Urinary Incontinence namesLoss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary
Urinary Incontinence Definition
Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.
The two main types of urinary incontinence are:
Bowel incontinence, a separate topic, is the inability to control the passage of stool.
Urinary Incontinence Considerations
Incontinence is most common among the elderly. Women are more likely than men to have urinary incontinence.
Infants and children are not considered incontinent, but merely untrained, up to the time of toilet training. Occasional accidents are not unusual in children up to age 6 years. Young (and sometimes teenage) girls may have slight leakage of urine when laughing.
Nighttime urination in children is normal until the age of 5 or 6.
The ability to hold urine is dependent on having normal anatomy and a normally functioning urinary tract and nervous system. You must also possess the physical and psychological ability to recognize and appropriately respond to the urge to urinate.
The process of urination involves two phases:
Normally, during the filling and storage phase, the bladder begins to fill with urine from the kidneys. The bladder stretches to accommodate the increasing amounts of urine.
The first sensation of the urge to urinate occurs when approximately 200 ml (just under 1 cup) of urine is stored. A healthy nervous system will respond to this stretching sensation by alerting you to the urge to urinate, while also allowing the bladder to continue to fill.
The average person can hold approximately 350 to 550 ml (over 2 cups) of urine. The ability to fill and store urine properly requires a functional sphincter (the circular muscles around the opening of the bladder) and a stable, expandable bladder wall muscle (detrusor).
The emptying phase requires the ability of the detrusor muscle to appropriately contract to force urine out of the bladder. At the same time, your body must be able to relax the sphincter to allow the urine to pass out of the body.
Urinary Incontinence Common Causes
Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:
Urinary Incontinence Causes that may be more long-term:
Urinary Incontinence Home Care
See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.
The following methods are used to strengthen the muscles of your pelvic floor:
To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. DO NOT contract your abdominal, thigh, or buttocks muscles. And DO NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.
Other measures include:
Your doctor may recommend medication or surgery, especially if home care measures are not helping or if your symptoms are getting worse.
Medications that may be prescribed include drugs that relax the bladder, increase bladder muscle tone, or strengthen the sphincter.
Surgery may be required to relieve an obstruction or deformity of the bladder neck and urethra. Uterine or pelvic suspension operations are sometimes needed in women. Men may require prostatectomy (removal of the prostate gland). Incontinence can sometimes be managed by artificial sphincters. These are synthetic cuffs that are surgically placed around the urethra to help retain urine.
If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.
Performing Kegel exercises while you are pregnant and soon after delivery may help prevent incontinence related to childbirth.
Call your health care provider if
Discuss incontinence with your doctor. Gynecologists and urologists are the specialists most familiar with this condition. They can evaluate the causes and recommend treatment approaches.
Call 911 or go to an emergency room if any of the following accompany a sudden loss of urine control:
Call your doctor if:
What to expect at your health care provider's office
Your doctor will take your medical history and perform a physical examination, with a focus on your abdomen, genitals, pelvis, rectum, and neurologic system.
Medical history questions may include:
Diagnostic tests that may be performed include:
Other tests may be performed to rule out pelvic weakness as the cause of the incontinence. One such test is called the Q-tip test. This test involves measurement of the change in the angle of the urethra when it is at rest and when it is straining. An angle change of greater than 30 degrees often indicates significant weakness of the muscles and tendons that support the bladder.
Urinary Incontinence Illustrations
Female Urinary Tract
The female and male urinary tracts are relatively the same except for the length of the urethra.
Male Urinary Tract
The male and female urinary tracts are relatively the same except for the length of the urethra.
American College of Obstetricians and Gynecologists. Urinary incontinence in women. Obstet Gynecol. 2005; 105(6): 1533-1545.
Madersbacher H, Madersbacher S. Men's bladder health: urinary incontinence in the elderly (Part I). J Mens Health Gend. 2005; 2(1): 31-37.
Kielb SJ. Stress incontinence: alternatives to surgery. Int J Fertil Womens Med. 2005; 50(1): 24-29.
[Article from the MedLine Plus Medical Encyclopedia of the US National Library of Medicine and the National Institutes of Health.]
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