urinary incontinence (redirected from Urinal incontinence)

Urinary Incontinence 

Definition

Urinary incontinence is unintentional loss of urine that is sufficient enough in frequency and amount to cause physical and/or emotional distress in the person experiencing it.

Description

Approximately 13 million Americans suffer from urinary incontinence. Women are affected by the disorder more frequently than are men; one in 10 women under age 65 suffers from urinary incontinence. A study published in late 2002 found that between 21% and 29% of adult women in the workforce reported at least one episode of urinary incontinence each month. Older Americans, too, are more prone to the condition. Twenty percent of Americans over age 65 are incontinent. In general, the condition is underrecognized and undertreated.

There are five major categories of urinary incontinence: overflow, stress, urge, functional, and reflex.

• Overflow incontinence. Overflow incontinence is caused by bladder dysfunction. Individuals with this type of incontinence have an obstruction to the bladder or urethra, or a bladder that doesn't contract properly. As a result, their bladders do not empty completely, and they have problems with frequent urine leakage.
• Stress incontinence. Stress incontinence occurs when an individual involuntarily loses urine after pressure is placed on the abdomen (i.e., during exercise, sexual activity, sneezing, coughing, laughing, or hugging).
• Urge incontinence. Urge incontinence occurs when an individual feels a sudden need to urinate, and cannot control the urge to do so. As a consequence, urine is involuntarily lost before the individual can get to the toilet.
• Functional incontinence. Individuals who have control over their own urination and have a fully functioning urinary tract, but cannot make it to the bathroom in time due to a physical or cognitive disability, are functionally incontinent. These individuals may suffer from arthritis, Parkinson's disease, multiple sclerosis, or Alzheimer's disease.
• Reflex incontinence. Individuals with reflex incontinence lose control of their bladder without warning. They typically suffer from neurological impairment.

In some cases, an individual may develop short-term or acute incontinence. Acute incontinence may occur as a symptom or by-product of illness, as a side effect of medication, or as a result of dietary intake. The condition is typically easily resolved once the cause is determined and addressed.

Causes and symptoms

Urinary incontinence can be caused by a wide variety of physical conditions, including:

• Childbirth. Childbirth can weaken the pelvic muscles and cause the bladder to lose some support from surrounding muscles, resulting in stress incontinence.
• Dysfunction of the bladder and/or the urinary sphincter. In a continent individual, as the bladder contracts, the outlet that releases urine into the urethra (bladder sphincter) opens and urine exits the body. In individuals with overflow incontinence, bladder contractions and dilation of the sphincter do not occur at the same time.
• Enlarged prostate. In men, an enlarged prostate gland can obstruct the bladder, causing overflow incontinence.
• Hysterectomy or other gynecological surgery. Any surgery involving the urogenital tract runs the risk of damaging or weakening the pelvic muscles and causing incontinence.
• Menopause. The absence of estrogen in the postmenopausal woman can cause the bladder to drop, or prolapse.
• Neurological conditions. The nervous system sends signals to the bladder telling it when to start and stop emptying. When the nervous system is impaired, incontinence may result. Neurological conditions such as multiple sclerosis, stroke, spinal cord injuries, or a brain tumor may cause the bladder to contract involuntarily, expelling urine without warning, or to cease contractions completely, causing urinary retention.
• Obesity. Individuals who are overweight have undue pressure placed on their bladder and surrounding muscles.
• Obstruction. A blockage at the bladder outlet may permit only small amounts of urine to pass, resulting in urine retention and subsequent overflow incontinence. Tumors, calculi, and scar tissue can all block the flow of urine. A urethral stricture, or narrow urethra caused by scarring or inflammation, may also result in urine retention.

Acute incontinence is a temporary condition caused by a number of factors, including:

• Bladder irritants. Substances in the urine that irritate the bladder may cause the bladder muscle to malfunction. The presence of a urinary tract infection and the ingestion of excess caffeine can act as irritants. Highly concentrated urine resulting from low fluid intake may also irritate the bladder.
• Constipation. Constipation can cause incontinence in some individuals. Stool that isn't passed presses against the bladder and urethra, triggering urine leakage.
• Illness or disease. Diabetes can greatly increase urine volume, making some individuals prone to incontinence. Other illnesses may temporarily impair the ability to recognize and control the urge to urinate, or to reach the toilet in time to do so.
• Medications and alcohol. Medications that sedate, such as tranquilizers and sleeping pills, can interfere with the proper functioning of the urethral nerves and bladder. Both sedatives and alcohol can also impair an individual's ability to recognize the need to urinate, and act on that need in a timely manner. Other medications such as diuretics, muscle
  

  Strengthening the pelvic floor muscles by performing Kegel exercises helps to alleviate stress incontinence in women. Contract the pelvic floor muscles as if stopping an imaginery flow of urine. Hold for 10 seconds and repeat.

