Urinary incontinence is a loss of control over urination so that urine leaks before you are able to get to a toilet. There are various types of urinary incontinence.

One type of urinary incontinence is stress incontinence. Stress incontinence happens when your pelvic muscles beneath the bladder aren't strong enough to withstand a "stress" or pressure pushing on the bladder from above. Whenever your pelvic muscles give way, they release their squeeze around the bottom of your bladder, so urine can drain out. Stress incontinence is common during pregnancy; during coughing, sneezing, lifting or laughing; or during awkward body movements that stress the body's bladder control.

Another common type of urinary incontinence is urge incontinence, also called overactive bladder. With urge incontinence, the bladder is overly sensitive to stretching and to nerve signals, so you may feel the urge to urinate when your bladder is only partly filled. Also with urge incontinence, your bladder can squeeze after such a minimal trigger that even the thought of urinating can trigger you to leak urine. In this case, you may wet yourself when you hear running water or turn on running water to wash dishes or to wash your hands. You may also wet yourself just at the time you arrive at a bathroom or just as you arrive home and place your key in your door if you are planning to go straight to the bathroom.

It is common for women to have urinary incontinence following childbirth. Pregnancy and childbirth can affect the conditioning of the pelvic muscles, but it can also cause stretching and injury of nerves in the pelvis. Nerve injury can cause urge incontinence. Incontinence may last for a surprisingly long time after childbirth, particularly when nerve healing must occur. One survey found that three months after giving birth, 15% of women still had urinary leakage.

Temporary urinary incontinence is frequently caused by a urinary tract infection. Urinary incontinence can also result from sagging of the uterus (uterine prolapse) or irritation of the vagina (vaginitis). Neurologic problems such as multiple sclerosis or a spinal cord injury can cause the bladder to overfill and overflow or to empty unpredictably. Incontinence can be a complication of radiation treatment or prostate surgery.

Some people have normal bladder function and control, but they are not able to move easily to get to the bathroom. Problems such as severe arthritis can lead to urinary incontinence because the person moves too slowly to get to the bathroom in time.

Urinary incontinence affects approximately 13 million people in the United States and is more common in women than in men. It occurs in 10% to 25% of women younger than age 65 and in 15% to 30% of women older than age 60 who do not live in nursing homes. Among nursing home residents, incontinence is even more common, affecting more than 50% of female patients.

The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent or rare, and it can be a soaking or a small squirt. Urge incontinence can cause episodes of leakage during sleep.

If your urine leakage is accompanied by pain during urination; pink, red or dark discoloration of your urine; odor of your urine; abdominal or back pain; or frequent urinating, it is likely that a urinary infection is the cause.

After reviewing your medical history, your doctor may ask you to keep a detailed record of the times and amounts of urine leakage over a 24- to 72-hour period. This sometimes is called a voiding diary. You can record your fluid intake during this period as well, and you can document any possible triggers such as physical activity, coughing or laughing that might have contributed to your episodes of urinary leakage.

A neurological examination and a pelvic examination may help your doctor to better understand the cause of your urinary incontinence. Your examination may also include a test to determine whether you are able to empty your bladder completely. For this test, you will be asked to urinate to empty your bladder. Then, the amount of urine left in the bladder will be measured, either by ultrasound ("bladder scan") or by draining the remaining urine from your bladder through a thin tube (a catheter) that is gently pushed into the urethra. The amount of urine that is measured is called the "post-void residual." In a thourough evaluation for urinary incontinence, urinalysis usually is done to check for a urinary tract infection.

If your doctor suspects that nerve injury is causing your incontinence, you may need to have a computed tomography scan (CT scan) or magnetic resonance imaging scan (MRI scan) of your brain or spinal cord.

Urinary incontinence may be a short-term problem if it is related to pregnancy or to a urinary tract infection. Urinary incontinence that is related to muscle weakness, pelvic injury or nerve problems is more often a long-term problem.

Most women do not need to worry about preventing urinary incontinence. This problem can be treated once it begins.

If you are considering whether or not to have a hysterectomy (removal of the uterus) and if this surgery is not essential, you should know that urinary incontinence is more common in women who have had a hysterectomy.

Estrogen replacement will not reduce your likelihood of developing urinary incontinence, although doctors once thought that estrogen could help. It is used only as a treatment for a specific cause of urinary tract symptoms (atrophic vaginitis) and is not recommended as a preventive strategy.

Women who are obese and women who don't exercise regularly are more likely to develop urinary incontinence. This is a good reason to eat a healthy diet and exercise throughout your life.

Kegel Exercises
In many cases, women can improve or eliminate urinary incontinence by doing pelvic muscle exercises. These exercises, called Kegel exercises, strengthen the muscles that surround the openings of the urethra, vagina and rectum. Kegel exercises are particularly helpful for stress incontinence, but they can also help you to control your bladder if you have other types of incontinence.

