childbirth. Childbirth can stretch the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence.
• Dysfunction of the bladder and/or the urinary sphincter. In a continent individual, as the bladder contracts, the outlet that releases urine into the urethra (bladder sphincter) opens and urine exits the body. In individuals with overflow incontinence, bladder contractions and dilation of the sphincter do not occur at the same time.
• Enlarged prostate. In men, an enlarged prostate gland can obstruct the bladder, causing overflow incontinence.
• Hysterectomy or other gynecological surgery. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence.
• Menopause. The absence of estrogen in the postmenopausal woman can cause the bladder to drop, or prolapse.
• Neurological conditions. The nervous system sends signals to the bladder telling it when to start and stop emptying. When the nervous system is impaired, incontinence may result. Neurological conditions such as multiple sclerosis, stroke, spinal cord injuries, or a brain tumor may cause the bladder to contract involuntarily, expelling urine without warning, or to cease contractions completely, causing urinary retention.
• Obesity. Persons who are overweight have undue pressure placed on their bladder and surrounding muscles.
• Obstruction. A blockage at the bladder outlet may permit only small amounts of urine to pass, resulting in urine retention and subsequent overflow incontinence. Tumors, calculi, and scar tissue can all block the flow of urine. A urethral stricture, or narrow urethra caused by scarring or inflammation, may also result in urine retention.

Acute incontinence is a temporary condition caused by a number of factors, including:

• Bladder irritants. Substances in the urine that irritate the bladder may cause the bladder muscle to malfunction. The presence of a urinary tract infection and the ingestion of excess caffeine can act as irritants. Highly concentrated urine resulting from low fluid intake may also irritate the bladder.

• Constipation. Constipation can cause incontinence in some individuals. Stool that isn't passed presses against the bladder and urethra, triggering urine leakage.
• Illness or disease. Diabetes can greatly increase urine volume, making some individuals prone to incontinence. Other illnesses may temporarily impair the ability to recognize and control the urge to urinate, or to reach the toilet in time to do so.
• Medications and alcohol. Medications that sedate, such as tranquilizers and sleeping pills, can interfere with the proper functioning of the urethral nerves and bladder. Both sedatives and alcohol can also impair an individual's ability to recognize the need to urinate, and act on that need in a timely manner. Other medications such as diuretics, muscle relaxants, and blood pressure medication can also affect bladder function.
• Surgery. Men who undergo prostate surgery can suffer from temporary stress incontinence as a result of damage to the urethral outlet.