Urinary Incontinence

Urinary incontinence is the inability to control leakage of urine. It's one of those embarrassing problems people don't like to talk about -- even with their doctors. It can also cause problems with bad odor, skin irritation, pressure ulcers, urinary tract infections, sleep, social isolation, depression and sexual dysfunction. But there is help for incontinence. In most cases, the problem is treatable. It can usually be improved, if not completely cured.

Normally, urination is controlled by the brain. When the bladder becomes full, its muscles contract and give you the feeling that you have to urinate. The urethra is the tube leading from your bladder to the outside of the body. Muscles that form a ring around the urethra keep it closed until you voluntarily allow these muscles to relax and the muscles in the walls of the bladder contract. This causes urine to pass from the bladder. After urination, the bladder shrinks and there is no urge to urinate

Types of Urinary Incontinence

There are four types of incontinence. Each has its own symptoms and causes.

Stress Incontinence

Stress incontinence can occur when the muscles around the urethra are too weak to prevent the urine from leaking out. Urine leaks when pressure inside your abdomen increases such as when you cough, sneeze, laugh, lift heavy objects, exercise or even get up from a chair. Sometimes the muscles that hold the bladder in place are weak. Urine does not leak during sleep. Stress incontinence can occur at any age, but it is most common in women who have borne children, because childbirth can weaken pelvic-floor muscles. Often, stress incontinence occurs after menopause because the decrease in estrogen can lead to thinning and weakening of the pelvic muscles and surrounding tissues. Muscles around the urethra can be weakened by bladder infections, vaginal scarring in women or prostate removal in men.

Urge Incontinence

Urge incontinence, also known as detrusor instability, is when a person has frequent, sudden and strong urges to urinate. It occurs when the bladder contracts when it shouldn’t. It can cause bed wetting while sleeping. A small or large amount of urine may leak out. 

The bladder wall is a muscle called the detrusor muscle. This muscle may contract involuntarily and more strongly than it should and overcome the ability of the muscles that form a ring around the urethra to keep it closed. That can cause a sudden need to urinate. The contractions may be strong enough to cause urine loss before you reach the bathroom.

Often the cause of urge incontinence is not known. It can be caused by defects in the parts of the brain that control urination such as a stroke or Parkinson’s disease. Bladder infections can irritate the bladder and the bladder muscles to contract involuntarily. Other conditions such as anxiety or dementia may cause it. Excess caffeine intake can also play a role.

Urge incontinence is treated most successfully without surgery. Nonsurgical treatment options include electrical stimulation; "timed voiding," or urinating at scheduled intervals; and reduction in caffeine consumption. Certain medications may also be helpful. In some cases, surgery may be required. One operation for women moves the bladder, allowing the bladder neck to return to its normal, closed position.

Overflow Incontinence

Overflow incontinence occurs when the bladder does not empty all the way. This occurs when the bladder muscle contractions are too weak to completely empty the bladder or when the flow of urine is obstructed by muscles around the urethra that don’t relax to allow urine to pass or a bladder stone. With this problem, urine builds up in the bladder and you can leak small amounts of urine all day long. You may feel the need to go to the bathroom and then urinate only a little. You may not feel completely "empty" after you finish. This may be more common at night.

In general, men seem to experience overflow incontinence more than women. Obstruction to the flow of urine can be caused by an enlarged prostate or prostate cancer. The enlarged prostate pushes on the urethra blocking the flow of urine.

Some disorders, such as diabetes, stroke, paralysis and multiple sclerosis, may prevent people from sensing when their bladder is full or prevent the bladder muscles from contracting with sufficient force. Chronic use of muscle relaxants or antidepressants can also interfere with bladder control.

To treat overflow incontinence, doctors first try to treat whatever disorder is causing the incontinence. They may also prescribe medications that relax the bladder outlet. In men, surgery may be recommended to remove part of the prostate gland that may be blocking urination.

Functional Incontinence

Functional incontinence is not because of a problem in the urinary system itself. It happens in people who have physical limitations and cannot get to the bathroom before urination occurs. It is particularly common in hospitals and nursing homes and in any setting where a person may be unfamiliar with his or her surroundings. It can also be a side effect of certain medications.

Treatment for functional incontinence depends mostly on society's help. Better-staffed nursing homes and better public restrooms can help, as can adjusting doses of medications to accommodate an individual's schedule. Providing an easy or shorter route to the bathroom is another easy way to assist those with functional incontinence.

Self-Care Steps for Urinary Incontinence

• If you are a woman, do Kegel exercises as often as you can.

• If urinary incontinence is worse for you at night, don't drink anything after dinner.

• Don't drink alcohol, especially after dinner.

• Cut out drinks with caffeine, such as coffee, tea, and colas.

• Use an absorbent undergarment. They are made for both men and women.

• Keep a list of your symptoms. It will help your doctor find the exact problem.

Kegel Exercises

Kegel exercises are designed to strengthen the pelvic-floor muscles, the muscles used to stop the flow of urine. There are many different ways to do Kegel exercises. All types involve tightening the pelvic floor muscles and then releasing them.

To determine which muscles you need to strengthen, try doing a Kegel exercise the first time you urinate after waking. While your bladder is full, start and stop the flow of urine. Let out only small amounts of urine at a time. Start and stop the flow of urine in this way until your bladder is empty. The muscles that you use to stop urination are the same ones that you will be tightening and releasing for Kegel exercises.

Two Ways That You Can Do Kegel Exercises

Exercise 1:

Contract the pelvic muscles as far as possible. Hold tightly for 3 seconds. Release and repeat 20 to 25 times. You can do these exercises anywhere -- while doing the dishes, brushing your teeth, reading the paper, even driving. If you do a set of 20 to 25 exercises three to five times a day, you should notice a difference within a few months.

Exercise 2:

Think of the pelvic floor as an elevator. Tighten the pelvic-floor muscles slightly to reach floor one. Hold for several seconds. Without releasing this hold, tighten the muscles again, this time moving to floor two. Pause again for several seconds. Continue to move up floor by floor until you reach floor five. At this point, the muscles should be fully contracted. Gradually release the muscles floor by floor in the same way you did to tighten them.