  (Illustration by Electronic Illustrators Group.)
  relaxants, and blood pressure medication can also affect bladder function.
• Surgery. Men who undergo prostate surgery can suffer from temporary stress incontinence as a result of damage to the urethral outlet.

Diagnosis

Urinary incontinence may be diagnosed by a general practitioner, urologist, or gynecologist. If the patient is over age 65, a geriatrician may diagnose and treat the condition. A thorough medical history and physical examination is typically performed, along with specific diagnostic testing to determine the cause of the incontinence. Diagnostic testing may include x rays, ultrasound, urine tests, and a physical examination of the pelvis. It may also include a series of exams that measure bladder pressure and capacity and the urinary flow (urodynamic testing). The patient may also be asked to keep a diary to record urine output, frequency, and any episodes of incontinence over a period of several days or a week.

Treatment

There are numerous invasive and noninvasive treatment options for urinary incontinence:

• Behavior modification therapy. Behavior modification is a psychological approach to the treatment of urinary incontinence in which patients gradually increase the length of the time interval between voidings and "retrain" the bladder in other ways. It is reported to be highly effective in treating urge incontinence.
• Biofeedback. The use of sensors to monitor temperature and muscle contractions in the vagina to help incontinent patients learn to control their pelvic muscles.
• Collagen injections. Collagen injected in the tissue surrounding the urethra can provide urethral support for women suffering from stress incontinence.
• External occlusive devices. A new single-use disposable urethral cap is available without a prescription as of late 2002 for women suffering from stress urinary incontinence. The cap is noninvasive and appears to be quite effective in managing incontinence.
• Inflatable urethral insert. Sold under the trade name Reliance, this disposable incontinence balloon for women is inserted into the urethra and inflated to prevent urine leakage.
• Intermittent urinary catheterization. The periodic insertion of a catheter into a patient's bladder to drain urine from the bladder into an attached bag or container.

• Medication. Estrogen hormone replacement therapy can help improve pelvic muscle tone in postmenopausal women. Other medications, including flurbiprofen, capsaicin and botulinum toxin, are sometimes prescribed to relax the bladder muscles or to tighten the urethral sphincter. As of late 2002, newer medications for the treatment of urinary incontinence were undergoing clinical trials. One of these drugs, duloxetine, differs from present medications in targeting the central nervous system's control of the urge to urinate rather than the smooth muscle of the bladder itself.
• Pelvic toning exercises. Exercises to tone the pelvic muscle can help alleviate stress incontinence in both men and women. These exercises involve tightening the muscles of the pelvic floor, and are also known as Kegel or PC muscle exercises.
• Perineal stimulation. Perineal stimulation is used to treat stress incontinence. The treatment uses a probe to deliver a painless electrical current to the perineal area muscles. The current tones the muscle by contracting it.
• Permanent catheterization. A permanent, or indwelling, catheter may be prescribed for chronic incontinence that doesn't respond to other treatments. A Foley catheter is usually used for urinary catheterization. One end is inserted through the urethra and into the bladder, and the external end is attached to a plastic reservoir bag that the patient may wear on the leg. A second alternative is a permanent catheter, called a suprapubic tube, surgically inserted into the bladder. The tube exits the body through the abdomen near the pubic bone, where it is attached to a drainage bag. As infection may result, this treatment should be reevaluated periodically, and the possibility of alternative treatment addressed.
• Sacral nerve stimulation (SNS). Also known as sacral neuromodulation, SNS is a procedure in which a surgeon implants a device that sends continuous stimulation to the sacral nerves that control the urinary sphincter. The FDA approved sacral nerve stimulation for the treatment of urinary urge incontinence in 1997 and for urinary frequency in 1999.
• Surgery. Bladder neck suspension surgery is used to correct female urinary stress incontinence. Surgical techniques such as the Marshall-Marchetti-Krantz and Burch procedures use sutures to raise and support the bladder neck and urethra. A sling procedure, which uses a strip of biocompatible material or the patient's own muscle or tissue as a supportive sling under the urethra and bladder neck, may also be used to treat stress incontinence. Bladder enlargement surgery may be recommended to treat incontinent men and women with unusually small bladders.
• Urinary sphincter implant. An artificial urinary sphincter may be used to treat incontinence in men and women with urinary sphincter impairment.
• Vaginal inserts. Devices constructed of silicone or other pliable materials that can be inserted into a woman's vagina to support the urethra.

