Urinary incontinence happens when muscles around the bladder and sphincter do not contract or relax properly. Urinary incontinence, also known as bladder control issues, can affect anyone; however older women are most commonly diagnosed.

The bladder is a sac-like structure, hollow and muscular, that collects and stores urine excreted by the kidneys. When you urinate, muscles in the bladder contract to move urine into the urethra, a tube that transports urine out of the body. Coinciding with this contraction is the relaxing of sphincter muscles around the urethra, which helps move urine out of the body.

Urine incontinence may happen like a leak, drop by drop when someone coughs or laughs. Or, someone may feel a sudden urge to urinate, but cannot make it to the restroom in time. Fortunately, today there is effective treatment available.

Older women are most often diagnosed with urinary incontinence. During menopause, estrogen levels in the body drop dramatically. Estrogen is responsible for keeping the urethra and the lining of the bladder healthy. It also stimulates blood flow to the pelvic region, increasing strength in the pelvic muscles. As the estrogen drops, you may find that your pelvic muscles are simply weaker than before. These muscles may not have enough strength to hold the opening to the bladder closed causing some urine to leak.

In younger women, pregnancy and childbirth cause hormonal changes that enlarge the uterus thereby weakening pelvic muscles. The stress of a vaginal delivery can cause organs to protrude into the vagina often resulting in incontinence.

Other causes for urinary incontinence include:

• Constipation

   

• Urinary tract infection

   

• Alcohol and caffeine

   

• Medications

   

• Over-hydration (drinking too much liquid)

   

• Excess weight

   

• Abnormal growths

   

• Neuromuscular problems

Constipation and urinary tract infections are medical conditions, and with proper treatment, urinary incontinence is typically resolved.

Alcohol, caffeine, medications (for heart, blood pressure, sedatives), excessive drinking of fluids and obesity can cause temporary or transient urinary incontinence. In these cases a simple change in lifestyle and habits can bring relief.

Abnormal growths may also lead to urinary incontinence, and can include a tumor on the urinary tract, bladder stones, or polyps. Neuromuscular problems occur when conditions such as diabetes mellitus, multiple sclerosis, or a stroke affects the nerve signals to the bladder.

Types of Urinary Incontinence

There are five types of urinary incontinence:

• Stress incontinence occurs when urine leaks as a result of sudden pressure on the lower stomach muscles. Coughing, sneezing, laughing, exercising, and lifting heavy objects can put pressure on the bladder causing it to leak. It is the most common type seen in younger and middle-aged women due to weakened tissues and muscles after pregnancy, childbirth, and menopause.

• Urge incontinence is a condition where someone feels a strong desire to urinate but leakage of urine occurs before a bathroom is reached. Here, the bladder muscles are overactive. Often called an “overactive bladder,” this is more common in older people and those affected with brain disorders like stroke and dementia. Post-menopausal women also experience urge incontinence due to low estrogen levels.

• Functional incontinence is seen in people who physically cannot reach a toilet in time. People suffering from a mental disorder such as dementia or Alzheimer’s, or those with physical immobility fall into this category.

• Mixed incontinence is experiencing more than one kind of incontinence, the most common being a combination of the stress and urge types. Urge and functional incontinence are also seen together as age progresses.

• Overflow incontinence occurs when there is a steady leak of small amounts of urine. The bladder does not empty fully while urinating, which could be due to weak muscles or a blocked urethra.

To help diagnose the right type of urinary incontinence, it is recommended to keep a bladder diary for at least three days and record the intake of fluids, the frequency of urination, if there is an urge to urinate, and the number of incontinence episodes.

At the doctor’s office, it is likely that urine and blood samples will be taken to rule out an infection. In addition, the doctor will conduct a physical examination to determine nerve damage leading to the bladder or other abnormalities.

Specialized tests that may be conducted include:

• Postvoid residual measurement to check leftover urine in the bladder

• Pelvic ultrasound

• Urodynamic tests to measure bladder strength

• Stress tests

• Dye test to easily identify the loss of urine

• Cystogram, an X-ray of the bladder

• Cystoscopy, a procedure that looks into the bladder with a flexible viewing tube

Based on the patient’s history and subsequent diagnosis, the doctor can determine the best treatment options.

Behavioral remedies like bladder training and Kegel exercises (pelvic muscle exercises), along with lifestyle changes, may be enough to treat urinary incontinence. Bladder training can help control the urge to urinate by scheduling set times to visit the bathroom. The objective is to lengthen the time between bathroom visits. When the urge to urinate occurs prior to the set time, it is recommended to distract yourself or employ relaxation techniques such as slow and deep breathing.

Kegel exercises help stop urine flow by training the pelvic floor muscles, which helps in stress and urge incontinence. To know whether the right muscles are being exercised, the urine flow must be stopped or slowed down without using the stomach, leg, or buttock muscles. Squeeze the muscles and hold for a few seconds. Repeat the exercise gradually increasing the hold to more counts. Kegel exercises are specially designed for women and best performed initially lying down. As the muscles get stronger, the exercises can be done standing or sitting. It is best to learn these exercises from a qualified trainer.

Biofeedback helps people identify the right muscles by placing an electrical patch over the bladder and connecting it to a TV screen so you can see the bladder working. For people who cannot physically perform the exercises, electro stimulation can be used to strengthen the muscles.

Lifestyle changes like losing weight, reducing caffeine intake, not drinking too much water, and scheduling urination will help fight incontinence. To ease the discomfort of leaking urine, absorbent pads and adult diapers are available at drug stores.

Medications can be prescribed along with behavioral therapy. These medicines help relax the bladder and prevent sudden contractions. Estrogen creams are also available and can be applied in the vagina for mild stress incontinence. Finally, surgery is an option when other treatments fail to relieve the symptoms.

Outlook

Millions of people, and especially women, are affected by urinary incontinence. It is recommended to talk with a doctor as soon as you notice the condition. In most cases, behavioral treatment and careful management can help cure urinary incontinence.