Urinary incontinence is involuntary loss of urine. When you urinate, the ring of muscles around the opening of your bladder — called the urinary sphincter — relaxes, your bladder muscles contract and urine travels out of your body through a tube called the urethra (u-REE-thrah). The sphincter's ability to function depends on muscles and ligaments in your lower pelvis called the pelvic floor muscles.
But sometimes, you may lose urine when you don't want to. Millions of Americans — the majority women — experience urinary incontinence. It can affect all ages, but is most common in older adults.
Urinary incontinence is generally divided into four categories:
- Stress incontinence is loss of urine that occurs when you exert pressure on your bladder by coughing, laughing, jumping or lifting. This is the most common type of incontinence.
- Urge incontinence is an immediate, strong urge to urinate. You can't hold it long enough to get to the bathroom.
- Overflow incontinence is an inability to properly empty your bladder, which can cause frequent or constant dribbling of urine.
- Mixed incontinence is a combination of types. Stress and urge incontinence often occur together, especially in older women.
Factors that can stress and weaken pelvic floor muscles and lead to incontinence include:
- Excess weight
- Frequent constipation
- Chronic cough
- Childbirth
Many women also experience reduced sphincter muscle strength due to a decrease in the hormone estrogen following menopause. Reduced estrogen can also cause tissues lining the urethra to thin, reducing bladder support.
Other causes of incontinence include:
- Urinary-related infections
- Overactive bladder muscles
- Malfunction of your urinary sphincter
- High fluid intake
- Diseases such as diabetes, stroke and Parkinson's disease
- Some medications for insomnia, depression, high blood pressure and heart disease
In men, the condition can also stem from noncancerous enlargement of the prostate gland, prostate cancer and prostate surgery.
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- Do pelvic floor exercises (Kegels). Women often use these exercises to treat stress incontinence. Men who develop incontinence following surgery for prostate cancer use a similar exercise. Begin by contracting your pelvic muscle, as you would to prevent a bowel movement or to stop urine flow. Relax, and then repeat the contraction. Do this 20 or 30 times. Rest 10 seconds between contractions. Repeat the exercise several times a day. Don't do it in the bathroom while urinating.
- Time urination. Try going to the bathrooom according to the clock rather than waiting for the need to go. You may start off urinating every hour or so and then build up to an acceptable interval.
- Decrease or avoid alcohol and caffeine. They cause you to urinate more. For some people, reducing the amount of all liquids before going to bed helps.
- Cross your legs. For stress incontinence, crossing your legs at certain times - such as when you feel a sneeze coming - may help.
- Wear a pad or absorbent underwear to protect against small leaks. Change it every couple of hours. Women can wear tampons while exercising.
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- Medications. Medications such as oxybutynin, propantheline and hyoscyamine may reduce urge incontinence by decreasing bladder contractions. Side effects may include dry mouth, blurred vision and constipation. Pseudoephedrine is sometimes recommended for episodes of stress incontinence. It slightly tightens the urinary sphincter. However, it can be associated with rapid heartbeat and should not be used frequently or without medical advice.
For urge incontinence resulting from menopausal changes, hormone replacement therapy may help. Estrogen used in hormone treatment helps keep the lining of the urethra healthy and functional.
- Bulking agents. These are substances injected into the lining of the urethra. They bulk up the lining so it provides increased resistance to urine flow. The most common bulking agent is collagen, a naturally occurring protein. Because your body breaks down the injected collagen, follow-up treatments are often needed.
- Surgery. Surgery is sometimes necessary to remove blockages, improve the position of your bladder neck, add bulk to tissues or add support to weakened pelvic muscles. An artificial urinary sphincter can also be implanted. In addition, a stimulator that's implanted in your spine is available. The device sends tiny electric impulses to nerves that control your bladder. The impulses may help reduce involuntary bladder contractions.
For women only:- Urethral plug. This prescription device is a balloon-tipped cylinder about one-fifth the size of a tampon After placing it in the urethra, a gentle push fills the small balloon with air and prevents urine from leaking. When it's time to urinate, you pull a string to deflate the balloon and then remove the plug.
- Urethral patch. The prescription patch is a foam pad with a gel-like adhesive on one side. Placing it over the opening of the urethra helps prevent mild leakage.
- Pessary. When inserted into the vagina, this device holds the bladder neck in place to help prevent urine leakage. You must remove and clean a pessary periodically.
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October 25, 1999 —
