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Urinary Incontinence
Also known as Loss of Bladder Control or Bladder Incontinence
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Urinary incontinence is more common than you might think. It is an embarrassing problem most likely occurring in women that can range from urinating a little bit when you cough and sneeze to having a sudden urge to void that you can't make it to the bathroom. Fortunately, there is good treatment and management of urinary incontinence so it doesn't have to be a big problem. There is a wide range of symptoms of urinary incontinence and three five of incontinence you can have.
The five major types of urinary incontinence include stress incontinence, when incontinence occurs during pressure on the bladder in coughing, straining, sneezing, laughing or exercise. It is worse in men who have had their prostate gland removed. Women of all ages can get this condition. Urge incontinence involves the sudden and intense urge to void with a loss of urine at the time. It is worse in diseases like Parkinson's disease, Alzheimer's disease, bladder injury, stroke or MS.
In overflow incontinence, there is constant dribbling with a full bladder that does not empty well. The stream is often weak and it occurs in those who have had a damaged bladder or a blocked urethra. Diabetic damage can cause this type of incontinence. Functional incontinence occurs when you are unaware that you have to void, such as with dementia or Alzheimer's disease. A physical impairment can make it difficult for you to get to the toilet on time and this can cause functional incontinence.
Gross total incontinence happens when there is continuous leakage of urine day and night. The bladder has no ability to store urine so the urine just flushes through the bladder all the time. It can happen with a fistula in the bladder that causes chronic leakage.
Risk factors for incontinence can cause temporary or permanent incontinence. It occurs when a person drinks excessive alcohol, which acts as a diuretic and bladder stimulant. It happens when you are over hydrated and can't get to the bathroom right away. Dehydration can concentrate the urine and irritate the bladder. Caffeine is a diuretic that can stimulate the bladder to void. Carbonated beverages, artificial sweeteners, spicy foods, high sugar foods and foods high in acid or corn syrup can irritate the bladder and can make incontinence worse. Certain medications can stimulate the bladder. A bladder infection can irritate the bladder and can lead to bladder incontinence. Constipation can make the nerves around the bladder become overactive and can increase urinary frequency.
Permanent incontinence is not uncommon during or after pregnancy. This is usually a type of stress incontinence. Trauma during the delivery can change the way the bladder is suspended and can yield stress incontinence. Uterine prolapse can press on the bladder and can increase incontinence. Changes associated with getting older can change the capacity of the bladder and can decrease the strength of the bladder sphincter. Women make less estrogen after menopause so that the lining of the bladder and urethra isn't as strong as it should be. This can make incontinence worse.
Injury to the bladder during a hysterectomy can cause urinary incontinence. Any pelvic surgery can disrupt the pelvic floor and can change the way the bladder works. Interstitial cystitis is a painful condition of the bladder that can result in incontinence and urgency of urination. Prostatitis or inflammation of the prostate gland can contribute to bladder trouble. Enlarged prostate glands, prostate cancer, bladder cancer or bladder stones can make incontinence worse. A tumor that partially blocks the outflow of the urine can cause overflow incontinence.
Tests for incontinence include a bladder diary that that the doctor asks you to keep to record your bladder functioning, including episodes of incontinence and urges to void. A urinalysis checks for blood or infection in the urine, and specialized testing examines the way the bladder functions.
Specialized testing includes a post-void residual that tells if the bladder empties normally. A pelvic ultrasound may be done to see the bladder and pelvic organs. A stress test checks for the strength of the urethral sphincter and urodynamic testing measures the pressure in the bladder and can tell if it voids normally. A cystogram is an x-ray of the bladder using a dye to see how the bladder fills. A cystoscopy is a camera study of the bladder to look for tumors and other irritations of the bladder.
The treatment of urinary incontinence depends on what type of incontinence you have. You can do pelvic floor exercises to strengthen the placement of the bladder and the strength of the urethral sphincter. You can actually undergo bladder training that can reverse several types of urinary incontinence. Scheduled trips to the toilet can make a difference in some people. Management of your fluid intake and your diet can decrease the stress on the bladder. Electrodes inserted in the vagina or rectum can alter the strength of the pelvic floor.
Medications are used to alter the activity of the bladder. These include taking topical estrogen to strengthen the pelvic floor. Anticholinergic medication can keep urine in the bladder longer without incontinence. Imipramine is an older antidepressant that works against mixed stress and urge incontinence.