Help for Patients and Caregivers

Help for Patients and Caregivers : Incontinence

What is Incontinence?
Common Symptoms
What Causes Incontinence?
Medications
Home Care
Additional Information

What is Incontinence?

Incontinence is the loss of control of urinary or fecal elimination. It is when you have no control over when and where you are going. This can range from an occasional leakage, to a complete inability to hold any at all. We are all born incontinent and we will most likely experience some degree of incontinence as we grow older. Incontinence affects approximately 13 million people in the United States and is more common in women than in men. It occurs in 10 percent to 25 percent of women younger than age 65 and in 15 percent to 30 percent of women older than age 60 who do not live in nursing homes. Among nursing home residents, incontinence is even more common, affecting more than 50 percent of female patients.

Types:

Incontinence is the inability to control either urine or fecal elimination. Essentially this means that to some degree you may lose urine or bowel movements at times that you do not choose to do so.

There are six basic types of Urinary incontinence:

• Stress Incontinence: an involuntary loss of small amounts of urine when you cough, laugh, lift or exercise. It can be caused by multiple vaginal births, enlarged prostate, pelvic trauma or loss of pelvic muscle tone. We recommend using a Bladder Control Pad or Male Guard.
• Urge Incontinence: inability to control urinating once you feel the need to void. Simply, you may feel the need to urinate but cannot wait to get to the bathroom. It can be caused by Alzheimer's, Parkinsonism, enlarged prostate, spinal cord injuries or urinary tract infections. We recommend using a Bladder Control Pad or Protective Underwear.
• Reflex Incontinence: This is frequent loss of urine with no warning. This is due to spinal cord injuries, brain tumors or strokes. We recommend using Protective Underwear or Adult Briefs.
• Overflow Incontinence: Leakage of urine when the bladder is full. For example the person experiences dribbling, frequency, urgency and bladder distention. It is most commonly caused by diseases that cause a blockage of the natural passageway of urine. We recommend using a Bladder Control Pad or Protective Underwear.
• Functional Incontinence: incontinence caused by factors outside the urinary tract, such as immobility or cognitive impairment. These individuals would be continent if the external factor were eliminated. We recommend using Protective Underwear or Adult Briefs.
• Mixed Incontinence: a combination of forms of incontinence, such as "mixed stress urge incontinence." We recommend using Protective Underwear or Adult Briefs.

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Common Symptoms?

The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent and heavy, or it can be small and rather rare. For an active woman or for a woman who loses a large amount of urine each time, even one episode per week may be too much.

Some other common symptoms of urinary incontinence include:

• A strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
• Urinating more than once in a two-hour period or more than seven times a day
• The need to get up and urinate at least twice during sleep
• Painful urination
• Bed wetting or urinating while sleeping

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What Causes Incontinence?

Incontinence may be sudden and temporary, or ongoing and long-term. Causes of sudden or temporary incontinence include:

• Urinary tract infection or inflammation
• Prostate infection or inflammation
• Stool impaction from severe constipation, causing pressure on the bladder
• Side effects of medications (such as diuretics, tranquilizers, some cough and cold remedies, certain antihistamines for allergies, and antidepressants)
• Increased urine amounts, like with poorly controlled diabetes
• Pregnancy
• Weight gain
• Short-term bed rest -- for example, when recovering from surgery
• Mental confusion

Causes that may be more long-term:

• Spinal injuries
• Urinary tract anatomical abnormalities
• Neurological conditions like multiple sclerosis or stroke
• Weakness of the sphincter, the circular muscles of the bladder responsible for opening and closing it; this can happen following prostate surgery in men, or vaginal surgery in women
• Pelvic prolapse in women -- falling or sliding of the bladder, urethra, or rectum into the vaginal space, often related to having had multiple pregnancies and deliveries
• Large prostate in men
• Depression or Alzheimer's disease
• Nerve or muscle damage after pelvic radiation
• Bladder cancer
• Bladder spasms

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Medications for Incontinence

Many times, urinary incontinence can be corrected with the help of medication. Drugs commonly used to treat incontinence include:

Anticholinergic (antispasmodic) drugs - These prescription medications calm an overactive bladder, so they may be helpful for urge incontinence.

Imipramine (Tofranil). This antidepressant may be used to treat incontinence. It causes the bladder muscle to relax, while causing the smooth muscles at the bladder neck to contract.

Hormone Replacement Therapy - After menopause, a woman's body produces less of the hormone estrogen. This drop in estrogen can contribute to changes in the skin lining the urethra and vagina, which can contribute to the development of incontinence in some women. Applying estrogen in the form of a vaginal cream, ring or patch may help relieve some of the symptoms of incontinence in these women.

Antibiotics - If your incontinence is due to a urinary tract infection or an inflamed prostate gland (prostatitis), your doctor can successfully treat the problem with antibiotics.

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Home Care

See your doctor for an initial evaluation and to come up with a treatment plan. Treatment options vary, depending on the cause and type of incontinence you have. Fortunately, there are many things you can do to help manage incontinence.

The following methods are used to strengthen the muscles of your pelvic floor:

• Bladder retraining -- this involves urinating on a schedule, whether you feel a need to go or not. In between those times, you try to wait to the next scheduled time. At first, you may need to schedule 1 hour intervals. Gradually, you can increase by 1/2 hour intervals until you are only urinating every 3-4 hours without leakage.
• Kegel exercises -- contract the pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Repeat 10 times. Do these exercises 3 times per day. You can do Kegel exercises any time, any place.

To find the pelvic muscles when you first start Kegel exercises, stop your urine flow midstream. The muscles needed to do this are your pelvic floor muscles. DO NOT contract your abdominal, thigh, or buttocks muscles. And DO NOT overdo the exercises. This may tire the muscles out and actually worsen incontinence.

Two methods called biofeedback and electrical stimulation can help you learn how to perform Kegel exercises. Biofeedback uses electrodes placed on the pelvic floor muscles, giving you feedback about when they are contracted and when they are not. Electrical stimulation uses low-voltage electric current to stimulate the pelvic floor muscles. It can be done at home or at a clinic for 20 minutes every 1 to 4 days.

Biofeedback and electrical stimulation will no longer be necessary once you have identified the pelvic floor muscles and mastered the exercises on your own.

Vaginal cones enhance the performance of Kegel exercises for women. Other devices for incontinence are also available.

For leakage, wear absorbent pads or undergarments. There are many well-designed products that go completely unnoticed by anyone but you.

Other measures include:

• Regulate your bowels to avoid constipation. Try increasing fiber in your diet.
• Quit smoking to reduce coughing and bladder irritation. Smoking also increases your risk of bladder cancer.
• Avoid alcohol and caffeinated beverages, particularly coffee, which can overstimulate your bladder.
• Lose weight if you need to.
• Avoid foods and drinks that may irritate your bladder like spicy foods, carbonated beverages, and citrus fruits and juices.
• Keep blood sugars under good control if you have diabetes.

If you have overflow incontinence or cannot empty your bladder completely, a catheter may be recommended. But using a catheter exposes you to potential infection.

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