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Urinary Incontinence

Urinary incontinence (leakage of urine) affects approximately 13 million Americans. Women are affected twice as often as men. The bladder stores urine from the kidneys, and when it is full, it empties into the urethra and leaves the body. Within the urethra are two rings of muscles (sphincters) that are responsible for preventing leakage of urine. The internal sphincter, located at the entrance to the urethra in the bladder neck, is supported by the pelvic floor muscles. These muscles are controlled automatically by the body. The external sphincter is located farther along the urethra and is voluntarily controlled.

Urinary incontinence is caused by either the bladder overreacting or the sphincter muscles being not active enough. There are six types of urinary incontinence: total incontinence, stress incontinence, urge incontinence, functional functinal incontinence, transient incontinence, and overflow incontinence. Each type has different causes and treatments.

Symptoms and causes

Total incontinence: urinary control is completely gone. This may be caused by a nonfunctioning sphincter muscle. The sphincter may have been damaged or removed during surgery (radical prostatectomy, for example), or there may be an abnormal passage (fistula) allowing the urine to bypass the sphincter.

Stress incontinence: urine leaks when the abdominal muscles are contracted, for example coughing, lifting objects, or sneezing. Stress incontinence may occur because pelvic floor muscles are weak. Some of the causes of weakened pelvic floor muscles are surgery, childbirth, or a decrease in estrogen.

Urge incontinence: inability to reach the bathroom in time when feeling the need to urinate. This is generally caused by the bladder contracting too soon. This may be worsened by substances that irritate the bladder muscle such as caffeine, certain medications, or a high intake of fluids.

Functional incontinence: urinary leakage because the patient is physically unable to reach the bathroom due to physical or mental limitations. The functioning of the sphincter and bladder muscle is normal.

Transient incontinence: loss urinary control for a short time due to a change in medication. Will regain urinary control soon.

Overflow incontinence: urine leakage may occur because of the inability to empty the bladder completely, due to an obstruction (BPH, medications, or inactivity) or the bladder may not contract effectively.

Diagnosis and treatment

Treatment for urinary incontinence depends upon its cause. The urologist will perform tests to determine the type of incontinence. The tests may include a urodynamics test which measures the pressure of urine exiting the bladder, bladder capacity, and how much urine is left in the bladder; a vaginal exam if necessary; a urinalysis; or possibly looking inside the bladder with a cystoscope.

  • Total incontinence is usually treated by one of three types of surgery, which are: 1) the creation of a sling which elevates the urethra, 2) the creation of an artificial sphincter, or 3) the injection of collagen into the urethra near the bladder neck.
  • Mild stress urinary incontinence can often be effectively treated by a combination of pelvic floor exercises which involve contraction of the same muscles used to interrupt the urinary stream, medications, and lifestyle modifications. If these treatments fail, surgery is an option. The most common operation in women is the vaginal sling which is the most effective and lasting surgical treatment for stress urinary incontinence.
  • Urge incontinence can be treated with medications that decrease the bladder's muscle activity.
  • Overflow incontinence can be treated by eliminating the obstruction, or improving the contraction of the bladder muscles allow the bladder to empty completely and which places less pressure on the sphincter.

Links

Incontinence in children
National Kidney and Urologic Diseases Information Clearinghouse

Incontinence in women
American Foundation for Urologic Diseases
National Kidney and Urologic Diseases Information Clearinghouse

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