To do Kegel exercises, you need to squeeze your muscles in a way that causes you to feel tightening of your rectum and vagina. A typical recommendation is for women to hold Kegel squeezes for 6 to 8 seconds at a time and to group 8 or 12 squeezes into each session. You can repeat groupings of these exercises several times each week. It can take several months or longer before benefits are seen.

Bladder Retraining
Urge incontinence can be improved by a simple plan that can help your bladder to become less sensitive to its triggers over time. The squeezing of your bladder is a conditioned response. To help your bladder to be less "jumpy", you will need to give your bladder a spell of time when it is not stimulated by the signal of a full bladder. To accomplish this, empty your bladder on a rigid schedule before it becomes full. This may require you to set a timer or a stopwatch and to stop at a bathroom every half hour or hour. After you have had a day or two of success, you can gradually lengthen the interval between your bathroom stops. Your bladder may not respond as urgently over several weeks of this re-conditioning program.

You also can improve urge incontinence by learning ways to calm your bladder signals. When you feel an urge to urinate, try sitting and breathing deeply for a short time instead of racing toward the bathroom. Do Kegel exercises to distract your bladder. Some specialists or specialized physical therapists provide patients with "bladder sphincter biofeedback," which shows recorded levels of bladder, rectum and abdominal pressure during Kegel squeezes or during a variety of relaxation techniques.

Medications
Several medications can lessen bladder muscle tone. These drugs can improve symptoms of urge incontinence. The most commonly used medicines to treat urinary incontinence are oxybutynin (Ditropan) and tolterodine (Detrol). Women who have a urinary tract infection are given antibiotics. For post-menopausal women who have vaginitis that is caused by too little estrogen, estrogen creams or tablets in the vagina can be helpful, but estrogen does not help urinary incontinence in women who do not have this vaginal condition.

Devices to Strengthen the Pelvic Muscles
A doctor occasionally recommends the use of cone-shaped weights to maximize the muscle-conditioning effect of Kegel exercises. You can place one of these cones into your vagina before you begin a group of pelvic muscle exercises.

Pessaries
If your urine leakage is caused by a sagging (prolapsed) uterus or a bulge or bend in your urethra, a firm rubber ring that supports the bottom of your uterus may help. This device is called a pessary; it can be inserted in the vagina by a physician and worn continuously.

Surgery
The most common cause of stress incontinence in women is lack of support at the bladder neck. Surgery can be used to treat this problem when other treatment methods have been ineffective.

Surgery can be done through an incision above the pubic bone, through an incision in the vagina or, in some cases, by inserting a needle-shaped instrument through the skin above the pubic bone or through the front wall of the vagina, guiding the movement of the needle by using an ultrasound probe in the urethra. Some highly specialized medical centers use "robotic" surgery techniques to improve the support of pelvic floor muscles. For this type of surgery, instruments attached to metal rods are inserted into the pelvis through small incisions, and the rods are held securely in place. The instruments on the rods can make very precise movements, and they are maneuvered by a surgeon who uses a remote control while watching a magnified video screen. In any of these surgical procedures, the goal is to wrap the urethra (the drainage tube for the bladder) with a "sling" of fibrous tissue or loops of suture material and then to tether the urethra to the pelvis so it won't sag or shift off center.

Occasionally, the bladder neck can be thickened by injecting a non-absorbable material. This can help some people to hold urine more easily.

Rarely, an electrical stimulator may be surgically implanted. This device periodically stimulates the sacral nerve which is the nerve that controls bladder function and pelvic muscles. This may reduce symptoms in certain people who have urge incontinence or overflow of the bladder.

Other Strategies
If you smoke and your urine leaks when you cough, this is an excellent reason for you to quit smoking. Seek treatment from your doctor for your cough.

Although pads or adult diapers can offer security, these products can also irritate the skin, and they should not be the first or only treatment used for incontinence.

Because women are sometimes reluctant to tell their doctors about symptoms of urinary incontinence, fewer than 50% seek medical care. Urinary incontinence is a very common problem, and it has a variety of possible treatments. If you experience urinary incontinence, tell your doctor. Your primary care provider can provide basic treatments for urinary incontinence. Physicians who specialize in evaluating and treating urinary incontinence are named "urogynecologists" or "female urologists."

About 80% of women who seek treatment for urinary incontinence find that their symptoms improve. Patients who continue a bladder retraining program may begin to see good results after only a few weeks of therapy. Kegel exercises improve urine control in 40% to 75% of women who use them consistently.

Surgery for urinary incontinence has been shown to be very successful, but it can result in one or more complications. Some of these possible complications include:

• Difficulty emptying the bladder
• Bladder spasms
• Bladder infection
• Injury to the bladder during surgery
• Return of incontinence

American Urological Association
1000 Corporate Blvd.
Linthicum, MD 21090
Phone: 410-689-3700
Toll-Free: 1-866-746-4282
Fax: 410-689-3800
Email: aua@auanet.org
http://www.urologyhealth.org/