| Feature
Story |
| 
With the right treatment, many people can control—if
not cure—the problem. |
Urinary Incontinence: A Common Problem That’s Often
Easily Controlled
Roughly 10 percent of all men and women over age 65 have urinary incontinence,
or loss of bladder control. Although incontinence can occur at any age,
it is far more common among older people, especially women. The symptoms
of urinary incontinence vary widely, ranging from slight leakage to uncontrollable
wetting.
Because of the embarrassing nature of bladder control problems, many
people with urinary incontinence go to great lengths to hide their symptoms.
But with the right treatment, many people can control—if not cure—the
problem. In fact, about 80 percent of those who suffer from urinary incontinence
can be cured or helped significantly through medical treatment. If you
have lost some bladder control, it’s important that you talk to
your doctor as soon as possible.
What Causes Urinary Incontinence?
Many factors can contribute to urinary incontinence, including:
| • |
Thinning and drying of the skin in the vagina
or urethra in women, especially after menopause |
| • |
Prostate surgery or enlargement of the prostate
in men |
| • |
Weakening of the pelvic muscles |
| • |
Buildup of stool in the bowels |
| • |
Some medications |
| • |
Inability to move around freely |
| • |
Infections of the urinary tract |
| • |
Other disorders, such as diabetes or high calcium
levels. |
What Are the Different Kinds of Incontinence?
The four main forms of urinary incontinence are stress incontinence,
urge incontinence, overflow incontinence, and functional incontinence.
| • |
Stress incontinence, which mostly affects women,
occurs when urine leaks after sudden pressure on the lower stomach
muscles, such as when you laugh, cough, exercise, or lift something.
People who have weak pelvic muscles following surgery or childbirth
are more likely to develop stress incontinence. |
| • |
Urge incontinence occurs when the need to urinate
comes on suddenly, before you can get to a toilet. People with urge
incontinence, most often the elderly, have only minutes at most
before urination begins. |
| • |
Overflow incontinence, characterized by a constant
dripping of urine, is caused by an overfilled bladder. People with
overflow incontinence—mostly men—feel as though they
are unable to completely empty the bladder and may be forced to
strain when urinating. Diabetes, certain medicines, or an enlarged
prostate gland or tumor can contribute to overflow incontinence.
|
| • |
Functional incontinence affects people who have
normal bladder control but experience difficulty in getting to the
toilet in time. Functional incontinence is caused by arthritis or
other diseases and disorders that reduce mobility. |
How Is Urinary Incontinence Diagnosed?
If you think you may have urinary incontinence, see your doctor. After
a giving you a physical examination, your doctor might perform a variety
of lab tests and blood tests to determine your bladder’s capacity
and how much urine remains in the bladder after you urinate.
Your doctor might refer you to a urologist, urogynecologist, or another
doctor who specializes in treating incontinence. If you see a specialist,
bring a list of all prescription and over-the-counter medications you’re
taking, as well as results from any earlier bladder-related tests.
What Treatments Are Available?
Depending on your diagnosis, your doctor could recommend a combination
of medications, behavioral techniques, absorbent products, exercise, and
rehabilitation. For some people, dietary changes or a change in medication
may be enough to resolve the problem.
| • |
Medications. Your doctor may prescribe such
medications as pseudoephedrine (Sudafed) or imipramine (Tofranil)
to help control your symptoms of incontinence. These drugs help
the muscles in the bladder to contract. Additionally, a certain
class of drugs called anticholinergenics, which relax bladder muscles,
is a popular medication for urge incontinence. Be sure to talk to
your doctor before you take any medications. |
| • |
Behavioral techniques. Many people can control
their symptoms by modifying their urination habits. Elderly people
and those with Alzheimer’s disease benefit from scheduled
toileting, or visiting the bathroom every 2 to 4 hours. Other people
start on a bathroom schedule and gradually visit the toilet less
often during the day. Bladder retraining has been very effective
in treating urge incontinence. Pelvic muscle rehabilitation, including
vaginal weight training and Kegel exercises, can strengthen the
muscles used in urination. |
| • |
Incontinence products. There are a variety of
products on the market, including disposable undergarments, catheters,
and external collection systems, which help people manage symptoms
while waiting for treatment. |
Surgery
If you haven’t responded to other treatments, your doctor may recommend
surgery. There are many surgical options available, depending on the type
and cause of your incontinence.
Surgical Treatments for Stress Incontinence
Talk to your doctor about which option is best for you.
| • |
Urethral injection. This method is used to treat
stress incontinence in men. A doctor will inject bulking agents
through the urethra to strengthen the sphincter, the muscle that
keeps the bladder shut until it is time to urinate. Unfortunately,
this method only has about a 10 percent cure rate. |
| • |
Artificial sphincter. This device is also used
to treat stress incontinence in men. A surgeon inserts a pressure-regulating
balloon in the abdomen and a cuff around the urethra. Fluid in the
abdomen travels to the cuff, which closes the urethra and prevents
leakage. |
| • |
Sling procedure. This noninvasive method is used
to treat stress incontinence in women. During this operation, a
surgeon places a strip of tissue beneath the urethra to help it
remain closed. |
| • |
Abdominal surgery. During this operation for
women, which is commonly performed if the sling procedure is unsuccessful,
a surgeon places vaginal tissue on the pelvic bone. |
Surgical Treatments for Urge Incontinence
Talk to your doctor about which option is best for you.
| • |
Bladder pacemaker. A surgeon inserts a device
in the person’s back, near the nerve that controls bladder
function. The device is connected to a pulse generator, which helps
control urination. |
| • |
Cystoplasty augmentation. This procedure is
only used if the person has not responded to any other form of treatment.During
the operation, a surgeon enlarges the bladder with a segment of
the small intestine. |
Surgical Treatments for Overflow Incontinence
Overflow incontinence, which is usually caused by an obstruction in the
bladder, can be treated with medication or surgery to remove the blockage.
How Can I Prevent Urinary Incontinence?
Most people urinate about three or four times every day. If you need
to get up more than once in the middle of the night to use the bathroom,
talk to your doctor. The following tips can help prevent symptoms of urinary
incontinence
| • |
Drink at least six to eight glasses of fluids
every day. You should drink more water if you’re exercising
or outdoors in hot weather. |
| • |
Don’t strain to empty your bladder.
|
| • |
Try to keep bowel movements regular. |
| • |
Talk your doctor if you find blood in your urine
or you experience pain when you urinate. |
References
1. “Urinary
Incontinence,” National Institute on Aging, August 2002.
2. “Urinary
Incontinence: Embarrassing But Treatable,” American Academy
of Family Physicians, April 2000.
3. “Treatment
Options,” National Association for Continence, 2002.
4. “Healthy
Bladder Habits,” The Simon Foundation for Continence, 1999.
5. “Minimally
Invasive Management of Urinary Incontinence,” American Urological
Association, 2002.
6. “Surgical
Management of Urinary Incontinence,” American Urological Association,
2002.
Writer: Don Amerman
Clinical Reviewer: Patt Panzer, MD, MPH
Editors: Andrea King, Joanne Poeggel
Date Written: 12/16/02
Date Last Revised: 12/19/02
Source of Material: Rockhill Communications, 14 Rock Hill Road Bala, Cynwyd,
PA 19004, (610) 667-2040, http://www.rockhillcommunications.com |