Prognosis

Left untreated, incontinence can cause physical and emotional upheaval. Individuals with long-term incontinence suffer from urinary tract infections, and skin rashes and sores. Incontinence can also affect their self-esteem and cause depression and social withdrawal. They frequently stop participating in physical activities they once enjoyed because of the risk of embarrassing "accidents." However, with the wide variety of treatment options for incontinence available today, the prognosis for incontinent patients is promising. If incontinence cannot be stopped, it can be improved in the majority of cases.

Key terms

Bladder neck — The place where the urethra and bladder join.

Bladder sphincter — The outlet that releases urine into the urethra.

Calculi (singular, calculus) — Mineral deposits that can form a blockage in the urinary system.

Occlusive — Closing off. One of the newest treatments for stress urinary incontinence in women is an external occlusive single-use cap that covers the urethral opening.

Perineal area — The genital area between the vulva and anus in a woman, and between the scrotum and anus in a man.

Sacral nerves — The five pairs of nerves that arise from the lowermost segments of the spinal cord and control bladder, bowel, and pelvic functions. Stimulation of the sacral nerves by an implanted device is a newer treatment for urinary incontinence.

Prevention

Women who are pregnant or who have gone through childbirth can reduce their risk for stress incontinence by strengthening their perineal area muscles with Kegel exercises. Men who have undergone prostate surgery may also benefit from pelvic muscle exercises. Men and women should consult with their doctor before initiating any type of exercise program.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Urinary Incontinence." Section 17, Chapter 215 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Amundsen, C. L., and G. D. Webster. "Sacral Neuromodulation in an Older, Urge-Incontinent Population." American Journal of Obstetrics and Gynecology 187 (December 2002): 1462-1465.

Bachmann, G., and B. Wiita. "External Occlusive Devices for Management of Female Urinary Incontinence." Journal of Women's Health (Larchmont) 11 (November 2002): 793-800.

Burgio, K. L. "Influence of Behavior Modification on Overactive Bladder." Urology 60, no.5, Supplement 1 (November 2002): 72-76.

Burgio, K. L., P. S. Goode, J. L. Locher, et al. "Behavioral Training With and Without Biofeedback in the Treatment of Urge Incontinence in Older Women: A Randomized Controlled Trial." Journal of the American Medical Association 288 (November 13, 2002): 2293-2299.

Haeusler, G., H. Leitich, M. van Trotsenburg, et al. "Drug Therapy of Urinary Urge Incontinence: A Systematic Review." Obstetrics and Gynecology 100, no. 5, Part 1 (November 2002): 1003-1016.

Palmer, M. H., and S. Fitzgerald. "Urinary Incontinence in Working Women: A Comparison Study." Journal of Women's Health (Larchmont) 11 (December 2002): 879-888.

Viktrup, L. "Female Stress and Urge Incontinence in Family Practice: Insight Into the Lower Urinary Tract." International Journal of Clinical Practice 56 (November 2002): 694-700.

Yoshimura, N., and M. B. Chancellor. "Current and Future Pharmacological Treatment for Overactive Bladder." Journal of Urology 168 (November 2002): 1897-1913.

Organizations

American Foundation for Urologic Disease. 1128 North Charles St., Baltimore, MD 21201. (800) 242-2383. http://www.afud.org.

American Urological Association (AUA). 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. www.auanet.org.

Center for Biologics Evaluation and Research (CBER), U. S. Food and Drug Administration (FDA). 1401 Rockville Pike, Rockville, MD 20852-1448. (800) 835-4709 or (301) 827-1800. www.fda.gov/cber.

National Association for Continence. P.O. Box 8310, Spartanburg, SC 29305-8310. (800) 252-3337. http://www.nafc.org.

National Kidney and Urologic Diseases Information Clearinghouse. 3 Information Way, Bethesda, MD 20892-3580. (800) 891-5390.

---

incontinence /in·con·ti·nence/ (-kon´tĭ-nens)

1. inability to control excretory functions.

