Urinary incontinence refers to the involuntary leakage of urine.
(last reviewed May 16, 2008)
Isn't it normal to leak urine as you get older?
No. Although it is more common for women to suffer from incontinence as they get older, incontinence is not normal at any age.
(last reviewed May 16, 2008)
What causes urinary incontinence?
In order to understand the possible causes of urinary incontinence it is important to understand the many processes that work together in the normal process of urination.
Urine is produced by the kidneys and passes into a muscular sac called the urinary bladder. The urethra is the tube that leads from the bladder to the outside of the body.
A ring of muscles, called the urinary sphincter, surrounds the urethra. As the bladder fills with urine, the sphincter muscles are contracted and the bladder muscle stays relaxed. This allows the bladder to fill with urine and prevents urine from leaking out.
When the bladder is nearing full, nerve signals are sent to the brain, letting the person know that the bladder is getting full. Additional nerve signals are sent out to begin urination. Some of these signals cause the bladder muscles to contract, which pushes urine into the urethra. At the same time, other signals cause the sphincter muscles to relax, which allows the urine to pass out of the body. Most people empty their bladder every three to five hours during the day and zero to one times during the night.
Now that we reviewed the normal process, it is easier to understand where things can go wrong.
Urge Incontinence - In this type of incontinence, the bladder contracts before the person is ready to urinate. This is the most common type of incontinence.
Stress Incontinence - In this type of incontinence, the sphincter does not close properly or does not stay closed when there is increased pressure (as with a cough or sneeze), allowing urine to leak. This is an especially common cause of incontinence in women, especially women who have had children.
Overflow Incontinence - If the bladder is too weak to empty completely, this can cause leakage when bladder is overly full. This is a rare type of incontinence.
Obstruction - If the urethra is obstructed, this can prevent urine from draining completely, which can also lead to overflow incontinence. This is common in men with an enlarged prostate.
Medical or other conditions - Urine leakage also can occur when a person is unable to make it to the toilet on time as a result of medical conditions, medications, and/or difficulty with thinking clearly.
Advancing age. In those age 65 and older, 15 to 30 percent of people have incontinence.
Obesity
high impact physical activities
heart failure
lung problems
smoking
chronic cough
depression
constipation
pregnancy
vaginal delivery
problems with mobility
(last reviewed May 17, 2008)
What is "urge incontinence?"
Urge incontinence occurs when the bladder contracts suddenly, so that the normal "urge" to urinate becomes a severe feeling of urgency. A person with urge incontinence will generally have a sudden urge to urinate, followed by urine leakage that can range from a few drops to soaking. The urgency and leakage may occur in response to a stimulus, such as unlocking the door when returning home, going out in the cold, turning on the faucet, or washing the hands.
There are many other names that are used to describe urge incontinence. These names include overactive bladder, detrusor instability or overactivity, and irritable or spastic bladder. These terms all describe the same condition.
Some people with overactive bladder have symptoms of urinary urgency and frequency during the daytime only, while other people also have to urinate frequently during the night (called nocturia). Frequency is defined as the need to urinate more often than other people (normal is considered to be eight times in 24 hours).
(last reviewed May 17, 2008)
What is "stress incontinence"?
Stress incontinence occurs when the urinary sphincter (the muscle that holds the urine inside) does not stay closed when there is an increase in pressure in the abdomen, leading to urine leakage. As an example, coughing, sneezing, laughing, or running can cause episodes of stress incontinence. Stress incontinence is the most common cause of urinary incontinence in younger women, the second most common cause in older women.
Stress incontinence is usually a result of weakness in the vaginal muscles that surround the urethra. Occasionally, the sphincter muscle itself may malfunction, this condition is called intrinsic sphincter deficiency (ISD). ISD is usually the result of of an injury or from radiation therapy.
(Last reviewed May 17, 2008)
What is mixed urinary incontinence?
Mixed incontinence is the combination of both urge and stress incontinence, and is most common in younger to middle aged women.
(last reviewed May 17, 2008)
What is "overflow urinary incontinence"?
Overflow incontinence refers to leakage that occurs when the bladder fails to empty properly, either because of obstruction of the urethra or weak bladder muscle contractions. Abnormally large amounts of urine remain in the bladder, even after the person tries to empty. The person may also notice a weak stream, dribbling, or needing to go frequently.
Overflow incontinence is extremely unusual in women, and is usually associated with prostate enlargement in men.
(last reviewed May 17, 2008)
How will my doctor diagnose what type of incontinence I have?
The first step in the proper diagnosis urinary incontinence is to discuss problem with your doctor. The history and physical examination are the most important steps in the investigation and treatment of urinary incontinence, and your doctor will need to know many things about your problem. Many women are embarrased to share the details of this problem, but it is very important for your doctor to know all of the facts so that he or she can properly treat you.
The questions will include many of the following examples:
When does the leakage occur? (ie, is it associated with urgency, coughing/sneezing, or does it occur without warning?)
When did your leakage begin?
Has it worsened or improved over time?
Have you tried any treatments to reduce leakage?
Is there is any leakage of stool (fecal incontinence)?
Your doctor may ask that you keep a diary of your urinary history. This will include collecting information about how much you have urinated, the frequency of urination, and the amount of leakage, amount of fluid consumed, and any associated factors that cause leakage, such as coughing or sneezing. This helps your doctor figure out what the problem really is.
(last reviewed May 17, 2008)
What kinds of tests might my doctor order to diagnose the cause of the urinary incontinence?
During the examination, your doctor may perform a number of simple tests. These will help determine the type of leakage that you are experiencing. This may include a cough test, when you are asked to cough several times while the doctor watches for urine leakage. Other possible tests include measurement of the post void residual, which is the amount of urine left in the bladder after urinating. This can be done with an ultrasound probe (called a bladder scan) or by inserting a catheter into the bladder.
Laboratory tests that may be ordered include a urinalysis to look for evidence of infection or blood in the urine. Sometimes blood tests may be ordered to measure your kidney function.
(last reviewed May 17, 2008)
What is urodynamic testing?
During a urodynamic test, a small catheter is inserted into the bladder and the rectum or vagina. The bladder is slowly filled with water and various measurements are taken. This testing examines the bladder, urethra, and urethral sphincter as the bladder is filled with water, when the bladder is full, and when the person coughs or bears down. Testing includes measurement of the bladder capacity (how much the bladder can hold), the pressures in the bladder and urethra, and how fast urine flows during urination.
Urodynamic testing is not always necessary when diagnosing the cause of urinary incontinence. In some confusing circumstances, it may provide helpful information.
