Incontinence

If you're leaking urine when you cough, laugh or sneeze, or you have sudden urges to go to the bathroom that are so intense you fear you won't get there in time, you're probably experiencing incontinence. The inability to control urination is a treatable, and often curable, problem faced by more than 13 million Americans, 85 percent of whom are women. While about half the elderly experience urinary incontinence, and it is a major cause of admission to nursing homes, it is often mistakenly thought of as a problem suffered only by older people. In fact, incontinence can occur at any age. Among women ages 15 to 64, it is estimated 10 to 30 percent have urine control troubles, and about one in four women ages 39 to 59 has had an episode of incontinence.
Although the majority of incontinence cases can be improved or cured, less than half of those afflicted ever discuss their problem with a health care professional. Instead of recognizing incontinence as a treatable condition and pursuing treatment, many women view it as an embarrassing consequence of aging, and wear protective pads and/or diaper-like products. Health care professionals recommend using absorbent products during treatment, or as a solution of last resort when other therapy fails, but not as the first and only treatment for incontinence. Left untreated, incontinence can lead to skin rashes and infections, loss of self-esteem, emotional distress and self-imposed isolation. You don't have to suffer incontinence in silence, as there are several treatment options from which you and your health care professional can choose.
Incontinence is not a disease-it's a symptom that can be caused by a wide range of conditions, such as diabetes, stroke and nerve diseases, like multiple sclerosis. Weak pelvic floor muscles or an overactive bladder muscle may also cause leakage. Your urinary tract includes two kidneys, two ureters, the bladder and the urethra. Your kidneys remove waste and water from your blood to produce urine. Urine travels through muscular tubes called the ureters, to the bladder. The bladder is a balloon-like organ composed of muscle, connective tissue and nerves that expands as it fills with urine. Urine is stored in the bladder until it is released from the body through a tube called the urethra.
Circular muscles, called the urinary sphincters, control the activity of the urethra. The sphincter muscles prevent the loss of urine. The sphincters close off the base of the bladder-like a rubber band at the base of a balloon-so you do not leak urine.
As the bladder fills with urine, you have an increasing urge to urinate. Sensory nerves in the bladder signal your brain when the bladder is full. Just before you urinate, the sphincter first relaxes and then, in reflex fashion the bladder muscle contracts, squeezing urine out through the urethra. When you stop urinating, the bladder muscle relaxes, and the sphincters contract.
Incontinence can worsen because of aging, illness or injury. A urinary tract infection, vaginal infection or irritation and constipation can cause temporary bouts of incontinence that are alleviated by treating the ailment. Additionally, some medications can cause incontinence, and changing or discontinuing a drug may bring relief. Women who are pregnant may also suffer from temporary bladder control problems, which are caused by hormonal changes and pressure exerted on the urinary tract by the growing fetus.
Most incontinence in women is triggered by problems with the bladder and sphincter muscles, which can weaken with age. A bladder muscle that is too active, weak pelvic muscles resulting from pregnancy and childbirth, hormonal imbalances in menopausal women, nerve disorders and immobility also can contribute to incontinence. Although these bladder control problems tend to be long-term, eight out of 10 women who seek treatment see an improvement or are cured.
To help you better understand your incontinence, and better explain it to your health care professional, it's helpful to recognize what kind of incontinence you may have. Health care professionals classify incontinence by the symptoms displayed or the circumstances occurring at the time urine is involuntarily released. The following are types of urinary incontinence:
Stress incontinence is the most common form of incontinence in women. This occurs when any kind of pressure is put on the bladder, such as during sneezing, laughing, lifting, running, coughing, exercising, walking or even rising from a chair. Childbirth and weight gain are two common causes of incontinence because these conditions stretch the pelvic floor muscles. The pelvic floor muscles support the bladder, and when they are stretched, the neck of the bladder, or the place where the bladder and the urethra meet, drops and pushes against the vagina wall, preventing the sphincter muscles that force the urethra shut from tightening as well as they should. The result is urine leaks during physical stress. Stress incontinence also can occur when the sphincter muscles themselves weaken. Women with this type of incontinence may notice that it seems to worsen the week before a menstrual period, when lower estrogen levels may result in lower muscular pressure around the urethra, permitting urine to leak. Menopausal women also may experience incontinence caused by similar hormone-related changes. Low estrogen levels in menopausal women may weaken sphincter muscles, causing urine leakage. Additionally, decreased estrogen levels may cause the lining of the urethra to thin, reducing bladder support.
Urge incontinence is characterized by urgent needs to urinate, followed by sudden urine leakage. Occasionally, some women have no warning or urge sensation. You also may leak urine when you drink small amounts of liquid, or when you hear or touch running water. You may also go to the bathroom as often as every two hours, and you may wet the bed at night. Involuntary bladder contractions are the most common cause of urge incontinence, and are described by health care professionals as "overactive," "unstable" or "spastic" bladder. The involuntary bladder muscle contractions can be caused by damage to the bladder muscle or nerves, or to the body's nervous system, including the spinal cord and brain. Such damage may be caused by diseases such as multiple sclerosis, Parkinson's, Alzheimer's, stroke, brain tumors or injuries, including those that can occur in surgery.
Overflow incontinence occurs when your bladder remains full and leaks urine. You may feel as though you need to empty your bladder, but cannot. Or you may urinate a small amount, but feel like your bladder is still full. Frequent or constant dribbling of urine also is a sign of this type of incontinence, which is rare in women. Weak bladder muscles or a blocked urethra can cause an inability to empty the bladder. Diabetes and other diseases can cause nerve damage that weakens the bladder muscle. Urinary stones or tumors also can block the urethra, which can force urine to remain in the bladder and even back up the urinary tract. This creates a serious condition that demands medical attention, because there is an increased chance of kidney infection and irreversible damage.
Functional incontinence: Untimely urination because of physical disability, external obstacles or problems in thinking or communicating that prevent a person from reaching a toilet. This may occur with severe arthritis, after joint replacement, or with Alzheimer's disease.
Mixed incontinence is a combination of types of incontinence, usually stress and urge. Stress and urge incontinence often occur together in older women. In some studies, mixed incontinence is the predominant form of incontinence.