2. immoderation or excess.incon´tinent

---

fecal incontinence  involuntary passage of feces and flatus.

overflow incontinence  urinary incontinence due to pressure of retained urine in the bladder after the bladder has contracted to its limits, with dribbling of urine.

passive incontinence  urinary or fecal incontinence in which the bladder or colon is full and cannot be emptied in the usual way but can be induced by pressure.

stress incontinence  involuntary escape of urine due to strain on the orifice of the bladder, as in coughing or sneezing.

urge incontinence , urgency incontinence urinary or fecal incontinence preceded by a sudden, uncontrollable impulse to evacuate.

urinary incontinence  inability to control the voiding of urine.

---

urinary incontinence,

inability to control urination, caused by acute or chronic factors. Five classes of chronic incontinence are recognized. Functional incontinence is the result of cerebral clouding and/or physical factors that make it difficult to get to bathroom facilities in time. Overflow incontinence occurs when the urinary tract is obstructed or when the detrusor muscle fails to contract as bladder capacity is reached. Spinal cord injury or benign prostatic hypertrophy may be the cause. Stress incontinence is precipitated by coughing, sneezing, or straining. It occurs more often in women and is commonly related to anatomic changes. Urge incontinence is the inability to delay voiding after a sensation of bladder fullness is perceived. Reflex incontinence occurs when there is detrusor hyperreflexia and/or urethral relaxation due to neurologic causes, such as spinal cord injury. Urinary incontinence can have mixed etiologies. Treatment depends on the underlying cause and may include anticipatory toileting, bladder retraining, exercise of perineal muscles, anticholinergic medications, and surgery. See also incontinence, retention with overflow.

---

urinary incontinence,

n failure to restrain urination. Functional incontinence is due to cognitive or physical aspects that increase the difficulty of reaching a facility in time. Overflow incontinence is due to an obstruction in the urinary tract or the failure of the detrusor muscle to contract when the bladder reaches capacity. Stress incontinence is brought on by a cough, sneeze or strain, most often after childbirth in women. The therapeutic approach depends on the source of the condition; retraining the bladder, anticipatory toileting, biofeedback, medication, surgery, and exercising perineal muscles may be prescribed. See also
incontinence.

---

urinary

pertaining to the urine; containing or secreting urine.

---

urinary bile pigment

bilirubin and urobilinogen are found in the urine of normal animals.

urinary calculi

see urolith, urolithiasis.

urinary diversion

various surgical procedures involving the ureters, bladder or urethra may be used to alter the usual route of urine flow, thereby bypassing portions of the urinary tract, usually the bladder and/or urethra. Ureters, bladder or urethra are transplanted or anastomosed to the bowel or placed so urine exits at an orifice created through the skin. See also ureteroileostomy, trigonal-colonic anastomosis, ureterocolostomy, transureteroureterostomy.

urinary flow monitor

periodic measurement of the amount of urine secreted. In an anesthetized animal a catheter draining into a calibrated container is used. In a conscious animal a clamped-off, self-retaining catheter is inserted and drained at intervals. A metabolism cage is an alternative.

urinary flowmetry

the measure of urinary flow rates.

urinary incontinence

an inability to control urination with the involuntary passage of urine. Most commonly occurs in dogs due to congenital abnormalities of the ureters or urethra. Other causes include congenital or acquired defects in nervous control of micturition, neoplastic or inflammatory disease of the lower urinary tract, and prostate gland and endocrine abnormalities.

urinary obstruction

urethral or ureteral obstruction often caused by lodgement of a urinary calculus in the narrow lumen. Constriction of urethra due to hyperplastic prostate in male dogs.

urinary pole

the point on the glomerulus where the proximal convoluted tubule exits.

urinary pooling

see urovagina.

urinary system, urinary tract

the system formed in the body by the kidneys, the urinary bladder (2), the ureters and the urethra, the organs concerned in the production and excretion of urine.

urinary territorial marking

see spraying.

urinary tract

see urinary system.

---

Patient discussion about Urinal incontinence.

Q. Can you treat urinary incontinence by only making exercise of circular muscles? I heard the exercise help but dont know if it is enough by itself.

A. This technique you have mentioned is called "bio-feedback" and it helps many people with urinary incontinence, by raising your awareness to muscles in your body you don't usually pay attention to, thus making you able to control them better. I do not think this is an only way to treat incontinence, however with the addition of the proper medications you can find this very helpful.