Incontinence. Anatomy The human body has two kidneys. The kidneys continuously filter the blood and make urine.

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Incontinence Introduction Urinary incontinence occurs when a person cannot control the emptying of his or her urinary bladder. It can happen to anyone, but is very common in older people.

1 Incontinence Introduction Urinary incontinence occurs when a person cannot control the emptying of his or her urinary bladder. It can happen to anyone, but is very common in older people. Urinary incontinence is a very common condition; one in twenty-five Americans suffer from it. At least 1 in 10 people age 65 or older has incontinence. Symptoms can range from mild leaking to uncontrollable wetting. Women are more likely than men to have incontinence. Unfortunately, most people who have incontinence do not seek medical help because either they feel embarrassed to talk about it or they do not realize there are successful, easy-to-implement treatment options. This reference summary explains how the urinary bladder works, the causes and symptoms of incontinence, and treatment options for urinary incontinence. Anatomy The human body has two kidneys. The kidneys continuously filter the blood and make urine. Urine goes from the kidneys to the bladder through two tubes called ureters. Urine is stored in the bladder until a person is ready to urinate. When a person goes to the bathroom, urine travels to the outside of the body through a tube called the urethra. Kidney Ureter Bladder Urethra 1

Urination Urine is continuously produced by the kidneys and stored in the bladder. The walls of the bladder have muscles in them. When empty, the bladder muscles are relaxed.

There are 2 groups of sphincter muscles: internal sphincters and external sphincters Internal sphincters are at the base of the bladder, while external sphincters are further down the urethra.

2 Urination Urine is continuously produced by the kidneys and stored in the bladder. The walls of the bladder have muscles in them. When empty, the bladder muscles are relaxed. As the bladder fills with urine, it gets bigger. As the bladder fills up, another set of muscles, called sphincters, clamps down around t he urethra to keep it closed and prevent urine from leaking. There are 2 groups of sphincter muscles: internal sphincters and external sphincters Internal sphincters are at the base of the bladder, while external sphincters are further down the urethra. Internal Sphincters External Sphincters When the bladder is full, the feeling is transmitted to the brain. At this point, a person realizes that he or she needs to go to the bathroom. To urinate, a person purposely relaxes the sphincters and contracts the bladder muscles, causing urine to pass through the urethra. When the bladder is empty, the bladder muscles relax and the sphincters become tight again. The flow of urine stops and the bladder is ready to be filled again. Types and Causes Urinary incontinence occurs when a person is unable to control the flow of urine. This causes the person to wet his or her pants. There are a number of causes for incontinence. Stress incontinence happens when urine flows out of the body uncontrollably when a person bears down. For example, it might happen when the person coughs, sneezes, or lifts heavy objects. Stress incontinence occurs because the sphincters, including the muscles around the urethra and the pelvic muscles, become weak and are unable to clamp down on the urethra. When a person bears down, it puts pressure on the bladder, which in turn pushes urine through the urethra. With the urethra unable to stop urine, some leaks out. 2

muscles contract while the bladder is full, forcing urine out before the person can get to a bathroom.

3 Stress incontinence usually happens in one of two situations. People who have had pelvic surgery, leading to weakness of the pelvic muscles and sphincters Women who have had babies, causing the pelvis muscles to weaken Urge incontinence happens when the bladder muscles contract while the bladder is full, forcing urine out before the person can get to a bathroom. Urge incontinence usually occurs in people with neurological problems such as multiple sclerosis, strokes, or Parkinson s disease. Patients with diabetes can have nerve damage that leads to urge incontinence. Urge incontinence can be an early sign of bladder cancer, as well as prostate enlargement. Overflow incontinence happens when a person cannot completely empty the bladder. This leads the bladder to overfill and then leak out uncontrollably. Overflow incontinence usually occurs in men who have an enlarged prostate. Diabetes can also lead to overflow incontinence. Functional incontinence is when a person is able to urinate, but is unable to get to a bathroom in time to urinate because of some other medical problem. For example, the person may be bedridden, or may walk very slowly because of a hip or knee problem. Mixed incontinence is when two or more types of incontinence occur at the same time. Other types of incontinence can be attributed to medications or diet. Different medications, prescribed or over-the-counter, can cause the bladder to either contract uncontrollably or to relax more than necessary, leading to incontinence. Drinking a lot of caffeine or alcoholic beverages may worsen incontinence. If not treated, incontinence can result in serious health problems. This is why it is very important to tell your doctor about incontinence early on. In case of overflow incontinence, the urine that stays in the bladder can cause pressure against the kidney. This could lead to kidney failure and possibly dialysis. 3

