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Information from Your Family Doctor
Finding Out About Incontinence
Am Fam Physician. 1998 Jun 1;57(11):2688-2690.See related article on incontinence.
What is urinary incontinence?
If your bladder leaks urine between trips to the bathroom, this is called urinary incontinence. People of any age can have incontinence, but it happens more often in older adults. Incontinence can bother you and even make you embarrassed. It can make you stop taking part in social activities. It makes it harder for you to take care of yourself. It can also lead to health problems like urinary infection, kidney problems or pressure sores.
How is my bladder supposed to work?
Think about filling a balloon with air. Don't tie a knot in the neck of the balloon. Just hold on. Now, if you let go of the neck of the balloon, the rubber walls of the balloon will push out the air. Your bladder does the same thing with urine. When your bladder is full, your brain says it's time to urinate. It also tells your bladder to push out the urine. At the same time, your brain tells the sphincter muscle at the neck of your bladder to relax. The sphincter works like a valve. When this muscle relaxes, urine comes out of the bladder through the urethra. The urethra is the tube leading from your bladder to the outside of your body.
What causes urinary incontinence?
Several things that affect your bladder or sphincter muscle can cause incontinence. Here are some of the reasons this might happen:
Childbirth can weaken muscles around the bladder.
Drinking large amounts of fluid means you have a large amount of urine in your bladder.
Some medicines—like diuretics, pain pills, sedatives, cold remedies, medicines for depression and high blood pressure, alcohol or caffeine—can affect your bladder.
Arthritis or other illnesses can make it hard for you to get to the bathroom in time.
A stroke, Alzheimer's disease or Parkinson's disease can cause damage to the bladder nerves.
Diabetes, cancer, radiation or surgery in your pelvic area or prostate area can cause damage to the bladder nerves.
Your bladder might be irritated by infection, bladder stones, cancer or low hormone levels after menopause.
An enlarged prostate gland, constipation or a urethral stricture (scar tissue that narrows your urethra) can block your urethra.
Are there different kinds of incontinence?
There are three main kinds of urinary incontinence. The kind most people have is called stress incontinence. You might get stress incontinence if your bladder muscle doesn't work well or if your urethra gets moved out of the right place (this could happen with age, or after childbirth). If you have stress incontinence, you may dribble urine when you cough, sneeze or laugh.
Another kind is called urge incontinence. It's also called hyperactive or irritable bladder. This happens when your bladder contractions are too strong for you to control. You feel a strong desire to urinate and can't get to the bathroom before the bladder releases the urine.
A kind of incontinence not many people have is called overflow incontinence. This happens when your bladder can't push out all the urine when you go to the bathroom. It starts to dribble out between trips to the toilet. A blocked urethra or weakness in your bladder muscles or in the bladder nerves may cause overflow incontinence.
How is urinary incontinence diagnosed?
Your doctor asks about your symptoms, examines you and takes a urine sample. Your doctor may also check to see how much urine is still in your bladder after you have tried to empty it. Sometimes special tests are needed.
How is incontinence treated?
Some of the following treatments may be used:
Bladder training. This means slowly making the time between urinations longer, until you can stay “dry” for about three hours.
Pelvic muscle exercise. This exercise, called Kegel's exercise, tightens the muscles around your urethra. Tighter muscles can hold back the urine better. To do the Kegel's exercise, you squeeze these muscles for five seconds, then relax them for five seconds. You do this squeeze-and-relax exercise 12 times. Then you repeat the whole exercise eight or more times during the day. You can find the right muscles to squeeze by starting to urinate into the toilet and then trying to stop the flow. The muscles you squeeze to stop the flow of urine are the same muscles you squeeze to do the Kegel's exercise. After a while, you can learn to do Kegel's exercise anywhere: when you talk on the telephone, or wait for a traffic light or stand in line at the bank. No one can tell you are doing this exercise.
Medication. Medicines such as estrogen creams or pills can improve bladder function.
Surgery. Surgery “lifts” the bladder in some women with stress incontinence. Surgery also helps some incontinent men who have an enlarged prostate gland.
Catheter. This is a drainage tube that helps some people by removing the urine into a small bag.
Pads. Incontinence pads soak up urine. These products are sold in grocery stores and drug stores.
Pessary. A pessary is a soft piece of plastic or rubber that women put into their vagina. It helps hold up a sagging bladder and uterus. Childbirth and aging can cause these organs to drop down.
Can I prevent urinary incontinence?
No, but there are some things you can do to help:
Don't drink too much liquid just before bedtime.
Don't drink very many alcoholic or caffeinated drinks like sodas, coffee or tea. These drinks make you urinate more often. They may make you feel more urgent about urinating.
Where can I get more information ?
You can call the U.S. Agency for Health Care Policy and Research (AHCPR) Publications Clearinghouse at 1-800-358-9295. Ask for a free brochure called “Understanding Incontinence.”
You can call a group called Help for Incontinent People at 1-800-252-3337. Ask for information about incontinence.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 1998 by the American Academy of Family Physicians.
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