Urinary 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.

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:

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

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:

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.

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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.