4 Patients with incontinence should also be checked for potentially serious medical problems that can lead to incontinence. Such medical problems include bladder cancer, enlargement of the prostate and prostate cancer. If incontinence is not managed properly, it can lead to skin rashes and ulceration. Incontinence can also lead to loneliness, since incontinence sufferers are often too embarrassed to socialize. The following conditions can cause bladder control problems that last a short time: urinary tract infections, vaginal infection or irritation, and constipation. Diagnosis Most people who have incontinence recognize the problem. However, accurate diagnosis of the type of incontinence is critical for determining the treatment options. Urologists and gynecologists are doctors that are trained in diagnosing and treating incontinence. A urologist is a specialist that deals with diseases of the urinary and genital systems. A gynecologist is a doctor that deals with women s health issues. To diagnose urinary incontinence, the doctor will first take a detailed medical history. Therefore, it is very important to know when incontinence happens and in which circumstances. The doctor also needs a list of ALL medications being taken. In addition, he or she will need to know about past medical events such as surgeries, pregnancies, deliveries, and medical problems. The doctor will then do a detailed examination, checking to make sure that the muscles of the pelvis are not weak. For men, the doctor may check the size of the prostate by doing a rectal examination. A full pelvic exam may be needed for women. Blood and urine tests might also be done to make sure that there are no urinary tract infections, prostate cancer, or other infections. Specialized tests to check the function of the bladder may be done. Such tests may include inserting a catheter in the bladder to measure pressures inside it, as well as to check for urine left in the bladder after urination. Ultrasounds and CAT scans of the kidneys and pelvis are sometimes also done. CAT Scan 4

5 Today, there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem, how serious it is, and what best fits the patient s lifestyle. When possible, the doctor recommends the simplest and safest treatments first. Bladder Control Training Your doctor may suggest that you try to gain control of your bladder through training. With bladder training, you can change how your bladder stores and empties urine. The following are three ways to train a patient to control the bladder: Pelvic muscle exercises, also called Kegel exercises Biofeedback Timed voiding Pelvic muscle exercises, or Kegel exercises, work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer. These exercises are easy to do. They can lessen or get rid of stress and urge incontinence. For Kegel exercises, the muscles you want to exercise are your pelvic floor muscles. These are the ones you use to stop the flow of urine or to keep from passing gas. Often, doctors suggest that you squeeze and hold these muscles for a certain count, and then relax them. You repeat this a number of times, usually several times a day. Your doctor will give you exact directions. Biofeedback helps you become more aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be used to help teach pelvic muscle exercises. Timed voiding and bladder training can also help you control your bladder. In timed voiding, you keep a chart of urination and leaking to determine the pattern. Once you learn that, you can plan to empty your bladder before you might leak. When combined with biofeedback and pelvic muscle exercises, timed voiding may help you control urge and overflow incontinence. During bladder control training, special absorbent underclothing that is available at most stores can be used. It is not bulky and can be worn easily under everyday clothes. 5

Medicines can be prescribed to treat incontinence. Some Pessary drugs prevent unwanted bladder contractions. Some relax muscles, helping the bladder to completely empty during urination.

6 Management and Treatment Besides bladder control training, there are several other ways to help manage incontinence. Sometimes doctors suggest a small, throwaway patch; a small, tampon-like urethral plug; or a vaginal insert called a pessary for women with stress incontinence. Medicines can be prescribed to treat incontinence. Some Pessary drugs prevent unwanted bladder contractions. Some relax muscles, helping the bladder to completely empty during urination. Others tighten sphincter muscles in the bladder and urethra to cut down leakage. Drugs can sometimes cause side effects such as dry mouth, eye problems, or urine buildup. Vaginal estrogen may be helpful in women after menopause. Talk with your doctor about the benefits and side effects of using any medicine for a long time. A doctor can inject an implant into the area around the urethra. The implant adds bulk. This helps close the urethra to reduce stress incontinence. Injections may have to be repeated after a while because the body slowly gets rid of these substances. Sometimes surgery can improve or cure incontinence if it is caused by a problem such as a change in the position of the bladder or blockage due to an enlarged prostate. Common surgery for stress incontinence involves pulling the bladder up and securing it. When stress incontinence is serious, the surgeon may use a wide sling. This holds the bladder up and narrows the urethra to prevent leakage. An operation that stimulates the nerves that control the bladder may help patients with urge incontinence. These nerves are called the sacral nerves. This operation causes the bladder to relax. This surgery is not right for everyone. If your doctor decides that this surgery is right for you, a urologist will surgically implant a pacemaker-type apparatus. This device hooks to an electrode that stimulates the sacral nerves. 6

Another procedure known as hydrodistention aims at increasing the amount of fluid the bladder can hold. During this procedure, a urologist will overfill the bladder for a few minutes to stretch it.

7 Another procedure known as hydrodistention aims at increasing the amount of fluid the bladder can hold. During this procedure, a urologist will overfill the bladder for a few minutes to stretch it. Because it may be painful, this is usually done under general anesthesia. Summary Incontinence is a very common medical problem. Urinary incontinence can be treated effectively, very often without resorting to surgery. Patients should feel at ease and discuss this problem with their doctors. Under a doctor s care, incontinence can be treated and often cured. Even if treatment is not fully successful, careful management can help you feel more relaxed and comfortable. 7

AgePage. Urinary Incontinence

AgePage. Urinary Incontinence National Institute on Aging AgePage Urinary Incontinence Sarah loves to spend time with her friends talking about grandchildren and visiting with neighbors. But lately she s been having a big problem that